PACKRAT 1 QUESTIONS ANSWERED AND GRADED
2025/26
When performing a pre-participation sports physical in the adolescent population, a murmur
with which of the following qualities indicates a risk for sudden death during exercise?
A. Increases with the Valsalva maneuver
B. Increases with squatting maneuver
C. Associated with a mid-systolic click
D. Mid-systolic without radiation to the carotids - Correct Answer (c) A. Hypertrophic
cardiomyopathy (HCM) is a known cause of sudden death during or just after physical exertion
and competitive sports. The murmur associated with HCM is worsened by conditions that cause
reduced ventricular volume such as the Valsalva maneuver, sudden standing, and tachycardia.
(u) B. Typical systolic flow murmurs will become accentuated with maneuvers which increase
venous blood flow to the heart and these murmurs do not place athletes at risk for sudden
cardiac death.
(u) C. Mitral valve prolapse is the most common type of heart murmur that is associated with a
mid-systolic click. Mitral valve prolapse does not place the patient at risk for sudden cardiac
death.
(u) D. A mid-systolic heart murmur that fails to radiate into the carotids is most commonly
associated with a benign systolic flow murmur and does not place the athlete at risk for sudden
cardiac death.
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration
of which of the
following?
A. Luteinizing hormone
B. Prostaglandin
C. Progesterone
D. Prolactin - Correct Answer (c) A. Luteinizing hormone is responsible for ovulation and,
therefore, peaks at that time.
,(u) B. Prostaglandin is likely associated with the production of vasospasm, vascular necrosis, and
menstrual flow, not ovulation.
(u) C. The majority of progesterone is secreted by the corpus luteum and, therefore, peaks after
ovulation has occurred.
(u) D. Prolactin is an anterior pituitary hormone, and although important in reproduction and
pregnancy, it is not present in high levels at the time of ovulation.
A positive direct Coombs' test may be seen in which of the following conditions?
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia - Correct Answer (u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. A positive direct Coombs' test indicates that antibody has attached to an antigen on the
RBC which causes agglutination. Autoimmune hemolytic anemia results when the patient has
antibodies against their own RBCs. G6PD deficiency does result from an antibody antigen
reaction. Sickle cell anemia is caused by a defective hemoglobin which detected by hemoglobin
electrophoresis. Hereditary spherocytosis is detected utilizing the
osmotic fragility test.
In order to prevent the progression of diabetic nephropathy which of the following medications
should be instituted?
A. Lisinopril (Prinipril)
B. Propanolol (Inderal)
C. Verapamil (Calan)
D. Hydrochlorothiazide (Diuril) - Correct Answer (c) A. All patients should be started on an ACE
inhibitor to prevent the progression of proteinuria. ACE inhibitors appear to improve glomerular
hemodynamics by decreasing glomerular pressure.
,(u) B. Beta blockers are not indicated for the treatment of microalbuminuria.
(u) C. Calcium channel blockers are not indicated for the treatment of microalubuminuria.
(u) D. Thiazide diuretics are not indicated for the treatment of microalbuminuria.
A 5 year-old male presents with a history of recurrent episodes of acute bronchitis,
characterized by fever and productive cough. He has no known significant past medical history.
His pulmonary examination reveals crackles in the bilateral lower lobes. The remainder of his
physical examination is normal. Chest x-ray demonstrates platelike atelectasis and dilated,
thickened airways in the middle and lower lungs. Which of the following is the most likely
diagnosis?
A. Acute bronchitis
B. Bronchiectasis
C. Pneumonia
D. Tuberculosis - Correct Answer (u) A. Barring underlying pulmonary pathology, the chest x-ray
in acute bronchitis should be normal.
(c) B. Bronchiectasis typically presents as recurrent episodes of acute bronchitis. Platelike
atelectasis and dilated and thickened airways, sometimes described as tram lines, are common
radiographic findings.
(u) C. While the history may suggest pneumonia, the radiographic findings do not support this
diagnosis.
(u) D. Tuberculosis would present with cavitating granuloma formation more commonly at the
apices.
Which of the following clinical characteristics is associated with bicipital tendonitis?
A. Aggravated by resisted supination of the forearm
B. Bulging appearance to the proximal arm
C. Weakness of the arm with internal rotation and adduction
D. Pain that awakens the patient at night - Correct Answer (c) A. Supraspinatus tendonitis will
be aggravated by resisted supination of the forearm.
(u) B. Biceps rupture may present with a bulging appearance of the proximal arm.
, (u) C. Weakness of the arm with internal rotation and adduction is characteristic of pectoralis
major rupture or tear.
(u) D. Night pain is characteristic of rotator cuff tear or tendonitis.
Which of the following antiarrhythmic drugs can be associated with hyper- or hypothyroidism
following long-term use?
A. Quinidine
B. Amiodarone
C. Digoxin
D. Verapamil - Correct Answer (u) A. See B for explanation.
(c) B. Amiodarone is structurally related to thyroxine and contains iodine, which can induce a
hyper- or hypothyroid state.
(u) C. See B for explanation.
(u) D. See B for explanation.
An 18 year-old male is involved in a motor vehicle accident with a question of cervical spine
fracture. What is the imaging test of choice to initially evaluate this patient and clear his cervical
c-spine?
A. Positron emission tomography
B. Magnetic resonance imaging
C. Computed tomography
D. Lateral radiograph - Correct Answer (u) A. There is no role for positron emission tomography
in suspected cervical spine injury.
(u) B. MRI and CT of the spine may be performed in the setting of acute cervical spine injury
when a major fracture or dislocation is identified.
(u) C. See B for explanation.
(c) D. Cervical spine x-rays are most commonly used as the initial screen for cervical spine injury.
A cervical spine series consists of a lateral view, anteroposterior (AP) view, and an odontoid
view. The lateral view detects up to 80% of traumatic spine injuries.
2025/26
When performing a pre-participation sports physical in the adolescent population, a murmur
with which of the following qualities indicates a risk for sudden death during exercise?
A. Increases with the Valsalva maneuver
B. Increases with squatting maneuver
C. Associated with a mid-systolic click
D. Mid-systolic without radiation to the carotids - Correct Answer (c) A. Hypertrophic
cardiomyopathy (HCM) is a known cause of sudden death during or just after physical exertion
and competitive sports. The murmur associated with HCM is worsened by conditions that cause
reduced ventricular volume such as the Valsalva maneuver, sudden standing, and tachycardia.
(u) B. Typical systolic flow murmurs will become accentuated with maneuvers which increase
venous blood flow to the heart and these murmurs do not place athletes at risk for sudden
cardiac death.
(u) C. Mitral valve prolapse is the most common type of heart murmur that is associated with a
mid-systolic click. Mitral valve prolapse does not place the patient at risk for sudden cardiac
death.
(u) D. A mid-systolic heart murmur that fails to radiate into the carotids is most commonly
associated with a benign systolic flow murmur and does not place the athlete at risk for sudden
cardiac death.
At the time of ovulation in a normal menstrual cycle, there is a peak in the serum concentration
of which of the
following?
A. Luteinizing hormone
B. Prostaglandin
C. Progesterone
D. Prolactin - Correct Answer (c) A. Luteinizing hormone is responsible for ovulation and,
therefore, peaks at that time.
,(u) B. Prostaglandin is likely associated with the production of vasospasm, vascular necrosis, and
menstrual flow, not ovulation.
(u) C. The majority of progesterone is secreted by the corpus luteum and, therefore, peaks after
ovulation has occurred.
(u) D. Prolactin is an anterior pituitary hormone, and although important in reproduction and
pregnancy, it is not present in high levels at the time of ovulation.
A positive direct Coombs' test may be seen in which of the following conditions?
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia - Correct Answer (u) A. See D for explanation.
(u) B. See D for explanation.
(u) C. See D for explanation.
(c) D. A positive direct Coombs' test indicates that antibody has attached to an antigen on the
RBC which causes agglutination. Autoimmune hemolytic anemia results when the patient has
antibodies against their own RBCs. G6PD deficiency does result from an antibody antigen
reaction. Sickle cell anemia is caused by a defective hemoglobin which detected by hemoglobin
electrophoresis. Hereditary spherocytosis is detected utilizing the
osmotic fragility test.
In order to prevent the progression of diabetic nephropathy which of the following medications
should be instituted?
A. Lisinopril (Prinipril)
B. Propanolol (Inderal)
C. Verapamil (Calan)
D. Hydrochlorothiazide (Diuril) - Correct Answer (c) A. All patients should be started on an ACE
inhibitor to prevent the progression of proteinuria. ACE inhibitors appear to improve glomerular
hemodynamics by decreasing glomerular pressure.
,(u) B. Beta blockers are not indicated for the treatment of microalbuminuria.
(u) C. Calcium channel blockers are not indicated for the treatment of microalubuminuria.
(u) D. Thiazide diuretics are not indicated for the treatment of microalbuminuria.
A 5 year-old male presents with a history of recurrent episodes of acute bronchitis,
characterized by fever and productive cough. He has no known significant past medical history.
His pulmonary examination reveals crackles in the bilateral lower lobes. The remainder of his
physical examination is normal. Chest x-ray demonstrates platelike atelectasis and dilated,
thickened airways in the middle and lower lungs. Which of the following is the most likely
diagnosis?
A. Acute bronchitis
B. Bronchiectasis
C. Pneumonia
D. Tuberculosis - Correct Answer (u) A. Barring underlying pulmonary pathology, the chest x-ray
in acute bronchitis should be normal.
(c) B. Bronchiectasis typically presents as recurrent episodes of acute bronchitis. Platelike
atelectasis and dilated and thickened airways, sometimes described as tram lines, are common
radiographic findings.
(u) C. While the history may suggest pneumonia, the radiographic findings do not support this
diagnosis.
(u) D. Tuberculosis would present with cavitating granuloma formation more commonly at the
apices.
Which of the following clinical characteristics is associated with bicipital tendonitis?
A. Aggravated by resisted supination of the forearm
B. Bulging appearance to the proximal arm
C. Weakness of the arm with internal rotation and adduction
D. Pain that awakens the patient at night - Correct Answer (c) A. Supraspinatus tendonitis will
be aggravated by resisted supination of the forearm.
(u) B. Biceps rupture may present with a bulging appearance of the proximal arm.
, (u) C. Weakness of the arm with internal rotation and adduction is characteristic of pectoralis
major rupture or tear.
(u) D. Night pain is characteristic of rotator cuff tear or tendonitis.
Which of the following antiarrhythmic drugs can be associated with hyper- or hypothyroidism
following long-term use?
A. Quinidine
B. Amiodarone
C. Digoxin
D. Verapamil - Correct Answer (u) A. See B for explanation.
(c) B. Amiodarone is structurally related to thyroxine and contains iodine, which can induce a
hyper- or hypothyroid state.
(u) C. See B for explanation.
(u) D. See B for explanation.
An 18 year-old male is involved in a motor vehicle accident with a question of cervical spine
fracture. What is the imaging test of choice to initially evaluate this patient and clear his cervical
c-spine?
A. Positron emission tomography
B. Magnetic resonance imaging
C. Computed tomography
D. Lateral radiograph - Correct Answer (u) A. There is no role for positron emission tomography
in suspected cervical spine injury.
(u) B. MRI and CT of the spine may be performed in the setting of acute cervical spine injury
when a major fracture or dislocation is identified.
(u) C. See B for explanation.
(c) D. Cervical spine x-rays are most commonly used as the initial screen for cervical spine injury.
A cervical spine series consists of a lateral view, anteroposterior (AP) view, and an odontoid
view. The lateral view detects up to 80% of traumatic spine injuries.
