PACKRAT practice test 2. 60 questions, give yourself 48 minutes. Dont screw this up.

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1) You can determine a pulse deficit by counting the:
A) Apical and radial pulses at the same time, then finding the difference between the two
B) Apical pulse first, then the radial pulse, and subtracting to find the difference between the two
C) Apical pulse and the femoral pulse at the same time and finding the difference between the
two
D) Radial pulse first, then counting the femoral pulse, and subtracting to find the difference
between the two
2) A hypertensive middle-aged man who is Native American has recently been diag- nosed with
mild renal insufficiency. He has been on lisinopril (Accupril) for many years. Which of the
following laboratory values should be carefully monitored?
A) Hemoglobin, hematocrit, and the MCV (mean corpuscular volume)
B) Serum creatinine and potassium levels
C) Aspartate aminotransferase and alanine aminotransferase
D) Serum sodium, potassium, and magnesium
3) What is the most common cause of left ventricular hypertrophy in the United States?
A) Chronic atrial fibrillation
B) Chronic hypertension
C) Mitral valve prolapse
D) Pulmonary hypertension
4) A 10-year-old male who was recently accepted into his schools soccer team has a history of
exercise-induced asthma. The child wants to know when he should take his albuterol inhaler.
The nurse practitioner would advise the patient:
A) Premedicate himself 20 minutes prior to starting exercise
B) Wait until he starts to exercise before using the inhaler
C) Premedicate 60 minutes before starting exercise
D) Wait until he finishes his exercise before using his inhaler
5) You suspect an enterobiasis infection in a 6-year-old girl. Which of the following tests would
you recommend?
A) Stool culture and sensitivity
B) Stool for ova and parasites
C) The scotch tape test
D) A Hemoccult test
6) A 12-year-old males peak expiratory flow results indicate 60 to 80% of the pre- dicted range.
How would you classify his asthma?

A) Mild intermittent asthma

B) Mild persistent asthma
C) Moderate persistent asthma
D) Severe asthma

7) Which of the following conditions is associated with a positive Auspitz sign?

A) Contact dermatitis
B) Seborrheic dermatitis
C) Systemic lupus erythematosus
D) Psoriasis
8) All of the following pharmacologic agents are used to treat inflammation in the lungs of
asthmatics except:
A) Nedocromil sodium (Tilade) two sprays QID
B) Cromolyn sodium inhaler (Intal) two puffs QID
C) A long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours
D) Fluticasone inhaler (Flovent) two puffs BID
9) All of the following clinical findings are considered benign oral findings except:
A) A patch of leukoplakia
B) Fordyce spots
C) Torus palatinus
D) Fishtail uvula
10) During a routine physical exam of a 90-year-old woman, a low-pitched diastolic murmur
Grade II/VI is auscultated. It is located on the fifth ICS on the left side of the midclavicular line.
Which of the following is the correct diagnosis?
A) Aortic regurgitation
B) Mitral stenosis
C) Mitral regurgitation
D) tricuspid regurgitation
11) Which of the following is considered an objective finding in patients who have a case of
suppurative otitis media?
A) Erythema of the tympanic membrane
B) Decreased mobility of the tympanic membrane as measured by tympanogram
C) Displacement of the light reflex

D) Bulging of the tympanic membrane

12) Pulsus paradoxus is more likely to be associated with:
A) Sarcoidosis
B) Acute bronchitis
C) Status asthmaticus
D) Bacterial pneumonia
13) John, a 10-year-old boy, has type 1 diabetes. His late afternoon blood sugars over the past 2
weeks have ranged between 210 mg/dL and 230 mg/ldL. He is currently on 10 units of regular
insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units of NPH
insulin in the evening. Which of the following is the best treatment plan for this patient?
A) Increase both types of the morning dose
B) Increase only the NPH insulin in the morning
C) Decrease the afternoon dose of NPH insulin
D) Decrease both NPH and regular insulin doses in the morning
14) A 55-year-old female with a history of migraine headaches has recently been diag- nosed
with Stage II hypertension. Her EKG strips reveal second-degree heart block. The chest x-ray is
normal. Which of the following drugs should this patient avoid?
A) ACE inhibitors
B) Angiotensin receptor blockers
C) Diuretics
D) Calcium channel blockers
15) A woman at 32 weeks gestation has a positive throat culture for strep pyogenes. She denies
allergies but gets very nauseated with erythromycin. Which of the following is the best choice for
this pregnant patient?
A) Clarithromycin(Biaxin)
B) Trimethoprim/sulfamethoxazole (Bactrim DS)
C) Ofloxacin(Floxin)
D) Penicillin (Pen VK)
16) The cones in the retina of the eye are responsible for:
A) Central vision
B) Peripheral vision
C) Night vision
D) Double vision
17) The posterior fontanel should be completely closed by:
A) 3months

B) 4months
C) 5months
D) 6months
18) A possible side effect from the use of nifedipine (Procardia XL) is:
A) Hyperuricemia and hypoglycemia
B) Hyperkalemia and angioedema
C) Edema of the ankles and headache
D) Dry hacking cough
19) Which of the following is the correct statement regarding the size of the arterioles and veins
on the fundi of the eye?
A) The veins are larger than the arterioles
B) The arterioles are larger than the veins
C) The arterioles are half the size of the veins
D) The veins and the arterioles are equal in size
20) A 70-year-old male with open-angle glaucoma is prescribed Betimol (timolol) oph- thalmic
drops. All of the following are contraindications to Betimol ophthalmic drops except:
A) Overt heart failure or sinus bradycardia
B) Asthmatic patients
C) Second- or third-degree AV block
D) Migraine headaches

21) Which of the following is correct regarding the best site to listen for mitral regurgitation?
A) The apical area during S2
B) It is best heard at the base at S1
C) It is best heard at the apex at S1
D) It is best heard at the base at S2

22) A 25-year-old woman complains of dysuria, severe vaginal pruritis, and a malodorous
vaginal discharge. Pelvic examination reveals a strawberry-colored cervix and frothy yellow
discharge. Microscopic exam of the discharge reveals mobile organisms that have flagella. The
correct pharmacologic therapy for the condition is:
A) Metronidazole(Flagyl)
B) Ceftriaxone sodium (Rocephin)
C) Doxycycline hyclate (Vibramycin)
D) Clotrimazole(Gyne-Lotrimin)

23) The earliest age that an MMR can be administered is at:

A) 4months
B) 6months
C) 8months
D) 12months
24) Orchitis is caused by which of the following?
A) Mumps virus
B) Measles virus
C) Chlamydia trachomatis
D) Chronic urinary tract infections that are not treated adequately
25) Which of the following is not a characteristic of delirium?
A) Sudden onset
B) Patient is coherent
C) Worse in the evenings
D) It has a brief duration
26) You are performing a pelvic exam on a 25-year-old sexually active woman. You palpate a
tender and warm cystic mass on the lower edge of the left labia majora, which is red. The most
likely diagnosis is:
A) Skenes gland cyst
B) Cystocele
C) Prostitute bacterial manginosis
D) Bartholins gland abscess
27) Which of the following effects is seen in every woman using Depo-Provera
(medroxyprogesterone injection) for more than 5 years?
A) Melasma
B) Amenorrhea
C) Weightloss
D) Headaches
28) The cremasteric reflex is elicited by:
A) Asking the patient to open his or her mouth and touching the back of the phar- ynx with a
tongue blade
B) Hitting the biceps tendon briskly with a reflex hammer and watching the lower arm for
movement
C) Hitting the patellar tendon briskly with a reflex hammer and watching the lower leg for
movement

D) Stroking the inner thigh of a male client and watching the testicle on the ipsi- lateral side rise
up toward the body
29) Which of the following tests would you order for an older diabetic male with the following
CBC results? Hb 11 g/dL, Hct 38%, and an MCV 105 fl. His reticulocyte count is normal.
A) Serum ferritin and a peripheral smear
B) Hemoglobinelectrophoresis
C) Serum folate acid and B12 level
D) Schilling test
30) Three of the following are eye findings associated with chronic uncontrolled hypertension.
Which one of the following is associated with diabetic retinopathy?
A) AV nicking
B) Copper wire arterioles
C) Flame hemorrhages
D) Microaneurysms
31) A post menopausal womans dual-energy x-ray absorption (DXA or DEXA) result shows
osteopenia. Which of the following t-scores is indicative of osteopenia?
A) T-score of 1.0 or higher
B) T-score between 1. 0 to 2.5
C) T-score of less than 2.5
D) T-score of 2.50 to 3.50
E) Normal results
32) A 45-year-old man is concerned because his father died of a ruptured abdominal aortic
aneurysm. On evaluation, he is found to have a bicuspid aortic valve. Which of the following is
the most accurate statement regarding his condition?
A. He is at risk for an aortic aneurysm of the ascending aorta.
B. B. He is at risk for an abdominal aortic aneurysm.
C. He is not at increased risk for aortic aneurysms.
D. He should have surgical correction of the aortic valve.
33) A healthy 75-year-old man undergoing an ultrasound examination for suspected gallbladder
disease is found incidentally to have a 4.5-cm abdominal aneurysm of the aorta. Which of the
following is the best management for this patient?
A. Surgical repair of the aneurysm
B. Serial ultrasound examinations every 6 months
C. Urgent MRI
D. Beta-agonist therapy

34) A 36-year-old woman with HIV is admitted with new-onset seizures. The CT scan of the
head reveals multiple ring enhancing lesions of the brain. Which of the following is the best
therapy for the likely condition?
A. Rifampin, isoniazid, ethambutol
B. B. Ganciclovir
C. Penicillin
D. Sulfadiazine with pyrimethamine
35) In a suicide attempt, an 18-year-old adolescent female takes 4 g of acetaminophen,
approximately 8 hours previously. Her acetaminophen level is 30 g/mL. Which of the following
is the best next step to be performed for this patient?
A. Immediately start N-acetylcysteine
B. Observation
C. Alkalinize the urine
D. Administer intravenous activated charcoal
For the following questions choose the one cause (A-G) that is probably responsible for the
patients presentation:
A. Wilson disease
B. Hematochromatosis
C. Primary biliary cirrhosis
D. Sclerosing cholangitis
E. Autoimmune hepatitis
F. Alcohol-induced hepatitis
G. Viral hepatitis
36) A 15-year-old adolescent female with elevated liver enzymes and a positive antinuclear
antibody (ANA)
37) A 56-year-old man with brittle diabetes, tan skin, and a family history of cirrhosis
38) A 35-year-old man with ulcerative colitis
39) A 56-year-old woman who presented with complaints of pruritus and fatigue
40) A 32-year-old man with Kayser-Fleischer rings, dysarthria, and spasticity
41) A 50 year old is diagnosed with Polycythemia Vera. Which of the following is the most
appropriate treatment for this patient?
a)Heparin
b)Phlebotomy

c)Plasmapheresis
d)Prednisone
e)Splenectomy
42) An 18yr old woman from Florida notices areas of flaky patches on her arms, neck, and
back. She is diagnosed with pityriasis versicolor. What is the most appropriate treatment
for this patient?
a)Mupirocin ointment
b)Oral acyclovir
c)Oral corticosteroids
d)Selenium sulfide lotion
e)Topical retinoid application
43) A four year old boy is brought in by mother for fever, sore throat, cough, and
conjunctivitis. PE shows generalized lymphadenopathy, pharyngeal erythema, and
Koplik spots. What is the most likely diagnosis?
a)Erythema infectiosum
b)Mumps
c)Roseola
d)Rubella
e)Rubeola
44) A patient has right sided sensorineural hearing loss. Which would you expect to find?
a)Bone conduction greater than Air conduction on R side during Rinne test
b)An abnormality on visual otoscopy
c)The sound lateralizes to the left side during the Weber
d)When the patient is placed into a noisy room, the hearing is improved
e)Otosclerosis
45) What is a common EKG finding in a patient with COPD?
a)A large S wave in Lead I and a Q wave and inverted T in Lead III
b)Left Ventricular Hypertrophy
c)Sinus bradycardia
d)Atrial fibrillation
e)Right axis deviation

46) Which of the following hypertensive medications should be used cautiously in diabetic
patients?
a)Clonidine
b)Atenolol
c)Nifedipine
d)Benazepril
e)Terazosin
47) To accentuate a mitral stenosis murmur during cardiac auscultation you should:
a)Place patient in left lateral decubitus and listen on the apical impulse
b)Ask patient to sit up and lean forward, exhale completely, and listen along left sternal
border.
c)Place patient in left lateral decubitus and listen over left sternal border.
d) Ask patient to sit up and lean forward, exhale completely, and listen on the apical
impulse.
e) Ask patient to sit up and lean forward, inhale completely, and listen along left sternal
border.
48) Which of the following is a complication of a pneumonia caused by Mycoplasma
pneumoniae?
a)Pleural effusion
b)Pneumothorax
c)Endocarditis
d)Bullous myringitis
e)Cavitation
49) Which of the following signs and symptoms is sufficient to make a diagnosis for chronic
bronchitis?
a)An increase of mucous secretions, whoch leads to chronic couch
b)Sputum production for longer than 3 months of the year for more than 2 successive
years
c)Chest enlargement of AP diameter
d)Wheezing, productive cough, and decreased PaO2 w/ increased PaCO2
e)A decreased FEV1/FVC ratio

50) Which of the following diagnostic tests is most useful in assessing a COPD patients
disease state?
a)Chest radiograph
b)Sputum culture
c)FEV1/FVC ratio
d)EKG
e)Blood gas
51) A 35yr old man complains of his heart racing. It typically lasts three hours and then
resolves spontaneously. No significant PMHx. Object findings show a pulse of 190bpm.
An EKG shows a regular narrow complex tachycardia. What is the first line drug therapy?
a)Lidocaine
b)Adenosine
C)Verapamil
d)Propranolol
e)Amiodarone
52) A patient is hospitalized with a deep vein thrombosis of the left lower extremity. Which of
the following is the most appropriate next step?
a)Warfarin therapy
b)Insertion of a vena cava filter
c)Heparin therapy
d)Simultaneous heparin and warfarin therapy
e)Contrast venography
53) A 49 year old male is admitted to the ICU with a diagnosis of an inferior myocardial
infarction. His heart is 35 bpm and a blood pressure of 90/50mmHg. His EKG shows a
Mobitz type I heart block. Which of the following is the best next step?
a)
b)
c)
d)
e)

Atropine
Transvenous pacer
Synchronized cardioversion
Amiodarone
Immediate defibrillation

54) A 32-year-old woman has a history of chronic diarrhea and gallstones and now has
rectovaginal fistula. Which of the following is the most likely diagnosis?

A. Crohn disease
B. Ulcerative colitis
C. Systemic lupus erythematosus
D. Laxative abuse
55) A 63-year-old woman with a history of cervical cancer treated withhysterectomy and
pelvic irradiation now presents with acute oliguricrenal failure. On physical examination,
she has normal jugular venous pressure, is normotensive without orthostasis, and has a
benign abdominal examination. Her urinalysis shows a specific gravity of 1.010, with no
cells or casts on microscopy. Urinary FENa is 2%, and the Na level is35 mEq/L. Which of
the following is the best next step?
A. Bolus of intravenous fluids
B. Renal ultrasound
C. Computed tomographic (CT) scan of the abdomen with intravenous
contrast
D. Administration of furosemide to increase her urine output

56) An 18-year-old marathon runner has been training during the summer. He is brought to
the emergency room disoriented after collapsing on the track. His temperature is 102F.
A Foley catheter is placed and reveals reddish urine with 3+ blood on dipstick and no
cells seen microscopically. Which of the following is the most likely explanation for his
urine?
A. Underlying renal disease
B. Prerenal azotemia
C. Myoglobinuria
D. Glomerulonephritis
57) Which of the following laboratory findings is most consistent with poststreptococcal
glomerulonephritis?
A. Elevated serum complement levels
B. Positive antinuclear antibody titers
C. Elevated ASO titers
D. Positive blood cultures
E. Positive cryoglobulin titers

58) A 22-year-old man complains of acute hemoptysis over the past week. He denies
smoking or pulmonary disease. His blood pressure is 130/70 mm Hg, and his physical
examination is normal. His urinalysis also shows microscopic hematuria and red blood
cell casts. Which of the following is the most likely etiology?
A. Metastatic renal cell carcinoma to the lungs
B. Acute tuberculosis of the kidneys and lungs
C. Systemic lupus erythematosus
D. Goodpasture disease (antiglomerular basement membrane)
59) A 32-year-old woman from Nigeria presents with a 12-week history of persistent lower
lumbar back pain, associated with a low-grade fever and night sweats. She denies any
extremity weakness or HIV (human immunodeficiency virus) risk factors. Her
examination is normal except for point tenderness over the spinous processes of L4-5.
Which of the following is the most likely diagnosis?
A. Staphylococcus aureus osteomyelitis
B. Tuberculous osteomyelitis (Potts disease)
C. Given her age, idiopathic low back pain
D. Metastatic breast cancer
E. Multiple myeloma
60) A 65-year-old man with colon cancer on chemotherapy presents with a fever and
headache of 3-day duration. An LP is performed, and Gram stain reveals gram-positive
rods. Which of the following therapies is most likely to treat the organism?
A. Vancomycin
B. Metronidazole
C. Ampicillin
D. Gentamicin
E. Ceftriaxone