Diagnostic Reasoning Exam 1 with
Complete Solutions
A 35-year-old male presents with a complaint of sore throat for 3 days. You order a
rapid strep test. This is an example of: - ANSWER-Diagnostic test
Screening assess the likelihood of the presence of a disease or condition in apparently
healthy or asymptomatic individuals who are at sufficient risk for a condition to benefit
from further investigation or preventive action. Laboratory tests used for diagnosis are
performed to determine the presence or absence of a specific disease or condition in
symptomatic individuals. Health promotion is associated with prevention of conditions is
asymptomatic individuals A test with high clinical utility yields results, whether positive
or negative, that provide information of value to the patient, clinician, or others involved
in making decisions about management of a patient with a given condition
A 36-year-old female presents to the office complaining of headache since she started a
new position at work. When completing the HPI, the clinician notes that the client's
previous position involved walking through the industrial plant, however the new job has
her sitting at a desk, looking at a computer most of the day. The client describes the
headaches as dull, non-throbbing and rates the pain 4/10. The provider would make
which likely diagnosis? - ANSWER-Tension Headache
Tension headaches are often the result of emotional or physical stress and can also
occur as a result of abnormal neck positions (especially neck tension) and prolonged
mental concentration. Tension HA is the most common cause of headache at any age
and occurs more commonly in females.
A 45 year old female patient presents with right upper quadrant abdominal pain and
nausea after eating for the last 2 weeks. She had a physical 6 months ago and labwork
was all within normal limits. Of note today, her physical exam is positive for Murphys
sign and abnormal labs are listed below: •AST=25 U/L(0-31) •ALT=45 U/L(0-31) •ALK
PHOS=355 U/L(0-125) •GGT=245 U/L(0-45) •UA=+ bilirubin You suspect: - ANSWER-
Choleycystitis
Alcoholic Liver Disease AST⁄ALT usually at least 2:1, if chronic Hep B most likely would
not have had normal labs 6 months ago and usually ALP and GGT not as elevated.
Paget's Disease would have isolated elevated ALP
A negative predictive value predicts the probablity of a client: - ANSWER-Being free of
disease after a negative test result.
Predictive values the positive predictive value (PPV) is the probability of a patient
actually being free of the disease if the test result is negative
,a patient with chronic tension headaches - ANSWER-may awaken with headaches but
rarely has a headache at night
a positive z stat flu test result and the presence of leukocytosis strongly suggests -
ANSWER-influenza
a sudden onset of painless unilateral blurred vision often associated with a relative
central scotoma and visual distortion - ANSWER-senile macular degeneration
Absolute count - ANSWER-TWBC X % of cell
Acute Cough - ANSWER-< 3 weeks
acute dyspnea in children - ANSWER-asthma, bronchiolitis, croup and epiglottis
acute facial pain - ANSWER-halos/rainbows around lights
temporary visual obscuration
conjunctival injection
steamy cornea
acute onset of dyspnea in women who are pregnant or taking oral contraceptives -
ANSWER-pulmonary embolism
acute sinus headaches - ANSWER-toothache
affective bias - ANSWER-the various ways that our emotions, feelings, and biases
affect judgement
Agranulocytosis - ANSWER-sudden onset of malaise
sudden onset of fever, possibly with chills and prostration
stomatitis and periodontitis accompanied by pain
pharyngitis with difficulty swallowing
ANC <500mm^3
always ask patient to cough so - ANSWER-you can hear the cough characteristics
An 8-year-old patient presents with their mother to the clinic. The client's chief complaint
is a "very sore throat". The vital signs for the patient are: temperature 101.6F, pulse 102
bpm, blood pressure 92/54 mmHg, respirations 12/min. Which diagnostic test should
the provider order first? - ANSWER-Rapid streptococcal testing
Rapid screening tests (rapid antigen detection testing [RADT]) for streptococcal
antigens are useful in patients with signs and symptoms of acute pharyngitis. Because
of improvements with RADT, a throat culture is not necessary unless the RADT is
negative, symptoms do not improve or the patient shows no response to appropriate
, antibiotics. Streptococcal pharyngitis is most common among those under 25 years of
age, especially 5 - 15 years.
Anchoring - ANSWER-the tendency to lock onto salient features in a patient's initial
presentation and failing to adjust this initial impression in the light of later information
angle closure glaucoma - ANSWER-episodic monocular blurring
ocular pain and redness
halos around lights
nausea and vomiting
red eye
corneal edema or haziness
RAPD present
pupil vertically oval
Asthma - ANSWER-recurrent cough (more likely in adults)
minimal/no secretions
SOB
bilateral wheezing
PFT
response to isoproterenol and methacholine
attack of cluster headache - ANSWER-ipsilateral lacrimation and rhinorrhea
atypical facial pain - ANSWER-antidepressants make it go away
doesn't follow nerve
availability bias - ANSWER-tendency to more easily recall things that we have seen
recently or things that are common or that impressed us
Bacterial conjunctivitis - ANSWER-sudden onset
unilateral initially
matting of eyelids
mucopurulent discharge
bacterial pneumonia - ANSWER-noisy cough that is worse at night
acute onset, usually in winter
fever
chills
pharyngitis
conjuntivitis
otitis
abdominal pain
headache
pleuritic chest pain
Complete Solutions
A 35-year-old male presents with a complaint of sore throat for 3 days. You order a
rapid strep test. This is an example of: - ANSWER-Diagnostic test
Screening assess the likelihood of the presence of a disease or condition in apparently
healthy or asymptomatic individuals who are at sufficient risk for a condition to benefit
from further investigation or preventive action. Laboratory tests used for diagnosis are
performed to determine the presence or absence of a specific disease or condition in
symptomatic individuals. Health promotion is associated with prevention of conditions is
asymptomatic individuals A test with high clinical utility yields results, whether positive
or negative, that provide information of value to the patient, clinician, or others involved
in making decisions about management of a patient with a given condition
A 36-year-old female presents to the office complaining of headache since she started a
new position at work. When completing the HPI, the clinician notes that the client's
previous position involved walking through the industrial plant, however the new job has
her sitting at a desk, looking at a computer most of the day. The client describes the
headaches as dull, non-throbbing and rates the pain 4/10. The provider would make
which likely diagnosis? - ANSWER-Tension Headache
Tension headaches are often the result of emotional or physical stress and can also
occur as a result of abnormal neck positions (especially neck tension) and prolonged
mental concentration. Tension HA is the most common cause of headache at any age
and occurs more commonly in females.
A 45 year old female patient presents with right upper quadrant abdominal pain and
nausea after eating for the last 2 weeks. She had a physical 6 months ago and labwork
was all within normal limits. Of note today, her physical exam is positive for Murphys
sign and abnormal labs are listed below: •AST=25 U/L(0-31) •ALT=45 U/L(0-31) •ALK
PHOS=355 U/L(0-125) •GGT=245 U/L(0-45) •UA=+ bilirubin You suspect: - ANSWER-
Choleycystitis
Alcoholic Liver Disease AST⁄ALT usually at least 2:1, if chronic Hep B most likely would
not have had normal labs 6 months ago and usually ALP and GGT not as elevated.
Paget's Disease would have isolated elevated ALP
A negative predictive value predicts the probablity of a client: - ANSWER-Being free of
disease after a negative test result.
Predictive values the positive predictive value (PPV) is the probability of a patient
actually being free of the disease if the test result is negative
,a patient with chronic tension headaches - ANSWER-may awaken with headaches but
rarely has a headache at night
a positive z stat flu test result and the presence of leukocytosis strongly suggests -
ANSWER-influenza
a sudden onset of painless unilateral blurred vision often associated with a relative
central scotoma and visual distortion - ANSWER-senile macular degeneration
Absolute count - ANSWER-TWBC X % of cell
Acute Cough - ANSWER-< 3 weeks
acute dyspnea in children - ANSWER-asthma, bronchiolitis, croup and epiglottis
acute facial pain - ANSWER-halos/rainbows around lights
temporary visual obscuration
conjunctival injection
steamy cornea
acute onset of dyspnea in women who are pregnant or taking oral contraceptives -
ANSWER-pulmonary embolism
acute sinus headaches - ANSWER-toothache
affective bias - ANSWER-the various ways that our emotions, feelings, and biases
affect judgement
Agranulocytosis - ANSWER-sudden onset of malaise
sudden onset of fever, possibly with chills and prostration
stomatitis and periodontitis accompanied by pain
pharyngitis with difficulty swallowing
ANC <500mm^3
always ask patient to cough so - ANSWER-you can hear the cough characteristics
An 8-year-old patient presents with their mother to the clinic. The client's chief complaint
is a "very sore throat". The vital signs for the patient are: temperature 101.6F, pulse 102
bpm, blood pressure 92/54 mmHg, respirations 12/min. Which diagnostic test should
the provider order first? - ANSWER-Rapid streptococcal testing
Rapid screening tests (rapid antigen detection testing [RADT]) for streptococcal
antigens are useful in patients with signs and symptoms of acute pharyngitis. Because
of improvements with RADT, a throat culture is not necessary unless the RADT is
negative, symptoms do not improve or the patient shows no response to appropriate
, antibiotics. Streptococcal pharyngitis is most common among those under 25 years of
age, especially 5 - 15 years.
Anchoring - ANSWER-the tendency to lock onto salient features in a patient's initial
presentation and failing to adjust this initial impression in the light of later information
angle closure glaucoma - ANSWER-episodic monocular blurring
ocular pain and redness
halos around lights
nausea and vomiting
red eye
corneal edema or haziness
RAPD present
pupil vertically oval
Asthma - ANSWER-recurrent cough (more likely in adults)
minimal/no secretions
SOB
bilateral wheezing
PFT
response to isoproterenol and methacholine
attack of cluster headache - ANSWER-ipsilateral lacrimation and rhinorrhea
atypical facial pain - ANSWER-antidepressants make it go away
doesn't follow nerve
availability bias - ANSWER-tendency to more easily recall things that we have seen
recently or things that are common or that impressed us
Bacterial conjunctivitis - ANSWER-sudden onset
unilateral initially
matting of eyelids
mucopurulent discharge
bacterial pneumonia - ANSWER-noisy cough that is worse at night
acute onset, usually in winter
fever
chills
pharyngitis
conjuntivitis
otitis
abdominal pain
headache
pleuritic chest pain
