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Family Med PACKRAT Exam Practice Questions and Answers

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Family Med PACKRAT Exam Practice Questions and Answers 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. ...

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Family Med PACKRAT Exam Practice

Questions and Answers

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.

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✔✔-c) B.

Inability to tan and propensity to burn are risk factors for developing malignant melanoma.

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✔✔-(c) B. Splinting in neutral position relieves impingement of the median nerve, thus

improving symptoms of carpal tunnel.

7. Which of the following is a cause of prerenal azotemia?

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A. Infection B. Renal toxins C. Poor renal perfusion D. Urinary tract obstruction - ANSWER✔✔-(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.

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.

Progesterone influence on the breast tissue prior to menstruation causes

A. proliferation of the mammary ducts. B. growth of the lobules and alveoli. C. proliferation of Cooper's

ligaments. D. increase in the number of glands of Montgomery - ANSWER✔✔-(u) A. Proliferation of the

mammary ducts is under the influence of estrogen. (c) B. Growth of the lobules and alveoli is under the

influence of progesterone. Prior to menses, the breast swelling that women notice is a result of the

progesterone which is secreted from the corpus luteum. During menses, the swelling subsides

A patient presents with chronic back pain. On physical examination testing, the patient is found to have

abnormalities of proprioception and vibration discrimination. Which of the following portions of the

spinal column are most likely affected?

A. Lateral spinothalamic tract B. Ventral spinothalamic tract C. Posterior column D. Transection of the

cord - ANSWER✔✔-(u) A. The lateral spinothalamic tract affects pain and temperature sensation.

(u) B. The ventral spinothalamic tract affects pressures and touch sensations.

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(c) C. The posterior column affects proprioception (position sense) and vibration sense.

A 65 year-old patient with steroid-dependent chronic obstructive lung disease presents with a headache

that has been increasing in severity over the past week, accompanied by nausea and vomiting. He denies

fever, but has had photophobia and a stiff neck. Which of the following is the most likely diagnosis?

A. Transient ischemic attack B. Bacterial meningitis C. Migraine headache D. Cryptococcosis -

ANSWER✔✔-(a) B. Bacterial meningitis is typically acute in onset and causes fever, but

immunocompromised patients may have a slower onset and no fever.

A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing

shortness of breath for 2 days. Her asthma has been well-controlled until 2 days ago. Since yesterday,

she has been using her albuterol inhaler every 4 to 6 hours. She is normally very active, however

yesterday she did not complete her 30 minute exercise routine due to increasing dyspnea. She denies

any cough, fever, recent surgeries, or use of oral contraceptives. On examination, you note the presence

of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the

following is the most appropriate initial diagnostic evaluation prior to initiation of treatment?

A. Chest x-ray B. Sputum gram stain C. Peak flow D. Ventilation-perfusion scan - ANSWER✔✔-(c) C. A

peak flow reading will help you to gauge her current extent of airflow obstruction and is helpful in

monitoring the effectiveness of any treatment interventions.

Which of the following medication classes is the treatment of choice in a patient with variant or

Prinzmetal's angina?

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A. Calcium channel blockers B. ACE inhibitors C. Beta blockers D. Angiotensin II receptor blockers -

ANSWER✔✔-(c) A. Calcium channel blockers are effective prophylactically to treat coronary vasospasm

associated with variant or Prinzmetal's angina.

Which of the following is an indication for vaccination against hepatitis A?

A. Illicit drug users B. Health care workers C. Renal dialysis patients D. Routine vaccination starting at

birth - ANSWER✔✔-(c) A. Hepatitis A vaccine is recommended for illicit drug users, anyone living or

traveling to endemic areas, sewage workers, food handlers, homosexual and bisexual men, animal

handlers, patients with a history of chronic liver disease or a clotting factor disease as well as children

and workers in day care settings and institutions. (u) B. Health care workers, renal dialysis patients and

routine vaccination starting at birth are some of the recommendations for vaccination against hepatitis

B, not hepatitis A

A 53 year-old female status post abdominal hysterectomy 3 days ago suddenly develops pleuritic chest

pain and dyspnea. On exam, she is tachycardic and tachypneic with rales in the left lower lobe. A chest x-

ray is unremarkable and an EKG reveals sinus tachycardia. Which of the following is the most likely

diagnosis?

A. Atelectasis B. Pneumothorax C. Pulmonary embolism D. Myocardial infarction - ANSWER✔✔-(c) C.

This patient's risk factors for pulmonary embolism include advanced age, surgery, and prolonged

bedrest. While the diagnosis of pulmonary embolism is difficult to make due to nonspecific clinical

findings, the most common symptoms include pleuritic chest pain and dyspnea associated with

tachypnea. Chest x-ray and EKG are usually normal.

A 34 year-old female with a history of asthma presents with complaints of increasing asthma attacks. The

patient states she has been well-controlled on albuterol inhaler until one month ago. Since that time she

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