PACKRAT Exam Study Guide | 100% Correct
Answers | Verified | Latest 2024 Version
1. Health Maintenance/Obstetrics/Gynecology
Which of the following portends the greatest risk for the development of breast cancer?
A. Nulliparity
B. Early menarche
C. BRCA 1 positivity
D. Maternal family history of breast cancer - ✔✔(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. BRCA1 positivity is associated with half of the early onset breast cancers and 90% of the hereditary
ovarian
cancers.
(u) D. See C for explanation.
2. Clinical Therapeutics/Urology/Renal
In order to help delay the progression to kidney disease in a diabetic patient with proteinuria, which of
the following would you consider using to treat the patient's concomitant hypertension?
A. Atenolol (Tenormin)
B. Amlodipine (Norvasc)
C. Accupril (Quinapril)
D. Amiloride (Midamor) - ✔✔(u) A. Atenolol is a beta blocker. Beta blockers are not first line therapy for
hypertensive diabetics.
(u) B. Amlodipine is a calcium channel blocker. Calcium channel blockers are not first line therapy for
hypertensive diabetics.
(c) C. Accupril is an ACE inhibitor. Because of their beneficial effects in diabetic neuropathy, ACE
inhibitors (and ARBs) should be part of the initial treatment regimen for hypertension in diabetics.
(u) D. Amiloride is a potassium-sparing diuretic. An ACE inhibitor is the standard first line therapy for
hypertensive diabetics.
:
,3. Diagnosis/Pulmonology
A 58 year-old with a 20 pack-year history of tobacco use presents to the emergency department with
sudden onset of
severe, progressive right-sided chest pain and shortness of breath. She denies fever, nausea and
productive cough
but reports returning from a mission trip to South Africa yesterday. Her exam reveals tachycardia,
tachypnea, clear
lung fields and 3+ edema and erythema of the left leg. Her chest radiograph is normal. Which of the
following is the
most likely diagnosis?
A. Pulmonary embolism
B. Pneumothorax
C. Pneumonia
D. Pleurisy - ✔✔(c) A. The patient's risk factors, acutely progressive presentation and normal chest
radiograph make a pulmonary
embolism the most likely and most worrisome diagnosis.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
: (8)
4. History & Physical/Dermatology
A 46 year-old male is brought to the emergency department after sustaining burns to his entire right arm
and leg in a
house fire. Which of the following percentages best classifies the extent of his burns?
A. 12
B. 18
C. 27
D. 36 - ✔✔(u) A. See C for explanation.
,(u) B. See C for explanation.
(c) C. According to the "rule of nines" the percentages can be calculated as follows: entire arm = 9% of
body surface
area (BSA). Anterior surface of each leg = 9% BSA, posterior surface of each leg = 9% BSA. The patient
has a
total of 27% BSA with burns.
(u) D. See C for explanation.
: (8)
5. Diagnostic Studies/ENT/Ophthalmology
Which of the following imaging modalities is most appropriate in the evaluation of chronic sinusitis?
A. Coronal CT
B. Sinus MRI
C. Panorex
D. Sinus radiographs - ✔✔(c) A. Coronal CT is the most effective imaging to determine the anatomy of
the sinuses as well as the presence and
extent of sinusitis.
(u) B. MRI is of limited value due to less than optimal visualization of bony structures.
(u) C. Panorex imaging provides limited viusalization of the sinus structures.
(u) D. Sinus radiographs are rarely used due to limited visualization of soft tissues.
: (8)
6. Clinical Therapeutics/Orthopedics/Rheumatology
Which of the following is indicated as the first-line treatment of an initial case of acute gouty arthritis?
A. Indomethacin (Indocin)
B. Colchicine (Probenicid)
C. Methylprednisolone (Medrol)
, D. Allopurinol (Zyloprim) - ✔✔(c) A. A nonsteroidal antiinflammatory agent is indicated as the first-line
treatment for an initial case of acute gout.
(u) B. Colchicine is a useful adjunct to NSAIDs, corticosteroids, or synthetic ACTH for the treatment of
severe gout,
refractory acute gouty attacks, or as prevention.
(u) C. An intra-articular injection of glucocorticoid or a tapered regimen of oral prednisone can be used
as an
alternative treatment to the first-line treatment of an NSAID.
(u) D. Allopurinol is a xanthine oxidase inhibitor used for patients with more than three occurrences per
year, gout
that is difficult to manage safely (polyarticular gout in a transplant patient or one with renal
insufficiency),
tophaceous gout, and hyperuricemia. Allopurinol can trigger an episode of gout, especially in the first
few
months of treatment.
: (8)
7. Diagnostic Studies/Infectious Diseases
Which of the following is the most sensitive laboratory test to diagnose herpes simplex virus?
A. Polymerase chain reaction (PCR)
B. Enzyme-linked immunosorbent assay (ELISA)
C. Tzanck smear
D. HSV antibody titer - ✔✔(c) A. Diagnosis is usually made clinically however, PCR is more sensitive than
culture.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
: (8)
8. Health Maintenance/Psychiatry/Behavioral Medicine
Which of the following is the drug of choice for the prevention of Wernicke's encephalopathy?
Answers | Verified | Latest 2024 Version
1. Health Maintenance/Obstetrics/Gynecology
Which of the following portends the greatest risk for the development of breast cancer?
A. Nulliparity
B. Early menarche
C. BRCA 1 positivity
D. Maternal family history of breast cancer - ✔✔(u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. BRCA1 positivity is associated with half of the early onset breast cancers and 90% of the hereditary
ovarian
cancers.
(u) D. See C for explanation.
2. Clinical Therapeutics/Urology/Renal
In order to help delay the progression to kidney disease in a diabetic patient with proteinuria, which of
the following would you consider using to treat the patient's concomitant hypertension?
A. Atenolol (Tenormin)
B. Amlodipine (Norvasc)
C. Accupril (Quinapril)
D. Amiloride (Midamor) - ✔✔(u) A. Atenolol is a beta blocker. Beta blockers are not first line therapy for
hypertensive diabetics.
(u) B. Amlodipine is a calcium channel blocker. Calcium channel blockers are not first line therapy for
hypertensive diabetics.
(c) C. Accupril is an ACE inhibitor. Because of their beneficial effects in diabetic neuropathy, ACE
inhibitors (and ARBs) should be part of the initial treatment regimen for hypertension in diabetics.
(u) D. Amiloride is a potassium-sparing diuretic. An ACE inhibitor is the standard first line therapy for
hypertensive diabetics.
:
,3. Diagnosis/Pulmonology
A 58 year-old with a 20 pack-year history of tobacco use presents to the emergency department with
sudden onset of
severe, progressive right-sided chest pain and shortness of breath. She denies fever, nausea and
productive cough
but reports returning from a mission trip to South Africa yesterday. Her exam reveals tachycardia,
tachypnea, clear
lung fields and 3+ edema and erythema of the left leg. Her chest radiograph is normal. Which of the
following is the
most likely diagnosis?
A. Pulmonary embolism
B. Pneumothorax
C. Pneumonia
D. Pleurisy - ✔✔(c) A. The patient's risk factors, acutely progressive presentation and normal chest
radiograph make a pulmonary
embolism the most likely and most worrisome diagnosis.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
: (8)
4. History & Physical/Dermatology
A 46 year-old male is brought to the emergency department after sustaining burns to his entire right arm
and leg in a
house fire. Which of the following percentages best classifies the extent of his burns?
A. 12
B. 18
C. 27
D. 36 - ✔✔(u) A. See C for explanation.
,(u) B. See C for explanation.
(c) C. According to the "rule of nines" the percentages can be calculated as follows: entire arm = 9% of
body surface
area (BSA). Anterior surface of each leg = 9% BSA, posterior surface of each leg = 9% BSA. The patient
has a
total of 27% BSA with burns.
(u) D. See C for explanation.
: (8)
5. Diagnostic Studies/ENT/Ophthalmology
Which of the following imaging modalities is most appropriate in the evaluation of chronic sinusitis?
A. Coronal CT
B. Sinus MRI
C. Panorex
D. Sinus radiographs - ✔✔(c) A. Coronal CT is the most effective imaging to determine the anatomy of
the sinuses as well as the presence and
extent of sinusitis.
(u) B. MRI is of limited value due to less than optimal visualization of bony structures.
(u) C. Panorex imaging provides limited viusalization of the sinus structures.
(u) D. Sinus radiographs are rarely used due to limited visualization of soft tissues.
: (8)
6. Clinical Therapeutics/Orthopedics/Rheumatology
Which of the following is indicated as the first-line treatment of an initial case of acute gouty arthritis?
A. Indomethacin (Indocin)
B. Colchicine (Probenicid)
C. Methylprednisolone (Medrol)
, D. Allopurinol (Zyloprim) - ✔✔(c) A. A nonsteroidal antiinflammatory agent is indicated as the first-line
treatment for an initial case of acute gout.
(u) B. Colchicine is a useful adjunct to NSAIDs, corticosteroids, or synthetic ACTH for the treatment of
severe gout,
refractory acute gouty attacks, or as prevention.
(u) C. An intra-articular injection of glucocorticoid or a tapered regimen of oral prednisone can be used
as an
alternative treatment to the first-line treatment of an NSAID.
(u) D. Allopurinol is a xanthine oxidase inhibitor used for patients with more than three occurrences per
year, gout
that is difficult to manage safely (polyarticular gout in a transplant patient or one with renal
insufficiency),
tophaceous gout, and hyperuricemia. Allopurinol can trigger an episode of gout, especially in the first
few
months of treatment.
: (8)
7. Diagnostic Studies/Infectious Diseases
Which of the following is the most sensitive laboratory test to diagnose herpes simplex virus?
A. Polymerase chain reaction (PCR)
B. Enzyme-linked immunosorbent assay (ELISA)
C. Tzanck smear
D. HSV antibody titer - ✔✔(c) A. Diagnosis is usually made clinically however, PCR is more sensitive than
culture.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
: (8)
8. Health Maintenance/Psychiatry/Behavioral Medicine
Which of the following is the drug of choice for the prevention of Wernicke's encephalopathy?
