Packrat Questions I got wrong the first time

Question 1

Which of the following signs or symptoms differentiates acute sinusitis from viral rhinitis?

fever
rhinorrhea
facial pain
swollen nasal mucous membranes

Answer 1

(c) C. Frontal headache, swollen nasal mucous membranes, rhinorrhea and fever may all be signs of viral rhinitis, along with sneezing and a scratchy throat. Sinusitis usually follows a viral rhinitis, but in addition to the above symptoms, it will include pain and tenderness over the involved sinus.

Question 2

The physician assistant would suspect food poisoning from Staphylococcus aureus in a patient who presents with

1. ingestion of mayonnaise-based salads 48 hours earlier.
2. bloody diarrhea with mucus for one week.
3. abdominal cramps and vomiting.
4. high fever.

Answer 2

(u) A. Staphylococcal food poisoning has a short incubation period of 1-8 hours.
(u) B. See C for explanation.
(c) C. Abdominal cramps, nausea, vomiting, and watery diarrhea typically last 1-2 days with Staphylococcal food poisoning.
(u) D. Staphylococcal food poisoning may be associated with low-grade fever or subnormal temperature.

Question 3

The most common location of bleeding seen in patients with von Willebrand’s disease is the

1. mucosal surfaces.
2. spleen.
3. joint spaces.
4. muscle groups.

Answer 3

(c) A. Von Willenbrand’s disease most commonly presents with mucosal bleeding such as epistaxis, gingival bleeding, and menorrhagia.
(a) B. Splenic bleeding is typically associated with trauma.
(u) C. Hemophilia is associated with bleeding into joint spaces, especially knees, ankles, and elbows, and into muscle groups.

(u) D. See C for explanation. REF: (9)

Question 4

Which of the following is the most common early presenting sign in patients with Alzheimer’s disease?

1. change in personality
2. loss of memory
3. multiple physical complaints
4. depressed mood

Answer 4

u) A. A change in personality is a late finding of Alzheimer’s disease.
(c) B. The presence of memory impairment is the most common sign of Alzheimer’s disease. Changes occur first with short-term memory.
(u) C. The history of multiple physical complaints is seen most commonly in somatization disorders. (u) D. A depressed mood is the most common presenting feature in depression or dysthymic disorders.

Question 5

The most frequent finding in a person presenting with a brain abscess is

1. nuchal rigidity.
2. headache.
3. seizures.
4. vomiting.

Answer 5

(u) A. Nuchal rigidity occurs in approximately 35% of patients with a brain abscess. (c) B. Headache occurs in over 70% of patients with a brain abscess.
(u) C. Seizures occur in approximately 35% of patients with a brain abscess.
(u) D. Vomiting occurs in approximately 35% of patients with a brain abscess.

Question 6

Which of the following physical examination findings is consistent with a herniated disk at L5-S1?

1. hypesthesia of the medial thigh upgoing
2. Babinski reflex absent
3. Achilles’ reflex
4. decreased sensation in the groin region

Answer 6

(u) A. Hypesthesia of the medial thigh is consistent with a herniated disk at L3-L4.
(u) B. Upgoing Babinski reflex would indicate upper motor neuron disease.
(c) C. Depression of the Achilles’ reflex is common with L5-S1disk disease, and may also be present in a significant number of L4-L5 disk diseases.
(u) D. Decreased sensation in the groin region is consistent with a herniated disk at L2-L3.

Question 7

Which of the following is the diagnostic test of choice for the evaluation of a patient suspected of secondary hypertension due to primary aldosteronism (Conn’s syndrome)?

1. chest x-ray
2. renal scan
3. serum electrolytes
4. urinalysis for metanephrines

Answer 7

(u) A. Chest x-ray may be used to evaluate a patient suspected of having coarctation of the aorta as a cause of secondary hypertension.
(u) B. A renal scan is indicated in the evaluation of a patient suspected of having secondary hypertension due to renal artery stenosis or fibromuscular dysplasia of the renal arteries.

(c) C. Patients having primary aldosteronism as a cause of their secondary hypertension are identified for this condition by finding unprovoked hypokalemia on the electrolyte testing.
(u) D. Patients having secondary hypertension due to pheochromocytoma will have an increase in their urinary metanephrines on testing due to increased catecholamine production by this tumor.

Question 8

Which of the following electrocardiographic findings is the hallmark of pericarditis?

1. ST elevation
2. prolonged Q-T interval
3. atrial fibrillation
4. tall peaked T waves

Answer 8

(c) A. The hallmark of pericarditis is ST segment elevation throughout the precordium along with PR segment depression.
(u) B. Prolonged Q-T interval is typically the result of hypocalcemia or due to the use of medications. (u) C. Pericarditis is not related to the production of atrial fibrillation.

(u) D. Tall peaked T waves are classically associated with hyperkalemia.

Question 9

The serum creatine phosphokinase-mB (CPK-MB) rises to a peak after an acute myocardial infarction after how many hours?

1. 4-6
2. 8 - 12
3. 18 - 20
4. 48 - 72

Answer 9

u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. CPK-MB is found mainly in cardiac muscle. It begins to rise in 4 to 6 hours, peaks at 18 hours, and returns to normal in 48 hours.
(u) D. See C for explanation.

Question 10

A 24-year-old male presents with a generalized erythematous maculopapular rash, including the palms and soles of the feet. He also shows generalized lymphadenopathy and flat, moist lesions in the genital area. The patient admits to having had a lesion on his penis a month or so before, but it did not bother him. Which of the following is the most appropriate to confirm the diagnosis?

1. C-reactive protein
2. Lyme titer
3. FTA-ABS
4. Weil-Felix test

Answer 10

(u) A. C-reactive protein is nonspecific for inflammatory processes.
(u) B. Lyme titer is elevated in Lyme’s disease.
(c) C. The fluorescent treponemal antibody absorption test is positive in secondary syphilis. (u) D. The Weil-Felix test is positive in cases of rickettsial diseases.

Question 11

An 18-year-old patient presents with fever, pharyngitis, and cervical lymphadenopathy. The CBC shows a leukocytosis with 25% atypical lymphocytes. Which of the following is the diagnostic test of choice for this patient?

1. heterophile test
2. throat culture
3. blood culture
4. lymph node biopsy

Answer 11

(c) A. A heterophile test is the test of choice for the diagnosis of infectious mononucleosis.
(u) B. Throat culture is used in the diagnosis of strep pharyngitis. Strep pharyngitis does not present with atypical lymphocytes.
(u) C. Blood cultures are of no value in the diagnosis of infectious mononucleosis.
(u) D. A lymph node biopsy is used in the diagnosis of lymphoma. Lymphoma typically does not present with pharyngitis or atypical lymphocytes.

Question 12

Which of the following would aid in the diagnosis of Reye’s syndrome?

1. hyperglycemia
2. elevated serum ammonia level
3. proteinuria
4. elevated cholesterol

Answer 12

(u) A. Hypoglycemia is more likely to be seen in Reye’s syndrome.
(c) B. Reye’s syndrome results in fatty liver with encephalopathy. It is a complication of influenza and other viral illnesses, particularly in the young and with the use of aspirin. Laboratory characteristics include elevated ammonia levels, elevation of liver enzymes, hypoglycemia, and a prolonged prothrombin time.
(u) C. Reye’s syndrome does not affect the kidneys and should not result in proteinuria.
(u) D. Cholesterol should not be affected by Reye’s syndrome.

Question 13

Which of the following abnormalities is most commonly noted in bulimia nervosa?

1. metabolic acidosis
2. hypokalemia
3. hyperalbuminemia
4. amenorrhea

Answer 13

(u) A. A metabolic alkalosis may be noted if potassium losses from purging are great enough.
(c) B. Episodes of binge eating are followed by purging in the bulimic patient. Vomiting and laxative abuse are the most common methods of purging, leading to hypokalemia.
(u) C. Serum albumin levels may be normal or decreased.
(u) D. Unlike anorexia nervosa, a patient who is bulimic may maintain a normal body weight and normal menstruation.

Question 14

Which of the following is the most common radiographic presentation of pulmonary tuberculosis?

1. cavitation
2. pleural thickening
3. hilar mass
4. hyperinflation

Answer 14

(c) A. Cavitation is seen with progressive primary tuberculosis or lung abscess.
(u) B. Pleural thickening is noted in mesothelioma.
(u) C. Hilar and mediastinal abnormalities are common on chest radiography in patients with lung cancer. (u) D. Hyperinflation is the main clinical feature in emphysema.

Question 15

A 68-year-old patient with chronic obstructive pulmonary disease will typically demonstrate a decreased

1. serum bicarbonate content.
2. blood hemoglobin.
3. blood pCO2.
4. blood pH.

Answer 15

(u) A. The serum bicarbonate content is sometimes normal, but is usually increased in respiratory acidosis.
(u) B. An elevated, not decreased, hemoglobin can be seen in heavy smokers, which is the primary cause of emphysema.

(u) C. COPD causes CO2 retention, which would result in an increased, not decreased, pCO2.
(c) D. COPD causes a state of respiratory acidosis, which would account for the decreased blood pH.

Question 16

A urinalysis performed during a routine physical examination on a 43-year-old male reveals 1-2 hyaline casts/HPF. The remainder of the UA is normal. Based upon these results, the physician assistant should

1. collect a urine for culture and sensitivity.
2. do nothing, since these casts are considered normal
3. refer the patient to a nephrologist.
4. schedule the patient for a CT scan.

Answer 16

(u) A. See B for explanation.
(c) B. Hyaline casts are not indicative of renal disease. They can be found following strenuous exercise and with concentrated urine or during a febrile illness.
(u) C. See B for explanation.
(u) D. See B for explanation.

Question 17

3. Clinical Therapeutics/ENT/Ophthalmology
   A 26 year-old man complains of itching, redness, tearing of both eyes, sneezing, and a clear nasal discharge for over a week. Both eyes are injected and a watery discharge is noted. There is no foreign body with lid eversion and there is no uptake of fluorescein. Which of the following is the most appropriate topical treatment at this time?

A. Bacitracin (AK-Tracin)
B. Prednisolone (Pred Forte)

C. Naphazoline (Naphcon).

D. Flurbiprofen (Ocufen)

Answer 17

(u) A. Antibiotics, steroids, and nonsteroidal anti-inflammatory medications are not indicated for allergic conjunctivitis.
(u) B. See A for explanation.
(c) C. Allergic conjunctivitis responds to cool compresses, topical vasoconstrictors, topical antihistamines, and topical cromolyn sodium.
(u) D. See A for explanation.