NUR 431- DIAGNOSTIC REASONING
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Coherence - Answer-do physiology, predisposing factors & complications make sense?
Adequacy - Answer-Does your diagnosis explain all of the symptoms?
Parsimony - Answer-Is this the simplest explanation for the symptoms?
What part of your documentation do you put in your own words? - Answer-HPI and CC
Review of Systems (ROS) - Answer-reveals subjective symptoms that patient hasn't yet
mentioned
Head to toe:
Skin
HEENT
Respiratory
Cardiovascular
GI
GU
Neuromuscular
Mental Health
Assessment - Answer-tentative diagnosis made by viewing that list in light of HP
findings
Plan - Answer-recommendation for refining the diagnosis, treating the problem:
medications, testing education, referrals
How do you document symptom analysis? - Answer-As a narrative
Tentative diagnosis - Answer-Coherence
Adequacy
Parsimony
Can competing diagnoses be eliminated?
Separating Zebras from Horses - Answer-1) Common diseases occur commonly; rare
diseases, rarely
2) The mind is an imperfect likelihood estimator
3) The unusual presentation of a common disease is more likely than the usual
presentation of an uncommon disease
4) Not everything we are taught is correct
, "worst HA of my life" - Answer-subarachnoid hemorrhage
Tension headache - Answer-viselike, occipital, frontal or band-like pain
Associated with stress/ anxiety
Migraines - Answer-throbbing supra/ retro orbital/ fronto-temporal
Associated with aura, vision changes, and N/V
Last 1-3 days; relieved with lying down
Precipitated by ETOH, chocolate, cheese, letdown after stress, menses
Tend to run in families
POUND Criteria - Answer-P: pulsating
O: one day duration
U: unilateral
N: Nausea/ Vomiting
D: disabling
Cluster - Answer-excruciating, unilateral pain around eye, temple, forehead and cheek
Associated with tearing, rhinorrhea, ptosis and nasal congestion
Last 1/2 to 2 hours and have 1-2 per day
Complete remissions for months/ years
Precipitated by ETOH and daytime napping
Sinusitis - Answer-associated with sinus tenderness: Baker's HA
Baker's HA - Answer-headache worsens when a patient bends head between knees
Temporal arteritis - Answer-TTT over artery: prominent area on temple
Meningitis/ Encephalitis - Answer-Associated with nuchal rigidity and fever
Conjunctivitis - Answer-allergic, bacterial or viral
Blurring intermittent & clears with blinking
Discharge & crusting of lashes
Pain is mild, scratchy
Conjunctival injection is diffuse
Iritis - Answer-Emergency! Immediate referral
Vision slightly blurred; photophobia
No discharge
Moderate to severe aching, photophobia
**Pupil constricted** with minimal response
Central redness
Corneal abrasion - Answer-Hx and/ or sensation of f/b in eye
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Coherence - Answer-do physiology, predisposing factors & complications make sense?
Adequacy - Answer-Does your diagnosis explain all of the symptoms?
Parsimony - Answer-Is this the simplest explanation for the symptoms?
What part of your documentation do you put in your own words? - Answer-HPI and CC
Review of Systems (ROS) - Answer-reveals subjective symptoms that patient hasn't yet
mentioned
Head to toe:
Skin
HEENT
Respiratory
Cardiovascular
GI
GU
Neuromuscular
Mental Health
Assessment - Answer-tentative diagnosis made by viewing that list in light of HP
findings
Plan - Answer-recommendation for refining the diagnosis, treating the problem:
medications, testing education, referrals
How do you document symptom analysis? - Answer-As a narrative
Tentative diagnosis - Answer-Coherence
Adequacy
Parsimony
Can competing diagnoses be eliminated?
Separating Zebras from Horses - Answer-1) Common diseases occur commonly; rare
diseases, rarely
2) The mind is an imperfect likelihood estimator
3) The unusual presentation of a common disease is more likely than the usual
presentation of an uncommon disease
4) Not everything we are taught is correct
, "worst HA of my life" - Answer-subarachnoid hemorrhage
Tension headache - Answer-viselike, occipital, frontal or band-like pain
Associated with stress/ anxiety
Migraines - Answer-throbbing supra/ retro orbital/ fronto-temporal
Associated with aura, vision changes, and N/V
Last 1-3 days; relieved with lying down
Precipitated by ETOH, chocolate, cheese, letdown after stress, menses
Tend to run in families
POUND Criteria - Answer-P: pulsating
O: one day duration
U: unilateral
N: Nausea/ Vomiting
D: disabling
Cluster - Answer-excruciating, unilateral pain around eye, temple, forehead and cheek
Associated with tearing, rhinorrhea, ptosis and nasal congestion
Last 1/2 to 2 hours and have 1-2 per day
Complete remissions for months/ years
Precipitated by ETOH and daytime napping
Sinusitis - Answer-associated with sinus tenderness: Baker's HA
Baker's HA - Answer-headache worsens when a patient bends head between knees
Temporal arteritis - Answer-TTT over artery: prominent area on temple
Meningitis/ Encephalitis - Answer-Associated with nuchal rigidity and fever
Conjunctivitis - Answer-allergic, bacterial or viral
Blurring intermittent & clears with blinking
Discharge & crusting of lashes
Pain is mild, scratchy
Conjunctival injection is diffuse
Iritis - Answer-Emergency! Immediate referral
Vision slightly blurred; photophobia
No discharge
Moderate to severe aching, photophobia
**Pupil constricted** with minimal response
Central redness
Corneal abrasion - Answer-Hx and/ or sensation of f/b in eye
