UPDATED 2026 i-Human Avery Brook Case Solution
Complete Step-by-Step Guide: HPI, ROS, Physical Exam, Differentials, SOAP Note &
Evidence-Based Management Plan
Section 1: Presenting Complaint & HPI (Questions 1–20)
1. Avery Brook, a 10-year-old female, presents with “slipping grades.” What is the most
important open-ended question to begin the HPI?
A) “Are you having trouble paying attention in class?”
B) “Tell me more about what has been happening with school and how you’ve been
feeling.”
C) “Have your parents noticed any changes in your sleep?”
D) “Do you feel sad or anxious?”
Correct Answer: B – Rationale: An open-ended question invites the patient and parent
to share the narrative without biasing the response.
2. Which associated symptom, if present, would most strongly suggest an organic
cause for declining academic performance?
A) Occasional daydreaming in class
B) New-onset frequent headaches with vomiting in the morning
C) Parental divorce 6 months ago
D) Increased use of social media
,Correct Answer: B – Rationale: Morning headaches with vomiting raise concern for
increased intracranial pressure (e.g., brain tumor).
3. The parent reports Avery was “always an A student” but now getting Cs and Ds over
the past 4 months. Which timeline question is most relevant?
A) “Was there any illness or injury before grades dropped?”
B) “What color is her urine?”
C) “Does she have seasonal allergies?”
D) “How many cavities does she have?”
Correct Answer: A – Rationale: Acute change after illness could suggest post-infectious
process (e.g., PANS, encephalitis).
4. Which sleep-related symptom is most concerning in this age group with cognitive
decline?
A) Snoring 2 nights/week
B) Difficulty falling asleep once a week
C) Loud snoring with witnessed apneas and daytime sleepiness
D) Nightmares once a month
Correct Answer: C – Rationale: Obstructive sleep apnea can cause neurocognitive
deficits mimicking ADHD.
,5. Avery’s teacher reports she “stares into space for 10–15 seconds” several times a
day. What is the most appropriate next HPI question?
A) “Does she have a family history of seizures?”
B) “Does she wet the bed?”
C) “Does she like math?”
D) “Has she had COVID-19?”
Correct Answer: A – Rationale: Absence seizures are common in childhood; family
history of epilepsy increases suspicion.
6. Which medication history is most critical to obtain in a child with new-onset cognitive
decline?
A) Antibiotics in the last year
B) Over-the-counter antihistamines or anticholinergics
C) Vitamins
D) Topical hydrocortisone cream
Correct Answer: B – Rationale: Anticholinergics (e.g., diphenhydramine) can impair
cognition in children.
7. Avery reports occasional double vision at the end of the school day. This suggests:
A) Need for glasses
B) Myasthenia gravis
, C) Migraine with aura
D) Dehydration
Correct Answer: B – Rationale: Fatigable ptosis or diplopia suggests myasthenia gravis.
8. Which dietary pattern is most relevant to investigate?
A) Preference for sweets
B) Pica (eating non-food items)
C) Vegetarian diet without B12 supplementation
D) All of the above
Correct Answer: D – Rationale: Pica (lead poisoning), B12 deficiency, and high sugar
(reactive hypoglycemia) can all impair cognition.
9. Parent reports Avery has become clumsy, tripping often. This suggests:
A) Normal growth spurt
B) Cerebellar or proprioceptive dysfunction
C) Lack of sleep
D) Poor eyesight
Correct Answer: B – Rationale: New-onset clumsiness with cognitive decline raises
concern for neurologic disorder (e.g., brain tumor, metabolic disease).
10. Which birth and early developmental history question is most relevant?
A) Birth weight
Complete Step-by-Step Guide: HPI, ROS, Physical Exam, Differentials, SOAP Note &
Evidence-Based Management Plan
Section 1: Presenting Complaint & HPI (Questions 1–20)
1. Avery Brook, a 10-year-old female, presents with “slipping grades.” What is the most
important open-ended question to begin the HPI?
A) “Are you having trouble paying attention in class?”
B) “Tell me more about what has been happening with school and how you’ve been
feeling.”
C) “Have your parents noticed any changes in your sleep?”
D) “Do you feel sad or anxious?”
Correct Answer: B – Rationale: An open-ended question invites the patient and parent
to share the narrative without biasing the response.
2. Which associated symptom, if present, would most strongly suggest an organic
cause for declining academic performance?
A) Occasional daydreaming in class
B) New-onset frequent headaches with vomiting in the morning
C) Parental divorce 6 months ago
D) Increased use of social media
,Correct Answer: B – Rationale: Morning headaches with vomiting raise concern for
increased intracranial pressure (e.g., brain tumor).
3. The parent reports Avery was “always an A student” but now getting Cs and Ds over
the past 4 months. Which timeline question is most relevant?
A) “Was there any illness or injury before grades dropped?”
B) “What color is her urine?”
C) “Does she have seasonal allergies?”
D) “How many cavities does she have?”
Correct Answer: A – Rationale: Acute change after illness could suggest post-infectious
process (e.g., PANS, encephalitis).
4. Which sleep-related symptom is most concerning in this age group with cognitive
decline?
A) Snoring 2 nights/week
B) Difficulty falling asleep once a week
C) Loud snoring with witnessed apneas and daytime sleepiness
D) Nightmares once a month
Correct Answer: C – Rationale: Obstructive sleep apnea can cause neurocognitive
deficits mimicking ADHD.
,5. Avery’s teacher reports she “stares into space for 10–15 seconds” several times a
day. What is the most appropriate next HPI question?
A) “Does she have a family history of seizures?”
B) “Does she wet the bed?”
C) “Does she like math?”
D) “Has she had COVID-19?”
Correct Answer: A – Rationale: Absence seizures are common in childhood; family
history of epilepsy increases suspicion.
6. Which medication history is most critical to obtain in a child with new-onset cognitive
decline?
A) Antibiotics in the last year
B) Over-the-counter antihistamines or anticholinergics
C) Vitamins
D) Topical hydrocortisone cream
Correct Answer: B – Rationale: Anticholinergics (e.g., diphenhydramine) can impair
cognition in children.
7. Avery reports occasional double vision at the end of the school day. This suggests:
A) Need for glasses
B) Myasthenia gravis
, C) Migraine with aura
D) Dehydration
Correct Answer: B – Rationale: Fatigable ptosis or diplopia suggests myasthenia gravis.
8. Which dietary pattern is most relevant to investigate?
A) Preference for sweets
B) Pica (eating non-food items)
C) Vegetarian diet without B12 supplementation
D) All of the above
Correct Answer: D – Rationale: Pica (lead poisoning), B12 deficiency, and high sugar
(reactive hypoglycemia) can all impair cognition.
9. Parent reports Avery has become clumsy, tripping often. This suggests:
A) Normal growth spurt
B) Cerebellar or proprioceptive dysfunction
C) Lack of sleep
D) Poor eyesight
Correct Answer: B – Rationale: New-onset clumsiness with cognitive decline raises
concern for neurologic disorder (e.g., brain tumor, metabolic disease).
10. Which birth and early developmental history question is most relevant?
A) Birth weight
