NSG 550 DIAGNOSTIC REASONING
COMPREHENSIVE REVIEW (EXAMS 1-3)
QUESTIONS AND ANSWERS
1. Which of the following best describes the ‘Hypothetico-Deductive’ method of diagnostic
reasoning?
A. Collecting all possible data before forming a list of potential diagnoses.
B. Using a computer algorithm to determine the most likely diagnosis based on labs.
C. Formulating early hypotheses and then testing them with focused clinical data.
D. Matching a patient’s presentation to a previously memorized ‘illness script’ or pattern.
Answer: C
Conceptual Explanation: The hypothetico-deductive method involves the clinician
developing preliminary hypotheses early in the encounter and then performing a focused
history and physical to rule in or out those specific possibilities.
2. In the SOAP note format, where should a patient’s reported history of present illness (HPI)
be documented?
A. Objective
B. Subjective
,C. Assessment
D. Plan
Answer: B
Conceptual Explanation: The Subjective section includes everything the patient or
caregiver reports, including the HPI, past medical history, and Review of Systems.
3. A test with high sensitivity is most useful for which of the following?
A. Confirming a specific diagnosis.
B. Identifying the exact cause of a localized infection.
C. Determining the severity of a chronic disease.
D. Ruling out a diagnosis when the test is negative.
Answer: D
Conceptual Explanation: Sensitivity (SnNout) means a sensitive test, when negative, is
excellent for ruling out a condition.
4. When performing the Weber test, a patient with conductive hearing loss in the right ear
will experience:
A. Sound lateralizing to the left ear.
B. No sound perceived in either ear.
C. Equal sound in both ears.
, D. Sound lateralizing to the right ear.
Answer: D
Conceptual Explanation: In conductive hearing loss, the sound lateralizes to the affected
(bad) ear because the background noise is blocked, making the vibration more apparent.
5. Which physical exam finding is most consistent with a diagnosis of Acute Otitis Media?
A. Pain with manipulation of the tragus.
B. A bulging, erythematous tympanic membrane with decreased mobility.
C. Fluid levels behind a pearly gray, translucent membrane.
D. White plaques on the external auditory canal.
Answer: B
Conceptual Explanation: Bulging and limited mobility of the TM are the hallmark
diagnostic features of Acute Otitis Media.
6. A 24-year-old female presents with a sore throat. On exam, she has tonsillar exudates,
tender anterior cervical lymphadenopathy, and a fever of 101F, but no cough. According to
the Centor criteria, what is the next step?
A. Empirically treat with Penicillin.
B. Prescribe supportive care only as the cause is likely viral.
C. Perform a Rapid Antigen Detection Test (RADT) for Strep.
D. Order a chest X-ray to rule out pneumonia.
COMPREHENSIVE REVIEW (EXAMS 1-3)
QUESTIONS AND ANSWERS
1. Which of the following best describes the ‘Hypothetico-Deductive’ method of diagnostic
reasoning?
A. Collecting all possible data before forming a list of potential diagnoses.
B. Using a computer algorithm to determine the most likely diagnosis based on labs.
C. Formulating early hypotheses and then testing them with focused clinical data.
D. Matching a patient’s presentation to a previously memorized ‘illness script’ or pattern.
Answer: C
Conceptual Explanation: The hypothetico-deductive method involves the clinician
developing preliminary hypotheses early in the encounter and then performing a focused
history and physical to rule in or out those specific possibilities.
2. In the SOAP note format, where should a patient’s reported history of present illness (HPI)
be documented?
A. Objective
B. Subjective
,C. Assessment
D. Plan
Answer: B
Conceptual Explanation: The Subjective section includes everything the patient or
caregiver reports, including the HPI, past medical history, and Review of Systems.
3. A test with high sensitivity is most useful for which of the following?
A. Confirming a specific diagnosis.
B. Identifying the exact cause of a localized infection.
C. Determining the severity of a chronic disease.
D. Ruling out a diagnosis when the test is negative.
Answer: D
Conceptual Explanation: Sensitivity (SnNout) means a sensitive test, when negative, is
excellent for ruling out a condition.
4. When performing the Weber test, a patient with conductive hearing loss in the right ear
will experience:
A. Sound lateralizing to the left ear.
B. No sound perceived in either ear.
C. Equal sound in both ears.
, D. Sound lateralizing to the right ear.
Answer: D
Conceptual Explanation: In conductive hearing loss, the sound lateralizes to the affected
(bad) ear because the background noise is blocked, making the vibration more apparent.
5. Which physical exam finding is most consistent with a diagnosis of Acute Otitis Media?
A. Pain with manipulation of the tragus.
B. A bulging, erythematous tympanic membrane with decreased mobility.
C. Fluid levels behind a pearly gray, translucent membrane.
D. White plaques on the external auditory canal.
Answer: B
Conceptual Explanation: Bulging and limited mobility of the TM are the hallmark
diagnostic features of Acute Otitis Media.
6. A 24-year-old female presents with a sore throat. On exam, she has tonsillar exudates,
tender anterior cervical lymphadenopathy, and a fever of 101F, but no cough. According to
the Centor criteria, what is the next step?
A. Empirically treat with Penicillin.
B. Prescribe supportive care only as the cause is likely viral.
C. Perform a Rapid Antigen Detection Test (RADT) for Strep.
D. Order a chest X-ray to rule out pneumonia.
