2026 Updated i-Human Avery Brook Case Complete Solution. Full step-by-step
guide with HPI, ROS, Physical Exam, Differentials, Diagnostic Workup, Final
Diagnosis, SOAP Note, and Management Plan. Perfect for NP and nursing
students
Section 1: History of Present Illness (HPI) & Chief Complaint (Questio–15)
1. What is the primary reason for Avery Brook’s visit today?
A) Routine well-child check
B) Slipping grades and declining school performance
C) Chronic cough
D) Abdominal pain
Correct Answer: B
Rationale: The chief complaint for this 10-year-old patient is slipping grades and
academic decline, which prompts the evaluation for underlying medical or behavioral
causes.
2. When interviewing the mother about Avery's slipping grades, what specific feedback
from the teacher is most characteristic of this case?
A) Disruptive and aggressive behavior
B) Daydreaming, falling asleep in class, and inattention
,C) Inability to read at grade level
D) Refusal to participate in physical education
Correct Answer: B
Rationale: Children with sleep-disordered breathing often present with inattention,
daydreaming, and falling asleep in class, which mimics ADHD.
3. Which question is most critical to ask regarding Avery's sleep habits to evaluate for
sleep-disordered breathing?
A) Does she sleep with a nightlight?
B) Does she snore loudly or have witnessed pauses in breathing?
C) Does she prefer a firm or soft mattress?
D) How many hours does she spend on homework?
Correct Answer: B
Rationale: Loud snoring and witnessed apneic episodes are hallmark symptoms of
Obstructive Sleep Apnea (OSA).
4. Avery's mother reports she is very difficult to wake up in the morning. This symptom
is most likely related to:
A) Depression
,B) Sleep fragmentation and poor sleep quality
C) Hypoglycemia
D) Early morning seizures
Correct Answer: B
Rationale: OSA causes frequent micro-arousals, preventing restorative deep sleep,
leading to excessive daytime sleepiness and difficulty waking.
5. Which of the following morning symptoms should be specifically assessed in a child
suspected of having OSA?
A) Morning nausea
B) Morning headaches
C) Morning joint stiffness
D) Morning diarrhea
Correct Answer: B
Rationale: Morning headaches are a classic symptom of pediatric OSA, caused by
nocturnal hypercapnia leading to cerebral vasodilation.
6. The mother mentions Avery has started wetting the bed again after being toilet
trained for years. This is known as:
, A) Primary enuresis
B) Secondary enuresis
C) Dysuria
D) Polyuria
Correct Answer: B
Rationale: Secondary enuresis (new-onset bedwetting) is associated with OSA due to
increased atrial natriuretic peptide (ANP) release caused by negative intrathoracic
pressure against an obstructed airway.
7. When assessing Avery's mood and behavior at home, which of the following is
commonly reported by parents of children with OSA?
A) Euphoria
B) Irritability and mood swings
C) Extreme shyness
D) Hyper-religiosity
Correct Answer: B
Rationale: Sleep deprivation from OSA frequently manifests as irritability, mood swings,
and behavioral issues in children.
guide with HPI, ROS, Physical Exam, Differentials, Diagnostic Workup, Final
Diagnosis, SOAP Note, and Management Plan. Perfect for NP and nursing
students
Section 1: History of Present Illness (HPI) & Chief Complaint (Questio–15)
1. What is the primary reason for Avery Brook’s visit today?
A) Routine well-child check
B) Slipping grades and declining school performance
C) Chronic cough
D) Abdominal pain
Correct Answer: B
Rationale: The chief complaint for this 10-year-old patient is slipping grades and
academic decline, which prompts the evaluation for underlying medical or behavioral
causes.
2. When interviewing the mother about Avery's slipping grades, what specific feedback
from the teacher is most characteristic of this case?
A) Disruptive and aggressive behavior
B) Daydreaming, falling asleep in class, and inattention
,C) Inability to read at grade level
D) Refusal to participate in physical education
Correct Answer: B
Rationale: Children with sleep-disordered breathing often present with inattention,
daydreaming, and falling asleep in class, which mimics ADHD.
3. Which question is most critical to ask regarding Avery's sleep habits to evaluate for
sleep-disordered breathing?
A) Does she sleep with a nightlight?
B) Does she snore loudly or have witnessed pauses in breathing?
C) Does she prefer a firm or soft mattress?
D) How many hours does she spend on homework?
Correct Answer: B
Rationale: Loud snoring and witnessed apneic episodes are hallmark symptoms of
Obstructive Sleep Apnea (OSA).
4. Avery's mother reports she is very difficult to wake up in the morning. This symptom
is most likely related to:
A) Depression
,B) Sleep fragmentation and poor sleep quality
C) Hypoglycemia
D) Early morning seizures
Correct Answer: B
Rationale: OSA causes frequent micro-arousals, preventing restorative deep sleep,
leading to excessive daytime sleepiness and difficulty waking.
5. Which of the following morning symptoms should be specifically assessed in a child
suspected of having OSA?
A) Morning nausea
B) Morning headaches
C) Morning joint stiffness
D) Morning diarrhea
Correct Answer: B
Rationale: Morning headaches are a classic symptom of pediatric OSA, caused by
nocturnal hypercapnia leading to cerebral vasodilation.
6. The mother mentions Avery has started wetting the bed again after being toilet
trained for years. This is known as:
, A) Primary enuresis
B) Secondary enuresis
C) Dysuria
D) Polyuria
Correct Answer: B
Rationale: Secondary enuresis (new-onset bedwetting) is associated with OSA due to
increased atrial natriuretic peptide (ANP) release caused by negative intrathoracic
pressure against an obstructed airway.
7. When assessing Avery's mood and behavior at home, which of the following is
commonly reported by parents of children with OSA?
A) Euphoria
B) Irritability and mood swings
C) Extreme shyness
D) Hyper-religiosity
Correct Answer: B
Rationale: Sleep deprivation from OSA frequently manifests as irritability, mood swings,
and behavioral issues in children.
