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PACKRAT Exam Elaborations – Questions & Solutions
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PACKRAT Exam Elaborations – Questions & SolutionsA 16 year old has just moved schools. He is quiet, moody and not like himself
at all. Within six months he seems to have completely changed back to his
previous personality. What is the most likely diagnosis? Right Ans -
Adjustment disorder
What is the prophylactic antibiotic most commonly given before a dental
procedure if one is necessary? Right Ans - Amoxicillin 2 grams po 1 hour
before procedure
Wilson's disease is associated with a buildup of what mineral? Right Ans -
There is a deficiency of the copper binding protein and therefore a buildup of
copper.
Name one oral medication that can be used for MRSA. Right Ans - Linezolid
(Zyvox) and Bactrim
Which cardiac medication is used to help with cardiac contractility after you
have optimized most of the other cardiac medications? Right Ans - Digoxin
What medication used in hepatitis B infection helps prevent the need for liver
transplant? Right Ans - Lamivudine
How is celiac disease most commonly diagnosed? Right Ans - Endoscopic
biopsy Mononucleosis
A 14 year old field hockey player presents with prominent adenopathy, white
purple exudates in the throat and a palpable spleen. What is the most likely
diagnosis? Right Ans - Wernicke's aphasia
A patient presents with what appears to be an inability to understand speech.
Which aphasia should be at the top of your differential? Right Ans - It is
blood in the joint indicating a fracture even if the fracture line cannot be seen.
,A fat pad sign on a lateral x-ray of the elbow has what significance? Right
Ans - It is blood in the joint indicating a fracture even if the fracture line
cannot be seen.
A corkscrew appearance on barium study should make you think of what
diagnosis? Right Ans - Esophageal spasms
What is the treatment for Turner's syndrome? Right Ans - Cyclical estrogen
and progesterone
What is the gold standard for diagnosing myocarditis? Right Ans -
Myocardial biopsy
By what age should a child be able to hold up her head? Right Ans - 3
months
On physical exam, you notice ulnar deviations and swan neck deformities.
What is the most likely diagnosis? Right Ans - Rheumatoid arthritis
What is the most accurate way to diagnose urethritis? Right Ans - Urine
PCR
You hear a loud harsh holosystolic murmur in a child. It is heard best at the
LLSB. What is the most likely diagnosis? Right Ans - Ventricular septal
defect
The accessory pathway known as the James bundle should make you think of
what syndrome? Right Ans - Lown-Ganong-Levine syndrome
A Blalock procedure is used to correct what congenital heart condition?
Right Ans - Tetralogy of Fallot
What medication can be used to control bleeding due to uterine atony?
Right Ans - Oxytocin (Pitocin)
What is the most common cause of a folate deficiency? Right Ans -
Alcoholism
,List three risk factors for placental abruption. Right Ans - HTN, smoking,
AMA, cocaine use, PROM
What ejection fraction is typical for a patient with CHF? Right Ans - 35-40%
What is the major concern with using lithium? Right Ans - It has a very
narrow therapeutic window. Blood tests are needed every four weeks.
List the four most common places lung cancer will metastasize to. Right
Ans - Bone, brain, adrenals and liver
What is the main risk factor for esophagitis? Right Ans -
Immunocompromised patient
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and
there is no visible P wave. What is the most likely diagnosis? Right Ans -
Junctional rhythm
List two diagnoses which require antibiotic prophylaxis for "dirty
procedures?" Right Ans - Prosthetic valve, valve repair with any prosthetic
material, prior endocarditis diagnosis, congential cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for
dental work? Right Ans - No, a recent change moves mitral valve prolapse
from high risk to moderate risk.
A pregnant woman and cat litter should make you think of what diagnosis?
Right Ans - Toxoplasmosis
What two valvular issues do patients with Marfan's syndrome often have?
Right Ans - Aortic regurgitation and mitral valve prolapse (you can tell them
apart by where they are heard).
What is the most common cause of sudden cardiac death? Right Ans -
Ventricular fibrillation
A positive straight leg test indicates what diagnosis? Right Ans - Herniated
disc
, What two psychiatric issues are more common in males than females?
Right Ans - Autism and ADD, the rest are all either equal or more common in
females.
How long must symptoms last before diagnosing ADD? Right Ans - 6
months
What are the two most common organisms responsible for cellulitis? Right
Ans - Strep and Staph
Does total lung capacity go up or down in COPD? What organism causes Lyme
disease? Right Ans - It goes up.
What organism is most commonly responsible for community acquired
pneumonia? Right Ans - Borrelia burgdorferi
An EEG showing focal rhythmic discharges at the onset of the seizure should
make you think of what diagnosis? Right Ans - Strep pneumoniae
What is the normal range for MCV? Right Ans - Simple partial seizure
A patient's lab work shows positive Smith antibody and positive double-
stranded DNA antibodies. What is the most likely diagnosis? Right Ans -
80-100 Lupus
You hear a continuous machine-like murmur. What is the most likely
diagnosis? Right Ans - Patent ductus arteriosus (PDA)
How do you administer the Weber hearing test? Right Ans - Tuning fork
placed in the middle of the forehead
By what age should a child be able to kick a ball? Right Ans - 24 months
A 6 year old boy seems to have all of the symptoms of ADD while at school, but
at home he has no problems. Does he have ADD? Right Ans - No, symptoms
must occur in both settings for diagnosis.
Duchenne's and Becker's muscular dystrophy have what genetic
characteristic? Right Ans - X-linked recessive
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