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PACKRAT Test Exam 5| Questions
and Verified Correct Answers|
Latest Version 2026-2027|
100%Score.
(C) indicated as Correct Answer
HIV+ pt presents w/ worsening dementia, fever, HA, & R hemiparesis. Brain MRI reveals 6 lesions throughout the brain that show ring enhancement & surrounding edema. Which is the tx of choice? A. Sulfadiazine and pyrimethamine B. Trimethoprim-sulfamethoxazole C. Radiation therapy D. Ventricular shunt placement (c) A. Toxoplasmosis is commonly noted in HIV positive patients and presents with multiple ring-enhancing lesions. Treatment of choice for possible toxoplasmosis is sulfadiazine and pyrimethamine. (u) B. Trimethoprim-sulfamethoxazole is used for prophylaxis of toxoplasmosis, but not for treatment of acute infection. (u) C. Radiation therapy is indicated in CNS lymphoma, which typically presents with a single lesion. (u) D. Shunt placement is not indicated in patients with toxoplasmosis. On examination of a pregnant patient the physician assistant notes a bluish or purplish discoloration of the vagina and cervix. This is called
A. Hegar's sign. B. McDonald's sign. C. Cullen's sign D. Chadwick's sign (u) A. Hegar's sign is the softening of the cervix that often occurs with pregnancy. (u) B. McDonald's sign is when the uterus becomes flexible at the uterocervical junction at 7-8 weeks. (u) C. Cullen's sign is a purplish discoloration periumbilical and noted in pancreatitis. (c) D. Chadwick's sign is a bluish or purplish discoloration of the vagina and cervix. A 52 year-old female comes to the office because of black stools for the past 3 days. She is afebrile and she has no pertinent physical examination abnormalities. Which of the following is the most appropriate initial diagnostic study? A. Stool for occult blood B. Stool cultures C. Sigmoidoscopy D. Abdominal CT scan (c) A. Occult bleeding, as evidenced by the patient's history of black stools, is initially verified by a positive fecal occult blood test. (u) B. Stool cultures are indicated in the evaluation of acute diarrhea and not for the evaluation of acute GI bleeding. (u) C. Melena suggests a source of bleeding that is proximal to the ligament of Treitz, not a lower GI bleed. Sigmoidoscopy is used to evaluate only lower GI bleeding sources. (u) D. Abdominal CT scan is indicated for evaluation of obscure bleeding in order to exclude a pancreatic or hepatic source of bleeding if endoscopy fails to identify the source.
- Which of the following is a cause of prerenal azotemia? A. Infection B. Renal toxins C. Poor renal perfusion D. Urinary tract obstruction (u) A. Infection is associated with interstitial nephritis, which is considered a cause of intrinsic renal azotemia. (u) B. This is one of the causes of intrinsic renal azotemia. (c) C. Renal hypoperfusion is the cause of prerenal azotemia, which may be rapidly reversible when renal blood flow and glomerular ultrafiltration pressure are restored. (u) D. Urinary tract obstruction is the cause of postrenal azotemia. Which of the following is the most common cause of secondary hypertension? A. Renal parenchymal disease B. Primary aldosteronism C. Oral contraceptive use D. Cushing's syndrome (c) A. Renal parenchymal disease is the most common cause of secondary hypertension. (u) B. Primary aldosteronism can cause secondary hypertension, but it is not the most common cause. (u) C. Oral contraceptives can cause small increases in blood pressure but considerable increases are much less common. (u) D. Cushing's disease is a less common cause of secondary hypertension.
A newborn weighs 8 pounds at birth. On average, what should the infant weigh at 1 year of age? A. 16 pounds B. 20 pounds C. 24 pounds D. 28 pounds (u) A. See C for explanation. (u) B. See C for explanation. (c) C. An infant will triple birth weight within the first year of life. A newborn that weighs 8 pounds at birth will weigh approximately 24 pounds at 1 year of age. (u) D. See C for explanation. The most reliable sign of acute otitis media (AOM) is A. bulging of the tympanic membrane. B. loss of tympanic membrane mobility. C. reddening of the tympanic membrane. D. air bubbles behind the tympanic membrane. (u) A. Bulging and air bubbles behind the TM represent OM with effusion. (c) B. Loss of tympanic membrane mobility during pneumonia sufflation is the most reliable sign for diagnosing acute otitis media. (u) C. Reddening of the eardrum is not reliable as it may be due to crying or other vascular changes. (u) D. See A for explanation. Which of the following is a staphylococcal infection characterized by a localized red swollen and acutely tender abscess of the upper or lower eyelid?
B. Bupropion (Wellbutrin) C. Fluoxetine (Prozac) D. Venlafaxine (Effexor) (u) A. See B for explanation. (c) B. The only two approved drugs for aiding smoking cessation are nicotine and bupropion. (u) C. See B for explanation. (u) D. See B for explanation. A patient presents with chronic back pain. On physical examination testing, the patient is found to have abnormalities of proprioception and vibration discrimination. Which of the following portions of the spinal column are most likely affected? A. Lateral spinothalamic tract B. Ventral spinothalamic tract C. Posterior column D. Transection of the cord (u) A. The lateral spinothalamic tract affects pain and temperature sensation. (u) B. The ventral spinothalamic tract affects pressures and touch sensations. (c) C. The posterior column affects proprioception (position sense) and vibration sense. (u) D. Patients with transection of the cord will have loss of sensation distal to the area of injury along with paralysis and hyperactive reflexes in the area distal to the transection. A 44 year-old female presents for follow-up results of her lipid profile. She is asymptomatic and has a past medical history of hypothyroidism treated with levothyroxine and hypertension controlled with atenolol (Tenormin). She drinks an average of 6 alcoholic beverages a day and smokes 1 pack per day for the last 32 years. Her family history is unremarkable for premature
coronary artery disease. Her fasting blood glucose is 98 mg/dL, total cholesterol is 198 mg/dL, LDL cholesterol is 132 mg/dL, HDL cholesterol is 56 mg/dL and triglycerides of 90 mg/dL. Excluding LDL cholesterol levels, how many major risk factors for coronary artery disease does this female possess? A. 2 B. 3 C. 4 D. 5 (c) A. This patient's major cardiac risk factors are smoking and hypertension in addition to the elevated LDL cholesterol. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. A 65 year-old patient with steroid-dependent chronic obstructive lung disease presents with a headache that has been increasing in severity over the past week, accompanied by nausea and vomiting. He denies fever, but has had photophobia and a stiff neck. Which of the following is the most likely diagnosis? A. Transient ischemic attack B. Bacterial meningitis C. Migraine headache D. Cryptococcosis (u) A. Transient ischemic attacks present with focal neurological findings rather than headaches. (a) B. Bacterial meningitis is typically acute in onset and causes fever, but immunocompromised patients may have a slower onset and no fever. (u) C. Migraines generally do not begin in this age group, and are not accompanied by nuchal rigidity.
(c) B. At 20-22 weeks, the fundal height is typically at the level of the umbilicus. (u) C. See B for explanation. (u) D. See B for explanation. Which of the following is a common symptom associated with laryngotracheobronchitis (viral croup)? A. Drooling B. High fever C. "Hot potato" voice D. Barking cough (u) A. Drooling and a "hot potato" voice are seen with epiglottitis, not viral croup. (u) B. Fever is usually absent or low-grade in patients with viral croup. (u) C. See A for explanation. (c) D. Viral croup is characterized by a history of upper respiratory tract symptoms followed by onset of a barking cough and stridor. A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing shortness of breath for 2 days. Her asthma has been well-controlled until 2 days ago. Since yesterday, she has been using her albuterol inhaler every 4 to 6 hours. She is normally very active, however yesterday she did not complete her 30 minute exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries, or use of oral contraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment? A. Chest x-ray
B. Sputum gram stain C. Peak flow D. Ventilation-perfusion scan (u) A. A chest x-ray should be ordered in an asthmatic patient only if you are concerned about the presence of pneumonia or pneumothorax, neither of which is supported by the H&P findings noted above. (u) B. A sputum gram stain is performed in patients who you suspect have an infectious process, such as pneumonia. (c) C. A peak flow reading will help you to gauge her current extent of airflow obstruction and is helpful in monitoring the effectiveness of any treatment interventions. (u) D. A ventilation-perfusion scan (V/Q scan) is indicated in cases of suspected pulmonary embolism. The patient above does not have any risk factors that would lead you to suspect such a diagnosis. A 3 year-old girl is diagnosed with atopic dermatitis. Which of the following disorders is this child at risk for in the future? A. Asthma B. Tinea pedis C. Squamous carcinoma D. Systemic lupus erythematosus (SLE) (c) A. Up to 50% of patients with atopic dermatitis develop asthma and/or allergic rhinitis in the future. (u) B. Patients with atopic dermatitis are more likely to get superimposed viral or bacterial infections such as herpes simplex or staphylococcal, but they are not more at risk for fungal infections. (u) C. Patients with atopic dermatitis are at no greater risk for any skin cancer. (u) D. Lupus is a connective tissue disorder of the immune system, but unrelated to atopic dermatitis.
Pharmacologic treatment of a patient with gestational diabetes should consist of which of the following? A.Oral hypoglycemic agents B. Regular insulin C. Oral corticosteroids D. Glucagon (h) A. Oral hypoglycemic agents have no role in the treatment of gestational diabetes as these drugs may cross the placenta and harm the fetus. (c) B. Regular insulin is the drug of choice as this will maintain the mother's blood sugar but not cross the placenta. (h) C. Oral corticosteroids have no role in the treatment of gestational diabetes. Corticosteroids will cause the blood glucose to increase. (u) D. Glucagon is given to patients when their blood glucose is abnormally low. Glucagon stimulates gluconeogenesis. Which of the following is an indication for vaccination against hepatitis A? A. Illicit drug users B. Health care workers C. Renal dialysis patients D. Routine vaccination starting at birth (c) A. Hepatitis A vaccine is recommended for illicit drug users, anyone living or traveling to endemic areas, sewage workers, food handlers, homosexual and bisexual men, animal handlers, patients with a history of chronic liver disease or a clotting factor disease as well as children and workers in day care settings and institutions. (u) B. Health care workers, renal dialysis patients and routine vaccination starting at birth are some of the recommendations for vaccination against hepatitis B, not hepatitis A.
(u) C. See B for explanation. (u) D. See B for explanation. The DSM-IV classifies mental disorders by using five axes in completing the process. Axis III is used to identify which of the following? A. Clinical disorders and other conditions that may be the focus of clinical attention B. Any physical disorder or general medical condition that is present in addition to the mental disorder C. The psychosocial and environmental problems that have had a significant contribution to the development or exacerbation of the disorder D. Personality disorders and/or mental retardation (u) A. Axis I identifies clinical disorders and other conditions that may be the focus of clinical attention. (c) B. Axis III identifies any physical disorder or general medical condition that is present in addition to the mental disorder. (u) C. Axis IV identifies the psychosocial and environmental problems having a significant contribution to the disorder. (u) D. Axis II identifies personality disorders and mental retardation. A 2 month-old infant presents for a routine health maintenance visit. The mother has been concerned about the infant's hearing since birth. Physical examination reveals no apparent response to a sudden loud sound. Which of the following is the most appropriate diagnostic evaluation? A. audiometry B. tympanometry C. acoustic reflectometry D. auditory-evoked potentials
(u) D. While a myocardial infarction usually presents with dyspnea, the chest pain is not usually pleuritic in nature. An EKG would commonly reveal ST segment changes which would be consistent with ischemia or infarct. Which of the following is an independent risk factor for development of a mesothelioma? A. Cigarette smoking B. Asbestos exposure C. Radon gas exposure D. Chronic obstructive lung disease (u) A. There has not been any evidence of association between cigarette smoking and the development of mesothelioma. (c) B. Studies confirm the association of asbestos exposure to the development of mesothelioma. (u) C. After cigarette smoking, radon gas is the second most common risk factor for development of bronchogenic lung cancer, not mesothelioma. (u) D. Chronic obstructive lung disease is associated with an increased risk of bronchogenic lung cancer, not mesothelioma. A 34 year-old female with a history of asthma presents with complaints of increasing asthma attacks. The patient states she has been well-controlled on albuterol inhaler until one month ago. Since that time she notices that she has had to use her inhaler 3- 4 times a week and also has had increasing nighttime use averaging about three episodes in the past month. Spirometry reveals greater than 85% predicted value. Which of the following is the most appropriate intervention at this time? A. Oral prednisone B. Oral theophylline (Theo-Dur) C. Salmeterol (Serevent) inhaler D. Beclomethasone (Qvar)inhaler
(u) A. Oral corticosteroids, such as prednisone, are added to therapy in severe persistent asthma. While a course of oral corticosteroids may be needed for mild exacerbations of asthma, they are not added until inhaled corticosteroids have failed to control the symptoms. (u) B. Due to its safety profile, oral theophylline is now considered a third or fourth line treatment option for asthma. (u) C. Long acting inhaled beta2-agonists, such as salmeterol, are not added to the treatment regimen until the symptoms indicate a moderate persistent asthma. Long acting inhaled beta2-agonists should also not be used in place of inhaled steroids. (c) D. This patient has progressed to mild persistent asthma. In addition to her inhaled beta2-agonist (albuterol), she should be started on an anti-inflammatory agent. Inhaled corticosteroids, such as beclomethasone, are preferred for long-term control. Which of the following mechanisms leads to a primary pneumothorax? A. Penetrating or blunt trauma forces B. Underlying lung cancer C. Pressure of air in the pleural space exceeds room air pressure D. Rupture of subpleural apical blebs due to high negative intrapleural pressures (u) A. Penetrating or blunt trauma force is responsible for a traumatic pneumothorax. (u) B. A pneumothorax that results from an underlying lung disease is classified as a secondary pneumothorax. (u) C. When pressure of air in the pleural space exceeds room air pressure, it leads to a tension pneumothorax. (c) D. A primary spontaneous pneumothorax is thought to result from a rupture of subpleural apical blebs secondary to high negative intrapleural pressures. What is the initial treatment of choice for hyperthyroidism in a 10-week pregnant patient? A. No treatment is necessary.
her blood pressure is 146/92. Recent blood work shows a Sodium 140 mEq/L, Potassium 4.2 mEq/L, BUN of 23 mg/dL, and Creatinine of 1.1 mg/dL. Which of the following is the most appropriate initial medication in this patient? A. Terazosin (Hytrin) B. Atenolol (Tenormin) C. Lisinopril (Zestril) D. Hydrochlorothiazide (HCTZ) (u) A. Alpha blockers are not the treatment of choice in a diabetic with hypertension. (u) B. Patients with hypertension and diabetes may require a Beta blocker, but it should be added to an ACE inhibitor if the ACE inhibitor is ineffective on its own. (c) C. ACE inhibitors should be part of the initial treatment of hypertension in diabetics because of beneficial effects in diabetic nephropathy and is the most appropriate initial medication. (u) D. Patients with hypertension and diabetes mellitus may require a diuretic, but it should be added to an ACE inhibitor if the ACE inhibitor is ineffective on its own. What is the EKG manifestation of cardiac end-organ damage due to hypertension? A. Right bundle branch block B. Left ventricular hypertrophy C. Right ventricular hypertrophy D. ST segment elevation in lateral precordial leads (u) A. Right bundle branch block is caused by a delay in the conduction system in the right ventricle. It may be caused by right ventricular hypertrophy or conditions with higher pulmonic resistance such as cor pulmonale. Hypertension, however, is likely to cause changes in the left ventricle rather than the right ventricle. (c) B. Long-standing hypertension can lead to left ventricular hypertrophy with characteristic changes noted on EKG. (u)C. See A for explanation. (u) D. ST segment elevation is a sign of acute myocardial infarction not hypertension.
Annual blood pressure determinations should be obtained beginning at the age of A. 3 years. B. 5 years. C. 12 years. D. 18 years.. (c) A. Periodic measurements of blood pressure should be part of routine preventive health assessments beginning at the age of 3 years. (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation In adults and intravenous drug abusers, which of the following bones is most commonly affected with acute osteomyelitis? A. Femur B. Humerus C. Vertebral spine D. Tibia (u) A. Long bones are most commonly affected with osteomyelitis in children. (u) B. See A for explanation. (c) C. The bones of the vertebral spine are most commonly affected in a patient with osteomyelitis. Organisms reach the well-perfused vertebral body of adults via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. The infection may originate in the urinary tract and intravenous drug use carries an increased risk of spinal infection (u) D. See A for explanation.
