PACKRAT 2 2026 EXAM PREPARATION PACK
KEY CLINICAL MEDICINE DIAGNOSIS
TREATMENT GUIDELINES AND PATIENT
MANAGEMENT WITH SAMPLE QUESTIONS
◉ A 20 year-old male presents with complaint of brief episodes of
rapid heart beat with a sudden onset and offset that have increased
in frequency. He admits to associated shortness of breath and
lightheadedness. He denies syncope. Electrocardiogram reveals a
delta wave prominent in lead II. Which of the following is the most
appropriate long-term management in this patient?
A. Implantable cardio defibrillator
B. Radiofrequency ablation
C. Verapamil (Calan)
D. Metoprolol (Lopressor). Answer: (u) A. Implantable cardio
defibrillators are indicated in the treatment of ventricular
arrhythmias, not Wolf-Parkinson-White (WPW) syndrome.
(c) B. Radiofrequency ablation is the procedure of choice for long-
term management in patients with accessory pathways (WPW) and
recurrent symptoms.
(u) C. Calcium channel blockers and beta-blockers are not the best
options for the long-term management of WPW. They may decrease
the refractoriness of the accessory pathway or increase the
refractoriness of the AV node in patients with atrial fibrillation or
,atrial flutter who have an antegrade conducting bypass tract. This
may lead to faster ventricular rates.
(u) D. See C for explanation.
◉ A 26 year-old woman requests screening after her boyfriend was
treated for a sexually transmitted infection recently. On examination
you find a painless vulvar ulcer. Which of the following is the most
likely diagnosis?
A. Herpes
B. Syphilis
C. Chancroid
D. Granuloma inguinale. Answer: (u) A. The classic presentation of
herpes is a painful vesicle.
(c) B. The primary lesion of syphilis presents as a painless ulcer or
chancre. Secondary syphilis presents with a skin rash
lymphadenopathy and mucocutaneous lesions.
(u) C. Chancroid presents with a painful genital ulcer and tender
suppurative inguinal adenopathy.
(u) D. Granuloma inguinale presents with raised, red lesions that
bleed easily.
◉ A 57 year-old male recently on a high protein diet presents with
an exquisitely tender, erythematous, warm right great toe. Which of
the following is the treatment of choice for this patient?
A. Corticosteroids
,B. Colchicine
C. Allopurinol
D. Non-steroidal antiinflammatory agents. Answer: (u) A.
Corticosteroids are effective in acute gout attacks but are reserved
for people with non-steroidal anti-inflammatory agent allergies or
contraindications.
(u) B. Colchicine is not recommended in the treatment of acute
gouty arthritis.
(u) C. Allopurinol is useful in reducing uric acid levels but is not the
treatment of choice in acute gouty arthritis.
(c) D. NSAID medications are the treatment of choice for acute gouty
attacks.
◉ A 55 year-old female presents to the clinic with lethargy, fatigue,
constipation, and menorrhagia. Physical examination reveals an
enlarged thyroid, dry skin, and a heart rate of 50 bpm. Laboratory
results show a decrease in free T4, and an elevation in TSH. Which of
the following is the most likely diagnosis?
A. Secondary hypothyroidism
B. Primary hypothyroidism
C. Primary hyperthyroidism
D. Secondary hyperthyroidism. Answer: (u) A. See B for explanation.
(c) B. This is a classic presentation of symptoms of primary
hypothyroidism. Symptoms include weight gain, fatigue, lethargy,
, depression, weakness, constipation, menorrhagia; and patients often
present with a palpable, enlarged thyroid.
(u) C. See B for explanation.
(u) D. See B for explanation.
◉ Which of the following diagnostic studies is indicated in the
evaluation of an upper gastrointestinal bleed?
A. Esophageal manometry
B. Bleeding scan
C. Upper endoscopy
D. Barium swallow. Answer: (u) A. Esophageal manometry is not
indicated in the evaluation of upper gastrointestinal bleeding.
(u) B. Bleeding scans are most useful to evaluate occult GI bleeding.
Radioactive isotope tracing is useful to concentrate bleeding sites at
a single location. It is most useful to find bleeding that is occurring in
the large or small bowel rather than in the upper GI sites.
(c) C. Endoscopy is the evaluation modality of choice in patients with
upper GI bleeding. The advantage of this technique is that it can be
used for both diagnostic and therapeutic purposes.
(u) D. Barium swallow is not indicated in the evaluation of upper
gastrointestinal bleeding.
◉ A 45 year-old male presents to the clinic complaining of morning
sluggishness, daytime fatigue, headaches. He admits to drinking two
cocktails each evening. His bed partner reports his loud cyclical
KEY CLINICAL MEDICINE DIAGNOSIS
TREATMENT GUIDELINES AND PATIENT
MANAGEMENT WITH SAMPLE QUESTIONS
◉ A 20 year-old male presents with complaint of brief episodes of
rapid heart beat with a sudden onset and offset that have increased
in frequency. He admits to associated shortness of breath and
lightheadedness. He denies syncope. Electrocardiogram reveals a
delta wave prominent in lead II. Which of the following is the most
appropriate long-term management in this patient?
A. Implantable cardio defibrillator
B. Radiofrequency ablation
C. Verapamil (Calan)
D. Metoprolol (Lopressor). Answer: (u) A. Implantable cardio
defibrillators are indicated in the treatment of ventricular
arrhythmias, not Wolf-Parkinson-White (WPW) syndrome.
(c) B. Radiofrequency ablation is the procedure of choice for long-
term management in patients with accessory pathways (WPW) and
recurrent symptoms.
(u) C. Calcium channel blockers and beta-blockers are not the best
options for the long-term management of WPW. They may decrease
the refractoriness of the accessory pathway or increase the
refractoriness of the AV node in patients with atrial fibrillation or
,atrial flutter who have an antegrade conducting bypass tract. This
may lead to faster ventricular rates.
(u) D. See C for explanation.
◉ A 26 year-old woman requests screening after her boyfriend was
treated for a sexually transmitted infection recently. On examination
you find a painless vulvar ulcer. Which of the following is the most
likely diagnosis?
A. Herpes
B. Syphilis
C. Chancroid
D. Granuloma inguinale. Answer: (u) A. The classic presentation of
herpes is a painful vesicle.
(c) B. The primary lesion of syphilis presents as a painless ulcer or
chancre. Secondary syphilis presents with a skin rash
lymphadenopathy and mucocutaneous lesions.
(u) C. Chancroid presents with a painful genital ulcer and tender
suppurative inguinal adenopathy.
(u) D. Granuloma inguinale presents with raised, red lesions that
bleed easily.
◉ A 57 year-old male recently on a high protein diet presents with
an exquisitely tender, erythematous, warm right great toe. Which of
the following is the treatment of choice for this patient?
A. Corticosteroids
,B. Colchicine
C. Allopurinol
D. Non-steroidal antiinflammatory agents. Answer: (u) A.
Corticosteroids are effective in acute gout attacks but are reserved
for people with non-steroidal anti-inflammatory agent allergies or
contraindications.
(u) B. Colchicine is not recommended in the treatment of acute
gouty arthritis.
(u) C. Allopurinol is useful in reducing uric acid levels but is not the
treatment of choice in acute gouty arthritis.
(c) D. NSAID medications are the treatment of choice for acute gouty
attacks.
◉ A 55 year-old female presents to the clinic with lethargy, fatigue,
constipation, and menorrhagia. Physical examination reveals an
enlarged thyroid, dry skin, and a heart rate of 50 bpm. Laboratory
results show a decrease in free T4, and an elevation in TSH. Which of
the following is the most likely diagnosis?
A. Secondary hypothyroidism
B. Primary hypothyroidism
C. Primary hyperthyroidism
D. Secondary hyperthyroidism. Answer: (u) A. See B for explanation.
(c) B. This is a classic presentation of symptoms of primary
hypothyroidism. Symptoms include weight gain, fatigue, lethargy,
, depression, weakness, constipation, menorrhagia; and patients often
present with a palpable, enlarged thyroid.
(u) C. See B for explanation.
(u) D. See B for explanation.
◉ Which of the following diagnostic studies is indicated in the
evaluation of an upper gastrointestinal bleed?
A. Esophageal manometry
B. Bleeding scan
C. Upper endoscopy
D. Barium swallow. Answer: (u) A. Esophageal manometry is not
indicated in the evaluation of upper gastrointestinal bleeding.
(u) B. Bleeding scans are most useful to evaluate occult GI bleeding.
Radioactive isotope tracing is useful to concentrate bleeding sites at
a single location. It is most useful to find bleeding that is occurring in
the large or small bowel rather than in the upper GI sites.
(c) C. Endoscopy is the evaluation modality of choice in patients with
upper GI bleeding. The advantage of this technique is that it can be
used for both diagnostic and therapeutic purposes.
(u) D. Barium swallow is not indicated in the evaluation of upper
gastrointestinal bleeding.
◉ A 45 year-old male presents to the clinic complaining of morning
sluggishness, daytime fatigue, headaches. He admits to drinking two
cocktails each evening. His bed partner reports his loud cyclical
