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PACKRAT 14 – Questions & Proper Solutions (100% Accurate)
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PACKRAT 14 – Questions & Proper Solutions (100%Accurate)
**(C) Denotes - Right Ans **
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 (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 (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 (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) (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 (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 (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 (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 (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.
A 4 year-old boy presents with pain and irritation of his left ear. Otoscopic
examination reveals an insect in the left auditory canal. The tympanic
membrane is not completely visualized. Which of the following is the most
appropriate management of this patient?
A. Debrox insertion with suction removal
B. Irrigation with room temperature saline
C. Insertion of 2% lidocaine solution with suction or forceps removal
D. Polymyxin drop insertion via wick (u) A. Debrox is used for cerumen
impaction not foreign body removal.
(u) B. Irrigation with room temperature saline is useful for small particle
removal only if the tympanic membrane is well-visualized and without
perforation. It is not indicated in the removal of an insect.
(c) C. Two percent lidocaine solution will paralyze the insect and provide
topical anesthesia for suction or forceps removal.
(u) D. Polymyxin B is indicated in otitis externa and administered via a wick
when there is significant edema of the auditory canal. It is not indicated in the
removal of a foreign body.
A 62 year-old male is brought to the emergency department with acute
hematemesis. The patient denies a previous history of vomiting. His wife
states he has chronic liver disease. Physical examination reveals a distended
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