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PACKRAT Review Questions | Correct
Answers | 2025 Version
What test is the single most useful test in establishing the diagnosis of multiple sclerosis? - ✔✔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? - ✔✔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? - ✔✔Compartment Pressure The initial sign or symptom of iron poisoning in a 3 year-old child is usually... - ✔✔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... - ✔✔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? - ✔✔ 20 weeks Cardiac nuclear scanning is done to detect... - ✔✔Ventricular Wall Dysfunction A classic skin finding seen in patients with inflammatory bowel disease would be... - ✔✔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? - ✔✔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? - ✔✔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... - ✔✔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? - ✔✔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? - ✔✔Masked Facies (thinking Parkinson's) Primary biliary cirrhosis will have which of the following laboratory results? - ✔✔Antimitochondiral antibodies Which of the following historical factors differentiates post-traumatic stress disorder from acute stress disorder? - ✔✔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? - ✔✔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... - ✔✔Distended neck veins
Premature beats can be increased in frequency by... - ✔✔Caffeine/stimulants What can cause a bundle branch block? - ✔✔MI Widened QRS, but nothing else: - ✔✔PVC Abnormally shaped P wave, but nothing else: - ✔✔PAC Periods of bradycardia and/or tachycardia: - ✔✔Sick Sinus Syndrome. Give pacemaker. Seen in elderly Pts Irregular tachycardia, narrow QRS complex, abnormally shaped P waves with different morphology - ✔✔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? - ✔✔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? - ✔✔Takotsubo dilated cardiomyopathy (Heartbreak heart - major catecholamine release). Disease is self-limiting What 2 diseases can cause restrictive cardiomyopathy and what is the Tx? - ✔✔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? - ✔✔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: - ✔✔Atrial flutter. Caused by COPD, CHF, ASD, CAD. Similar Tx as A-fib
Pt has HR of 150 - 250 bpm, narrow QRS w/ no structural abnormalities. Dx? - ✔✔Paroxysmal SVT Pt has HR of 150 - 250 bpm, narrow QRS w/ delta wave. Dx? - ✔✔Wolff-Parkinson-White Tx for SVT's: - ✔✔Valsalva for stable Pts. Adenosine for symptomatic Pts. Definitive Tx is radiofrequency ablation. Irregular beat every third beat: - ✔✔Trigeminy Irregular beat every other beat: - ✔✔Bigeminy Tx for irregular beats: - ✔✔None or beta blockers if symptomatic Wide complex tachycardia on EKG. Dx and Tx? - ✔✔V-tach. Amiodarone or lidocaine in stable Pt. CPR and defibrillation in unstable Pt. What can cause long QT syndrome? - ✔✔Hypokalemia, antiarrhythmics, antifungals, antimalarials Pt has QT interval > 0. 45 seconds. Dx, risks, and Tx? - ✔✔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? - ✔✔Brugada syndrome. Treat w/ implantable defibrillator Unstable Pt presents w/ no discernible heart contractions. Dx and Tx? - ✔✔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? - ✔✔Torsades de pointes. Caused by hypokalemia or hypomagnesemia. Treatment is IV magnesium sulfate. HR less than 60 bpm. Dx and Tx? - ✔✔Bradycardia. Treat w/ atropine
Pt has 2 BP readings of 140 - 159 / 90 - 99. Dx: - ✔✔Stage 1 Essential HTN Pt has 2 BP readings of 160 - 179 / 100 - 109. Dx: - ✔✔Stage 2 Essential HTN Resistant essential HTN is defined by... - ✔✔HTN not controlled after 3 meds Refractory essential HTN is defined by... - ✔✔HTN not controlled after 5 meds In Pts under 50 , (systolic/diastolic) is better indicator of heart disease. - ✔✔Diastolic In Pts over 50 , (systolic/diastolic) is better indicator of heart disease. - ✔✔Systolic Diuretics used for HTN that work @ distal tubule: - ✔✔HCT, Chlorthiadone, Indapamide Drugs used to Treat HTN: - ✔✔Diuretics, ACEIs, ARBs, CCBs, beta blockers 1 st line for HTN: - ✔✔Diuretic Side Effects of ACEIs: - ✔✔Hyperkalemia, cough, angioedema. Switch to ARB. Not effective in African Americans. 1 st line for Pt w/ HTN and CKD/DM: - ✔✔ACEIs Side Effects of CCBs: - ✔✔Peripheral edema, CHF exacerbation, flushing Drugs for HTN that are safe in pregnancy: - ✔✔Methyldopa, hydralazine, labetalol, nifedipine
Causes of secondary HTN: - ✔✔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? - ✔✔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? - ✔✔Hypertensive urgency. Oral antihypertensive Common causes of cardiogenic shock? - ✔✔Acute MI, HF, cardiac tamponade Pt presents w/ hypotension (systolic <9 0 mmHg), cyanosis, cool extremities, altered mental status, crackles. dx and Tx? - ✔✔Cardiogenic shock. Fluid resuscitation, pressors (dopamine), and treat underlying cause Orthostatic Hypotension Definition: - ✔✔ 20 mmHg drop in systolic BP, 10 mmHg drop in diastolic pressure. 15 bpm increase in pulse when Pt moves from supine to standing
