Download PACKRAT Test Exam 4| Questions and Verified Correct Answers| Latest Version 2026-2027| and more Exams Clinical Medicine in PDF only on Docsity!
PACKRAT Test Exam 4| Questions
and Verified Correct Answers|
Latest Version 2026-2027|
100%Score.
(C) indicated as Correct Answer
Long term use of which of the following drugs may cause a drug-induced lupus-type eruption? A. prednisone B. tetracycline C. procainamide D. oral contraceptives (u) A. Prednisone is not implicated in drug-induced skin reactions. (u) B. Tetracycline and sulfonamides are known to cause a photosensitive rash on sun exposed areas of the skin. (c) C. Procainamide and hydralazine are the most common drugs that may cause a lupus-like eruption. (u) D. Oral contraceptives may induce erythema nodosum. Which of the following clinical manifestations is most commonly seen in viral croup? A. drooling B. wheezing C. sputum production
D. inspiratory stridor (u) A. Drooling is common in epiglottitis not viral croup. (u) B. Wheezing is noted in asthma. (u) C. Sputum production is noted in bacterial infections. (c) D. Viral croup typically presents with a barking cough and stridor. Whispered voice test on a patient reveals decreased hearing in the left ear. Which of the following would be most consistent with conductive hearing loss in the left ear? A. Sounds best heard in the left ear on Weber test. B. Air conduction longer than bone conduction in the left ear on Rinne test. C. Sound best heard in the right ear on Weber test. D. Bone conduction longer than air conduction in the right ear. (c) A. Sound best heard in the ear with decreased hearing on Weber test (in this case, the left ear) is indicative of conductive hearing loss. (u) B. With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the effected ear. Air conduction lasting longer than bone conduction of sound would indicate sensorineural hearing loss. (u) C. Sound best heard in the ear with unaffected hearing on Weber test (in this case, the right ear) is indicative of sensorineural hearing loss. (u) D. With conductive hearing loss, bone conduction should be heard as long as or longer than air conduction of sound in the effected ear. The right ear showed normal hearing on physical exam. A 65 year-old male presents with multiple lesions on his back. He denies any pruritis. Physical examination reveals the presence of multiple scattered brown plaques with a raised, warty surface that appear to be stuck onto the skin and feel greasy. Which of the following is the most likely diagnosis? A. lentigines
(c) C. Hyaline membrane disease is the most common cause of respiratory distress in the premature infant. The infant typically presents with tachypnea, cyanosis and expiratory grunting. A chest x-ray reveals hypoexpansion and air bronchograms. (u) D. Chronic lung disease of prematurity is a complication in about 20% of infants with hyaline membrane disease. It is defined as respiratory symptoms, oxygen requirement and chest x-ray abnormalities at 1 month of age so it cannot be diagnosed at this time in this newborn. A 54 year-old patient has acute onset of palpitations, tremulousness, profuse sweating, shortness of breath, and numbness and tingling of the extremities. Physical examination reveals a pulse of 104 beats/min and regular, respiratory rate of 30/min, blood pressure of 160/95 mm Hg. Arterial blood gases reveal a low pCO2. ECG shows no acute changes. The most likely diagnosis is A. anxiety neurosis. B. atrial fibrillation. C. depressive neurosis. D. myocardial infarction. (c) A. Anxiety is characterized by short-lived, recurrent, unpredictable episodes of intense anxiety accompanied by marked physiological manifestations. (u) B. Atrial fibrillation would not account for abnormal respiratory rate or blood gases, and the pulse would be irregular. (u) C. Depressive neurosis may be associated with somatic complaints, but it is not manifested by an acute, abrupt onset of them. (u) D. Even though the patient manifests some signs of a myocardial infarction (sweating and numbness), the ECG is normal. Lab results for a post-operative oliguric patient reveals an increased BUN to creatinine ratio. The patient has a low fractional excretion of sodium (less than 1%). Which of the following is the most likely diagnosis? A. prerenal azotemia
B. acute tubular necrosis C. acute glomerulonephritis D. obstructive uropathy (c) A. Patients who have prerenal azotemia with otherwise normal kidneys will have severe sodium retention in order to help to save fluid. The amount of sodium in the urine is therefore very low. (u) B. Acute tubular necrosis may occur in the post-operative setting but these kidneys are damaged and unable to save sodium. (u) C. Acute glomerulonephritis is a complication of a streptococcal infection wherein the immune complexes damage the glomeruli and lead to hematuria, red blood cell casts, and proteinuria. (u) D. Although patients who undergo abdominal surgery are at risk for damage to the genital urinary system, these patients will not have sodium retention because it is a post renal, not a prerenal injury. Which of the following is the treatment of choice for stage one Lyme disease in a patient less than 12 years of age? A. doxycycline B. amoxicillin C. chloramphenicol D. azithromycin (u) A. See B for explanation. (c) B. Amoxicillin is first line therapy in a patient less than 12 years of age due to the harmful effects of doxycycline on teeth and bones in children. (u) C. Chloramphenicol is only indicated in disseminated disease with known drug resistance. It is not indicated as first line therapy due to its tendency to cause aplastic anemia. (u) D. Azithromycin is not as effective as doxycycline or amoxicillin.
(u) C. See D for explanation. (c) D. Philadelphia chromosome is noted most commonly in patients with chronic myelogenous leukemia. A 53 year-old man who had previously been in good health presents to the emergency department with a history of passing approximately 300 cc of bright red blood from the rectum 45 minutes ago. From which of the following anatomical sites is the bleeding most likely originating? A. rectosigmoid B. duodenum C. stomach D. esophagus (c) A. Rectosigmoid is the most common site leading to hematochezia. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. Which of the following treatment strategies is most likely to promote optimal health and limit the morbidity and mortality associated with rheumatoid arthritis? A. meningococcal vaccination B. NSAIDs C. methotrexate D. corticosteroids (u) A. RA patients are at increased risk of infection and should receive influenza and pneumococcal vaccines, not meningococcal. (u) B. NSAIDs provide only symptomatic therapy and do not stop the disease progression of RA.
(c) C. Methotrexate is the most commonly prescribed DMARD for RA and has been proven to induce remission in some patients. (u) D. Chronic corticosteroid use is associated with greater toxicity than DMARDs and should be used only for symptomatic therapy. A 20 year-old female presents with episodes of binge eating, overuse of laxatives, and periods of starvation. Which of the following is the best treatment option for this patient? A. fluoxetine (Prozac) B. gabapentin (Neurontin) C. amitriptyline (Elavil) D. phenelzine (Nardil) (c) A. Fluoxetine, a SSRI, is the drug of choice for the treatment of bulimia nervosa. (u) B. Gabapentin is used in the treatment of seizure disorders. (u) C. Amitriptyline, a tricyclic antidepressant, is not effective in the treatment of bulimia nervosa. (u) D. Phenelzine, a monoamine oxidase inhibitor, is not indicated in the treatment of bulimia nervosa. A 40 year-old female complains of acute right upper quadrant pain radiating to the back and low grade fever. Laboratory evaluation indicates the presence of urinary bilirubin and an elevation of serum alkaline phosphatase. Which of the following is the most likely diagnosis? A. cholecystitis B. viral hepatitis C. Gilbert's syndrome D. Dubin-Johnson syndrome
A. focal seizure disorder B. intracerebral neoplasm C. transient ischemic attack D. amyotrophic lateral sclerosis (u) A. Focal seizure disorder is not associated with morning headaches. (c) B. Intracerebral neoplasms may present with headaches that are worse in the morning, with improvement during the day. Focal motor or sensory loss depends upon the tumor's location. (u) C. A TIA is characterized by focal findings that resolve completely and spontaneously within 24 hours. (u) D. Amyotrophic lateral sclerosis is a degenerative disorder characterized by motor weakness, but is not associated with morning headaches. Which of the following signs is positive in the presence of ascites? A. shifting dullness B. CVA tenderness C. ballottment sign D. cutaneous hypersensitivity (c) A. Shifting dullness or the presence of a fluid wave is noted in patients with ascites. (u) B. CVA tenderness is noted in patients with pyelonephritis. (u) C. Ballottment test is used to assess a floating mass in the abdomen. (u) D. Cutaneous hypersensitivity is used to identify a specific zone of peritoneal irritation A 42 year-old male with unremarkable past medical history is admitted to the general medical ward with community-acquired pneumonia. He has a 20 pack-year history of cigarette smoking. He is empirically started on ceftriaxone (Rocephin). Which of the following antibiotics would be most appropriate to add to his empiric treatment regimen?
A. piperacillin (Pipracil) B. vancomycin (Vancocin) C. clindamycin (Cleocin) D. azithromycin (Zithromax) (u) A. Antipseudomonal penicillins, such as pipercillin, added to an aminoglycoside or fluoroquinolone are indicated for empiric treatment of nosocomial pneumonia. (u) B. Use of vancomycin should be restricted to cases where there is a high index of suspicion of involvement of methicillin resistant Staphylococcus aureus (MRSA). (u) C. Clindamycin is indicated in cases of suspected anaerobe involvement. (c) D. Patients with community-acquired pneumonia who require hospitalization on the general medical ward are treated with an extended-spectrum beta-lactam antibiotic, such as ceftriaxone, with a macrolide, such as azithromycin. Addition of a macrolide is also recommended due to the patient's smoking history and possible involvement of Hemophilus influenzae. During an influenza epidemic, a 6 year-old child is seen with fever and a severe sore throat. A throat swab is taken for culture and the child is sent home. The next day, he is reported to have persistent vomiting and increased lethargy. On examination, he is delirious and disoriented. No rash is noted. His reflexes are hyperactive. The liver edge is 3 cm below the right costal margin in the midclavicular line. Which of the following is the most likely diagnosis? A. acute bacterial meningitis B. Guillain Barré syndrome C. Reye syndrome D. measles encephalitis (u) A. Acute bacterial meningitis presents with fever, malaise, and neck stiffness. The liver is typically normal. (u) B. Guillain Barré syndrome typically presents post-Campylobacter enteritis. Signs and symptoms include an ascending weakness. No hepatomegaly is noted and reflexes are diminished.
(c) A. Fibroadenoma of the breast most commonly is seen in young females. Typical characteristics include a solitary 1-3 cm firm, painless, freely movable mass that does not change with the menstrual cycle and are slow growing. Most are found as an incidental finding on physical examination or during self-breast examination. (u) B. Fat necrosis of the breast is rare. It is thought to result from trauma to the breast and occasionally is accompanied by ecchymosis. If left untreated, the mass eventually disappears. (u) C. Fibrocystic changes in the breast are most common in females between 30- 50 years of age. The disorder is characterized by painful, often multiple and usually bilateral masses that are associated with increased pain and size of breast mass premenstrually. (u) D. Intraductal papillomas are usually non-palpable. The patient presents with complaints of spontaneous onset of bloody, serous, or cloudy nipple discharge. A 25 year-old male with a history of asthma presents complaining of increasing episodes of evening and daytime symptoms. He is on a short acting inhaled beta agonist prn. He is presently using his short acting beta agonist on a daily basis. Which of the following is the most appropriate addition to this patient's regimen? A. methylxanthine oxidase inhibitor B. long acting beta agonist inhaler C. leukotriene inhibitor D. inhaled corticosteroid (u) A. Methylxanthine oxidase inhibitor preparations may have beneficial effects in some patients, but their value is limited due to a narrow therapeutic window and modest efficacy. (u) B. Long acting beta agonist inhalers should not be used in place of anti-inflammatory therapy. (u) C. Leukotriene inhibitors are less desirable alternatives to inhaled corticosteroids. (c) D. According to the stepwise approach for managing asthma by the National Asthma Education and Prevention Program, inhaled corticosteroids are indicated for mild to moderate persistent asthma.
Which of the following is considered a risk factor for retinopathy of prematurity? A. maternal rubella infection B. maternal alcohol abuse C. perinatal oxygen therapy D. family history of retinal detachment (u) A. While maternal rubella infection is a risk factor for ocular disease in the newborn, it is not a specific risk for retinopathy of prematurity. (u) B. Maternal alcohol abuse is associated with the development of fetal alcohol syndrome, which includes craniofacial abnormalities, but does not include increased risk for retinopathy of prematurity. (c) C. Risk factors for retinopathy of prematurity include perinatal oxygen therapy, low birth weight, prematurity, and sepsis. (u) D. If retinopathy of prematurity is not treated, retinal detachment may occur causing blindness. A family history of retinal detachment is not considered a risk factor for the development of retinopathy of prematurity Which hormone is responsible for producing 1,25-dihydroxyvitamin D (calcitriol) in the kidney? A. TSH B. ACTH C. PTH D. CRH (u) A. TSH is thyroid stimulating hormone and comes from the pituitary gland. It is responsible for the production of T4 within the thyroid. (u) B. ACTH is adrenocorticotropin hormone and comes from the pituitary gland. It is responsible for the production of glucocorticoids within the adrenal gland. (c) C. PTH is parathyroid hormone and comes from the parathyroid glands. It is responsible in making calcitriol which is needed for calcium absorption in the gut. Under
B. pericarditis C. hypertrophic cardiomyopathy D. coronary artery disease (c) A. Myocarditis often occurs secondary to acute viral illness and causes cardiac dysfunction. Patients will commonly have a history of a recent febrile illness. Chest pain may mimic that of a myocardial infarction and Troponin I levels maybe elevated in one- third of patients. Contractile dysfunction is seen on catheterization and/or echocardiogram. (u) B. Pericarditis does not typically cause ventricular dysfunction and cardiac enzymes are usually normal. (u) C. Hypertrophic cardiomyopathy is associated with ventricular hypercontractility. (u) D. This patient had normal coronary arteries on cardiac catheterization, no signs of coronary artery disease. Which of the following is the most common underlying cause of early postpartum hemorrhage? A. uterine atony B. genital tract trauma C. coagulation disorders D. retained placental tissue (c) A. Uterine atony is the most common cause of postpartum hemorrhage. Predisposing factors include any conditions that cause excessive uterine enlargement, abnormal labor or conditions that interfere with uterine contraction. (u) B. Genital tract trauma may lead to lacerations of the lower genital tract that cause postpartum hemorrhage, however this is much less common than uterine atony. (u) C. Coagulation disorders can cause postpartum hemorrhage, but are not the most common cause. (u) D. Retained placental tissue only acccounts for 5-10% of postpartum hemorrhage and usually occurs later.
A 30 year-old male has a history of weakness without pain on the left side of his face for the past 4 days. Physical examination of the face reveals unilateral weakness to the left side, but not complete paralysis. The left eye does not close completely. The most appropriate initial treatment is to A. begin physical therapy. B. refer for surgical ablation. C. reassure patient and provide patient education. D. initiate high dose steroids and recheck in 24 hours. (u) A. Physical therapy is not indicated for Bell's palsy (u) B. Surgery has not been shown to provide any significant benefit in the treatment of Bell's palsy. (c) C. Bell's palsy is usually a self-limited condition and typically resolves within a few weeks. (u) D. Corticosteroids may be used if paralysis is complete or there is significant pain, but are not first-line. A patient presents with a concern about an upcoming trip. He states he is traveling to Mexico and has a question about how to treat diarrhea should it develop. In addition to promoting fluid intake which of the following is recommended? A. kaolin-pectin B. ciprofloxacin C. simethicone D. doxycycline (u) A. Kaolin-pectin is not indicated in the treatment of traveler's diarrhea. (c) B. Ciprofloxacin is indicated in the treatment of traveler's diarrhea. (u) C. Simethicone is used in the treatment of intestinal gas. (u) D. Doxycycline is not indicated in the treatment of traveler's diarrhea due to increasing resistance.
stage with high titers. (u) B. Patch testing is utilized to identify a causative agent and confirm a diagnosis of allergic contact dermatitis. (u) C. Acetowhitening helps in the detection of subclinical penile or vulvar warts. (u) D. Gram stain and culture should be performed on lesions suspected to have a bacterial origin. Which of the following leads to retropatellar pain? A. increased Q angle B. increased quadriceps tone and strength C. Osgood-Schlatter Disease D. hamstring stretching (c) A. Patients with an increased Q angle have more force directed laterally during knee flexion and are at greater risk of patellofemoral pain syndrome. (u) B. Quadriceps strengthening aids in restoring patellofemoral tracking. (u) C. Osgood-Schlatter disease involves the tibial tubercle, not the patellofemoral joint. (u) D. Hamstring stretching aids in restoring patellofemoral tracking. Which of the following is most helpful in the diagnosis of a retropharyngeal abscess? A. CBC with differential B. fever and a muffled voice on examination C. CT of the neck with contrast D. history of a recent throat infection (u) A. A CBC with differential would identify an infection but not specifically a retropharyngeal abscess. (u) B. The presence of fever and a muffled voice on physical exam is not specific for a retropharyngeal abscess.
(c) C. CT of the neck is considered the "gold standard" for the diagnosis of a retropharyngeal abscess. (u) D. A recent throat infection is not specific for a retropharyngeal abscess. Which of the following is the most likely physical examination finding in a patient with Peyronie's disease? A. inflammation of the glans of the penis B. foreskin that cannot be retracted C. chancre on the shaft of the penis D. fibrous band on lateral portion of the penis (u) A. Inflammation of the glans of the penis is noted in balanitis. (u) B. A foreskin that cannot be retracted is seen in phimosis. (u) C. A chancre on the shaft of the penis is noted in primary syphilis. (c) D. Peyronie disease typically presents with fibrotic areas under the penile skin along with a history of penile curvature during erection Which of the following antihypertensive agents is considered to have both alpha- and beta-blocker activities? A. carvedilol (Coreg) B. hydralazine (Apresoline) C. minoxidil (Loniten) D. spironolactone (Aldactone) (c) A. Carvedilol has both alpha- and beta-blocker activities. (u) B. Hydralazine and minoxidil are considered vasodilators. (u) C. See B for explanation.
