PACKRAT 2 2026 REVISION NOTES AND
STRUCTURED PHYSICIAN ASSISTANT
OVERVIEW GUIDE
◉ 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. Answer: (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. Answer: (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 considered a risk factor for the
development of malignant melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals. Answer: (u) A. Incidence of malignant
melanoma is equal in males and females.
,(c) B. Inability to tan and propensity to burn are risk factors for
developing malignant melanoma.
(u) C. Malignant melanomas are most common in Caucasians and
are rarely seen in the Japanese population.
(u) D. Red hair and freckling is one of the major risk factors for
malignant melanoma, not brown hair.
◉ A 43 year-old data entry clerk presents with a one-month history
of pain and tingling in the right thumb, index finger,
and middle finger. Tinel's sign and Phalen's maneuver are positive.
The most appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery.. Answer: (u) A. A Medrol dose pack will have no affect on
carpal tunnel syndrome.
(c) B. Splinting in neutral position relieves impingement of the
median nerve, thus improving symptoms of carpal tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to
conservative therapy.
◉ 7. Which of the following is a cause of prerenal azotemia?
A. Infection
, B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction. Answer: (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. Answer: (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.
STRUCTURED PHYSICIAN ASSISTANT
OVERVIEW GUIDE
◉ 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. Answer: (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. Answer: (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 considered a risk factor for the
development of malignant melanoma?
A. male gender
B. inability to tan
C. Japanese ethnicity
D. brown-haired individuals. Answer: (u) A. Incidence of malignant
melanoma is equal in males and females.
,(c) B. Inability to tan and propensity to burn are risk factors for
developing malignant melanoma.
(u) C. Malignant melanomas are most common in Caucasians and
are rarely seen in the Japanese population.
(u) D. Red hair and freckling is one of the major risk factors for
malignant melanoma, not brown hair.
◉ A 43 year-old data entry clerk presents with a one-month history
of pain and tingling in the right thumb, index finger,
and middle finger. Tinel's sign and Phalen's maneuver are positive.
The most appropriate intervention at this time is
A. methylprednisolone (Medrol) dose pack.
B. splint in neutral position.
C. observation.
D. surgery.. Answer: (u) A. A Medrol dose pack will have no affect on
carpal tunnel syndrome.
(c) B. Splinting in neutral position relieves impingement of the
median nerve, thus improving symptoms of carpal tunnel.
(u) C. Observation will not improve symptoms.
(u) D. Surgical intervention is reserved for cases unresponsive to
conservative therapy.
◉ 7. Which of the following is a cause of prerenal azotemia?
A. Infection
, B. Renal toxins
C. Poor renal perfusion
D. Urinary tract obstruction. Answer: (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. Answer: (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.
