Diagnostic Reasoning Flashcards

A 55-year-old male presents with sudden-onset severe headache described as 'the worst headache of my life.' The FNP's PRIORITY action is:

Answer: Emergent referral to the ED for CT head and lumbar puncture if negative

A 'thunderclap' headache is a subarachnoid hemorrhage until proven otherwise and requires immediate emergency evaluation with CT head.

A female patient presents with unilateral lower abdominal pain, missed period, and vaginal spotting. The FIRST test the FNP orders is:

Answer: Urine or serum hCG (pregnancy test)

Ruling out ectopic pregnancy is the top priority; a pregnancy test is required immediately because ectopic pregnancy is life-threatening.

A 60-year-old smoker presents with a new persistent cough, hemoptysis, and unintentional weight loss. The FNP orders a chest X-ray, which shows a hilar mass. The NEXT step is:

Answer: Urgent referral to pulmonology and CT chest

A hilar mass with constitutional symptoms in a smoker has high malignancy risk and requires urgent CT chest and pulmonology referral for tissue diagnosis.

A patient with sudden painless vision loss in one eye is MOST likely experiencing which condition?

Answer: Central retinal artery occlusion

Central retinal artery occlusion causes sudden, painless, complete monocular vision loss and is an ophthalmic emergency requiring immediate intervention.

Which D-dimer result interpretation is CORRECT when using the Wells score for PE pre-test probability?

Answer: A negative D-dimer effectively rules out PE in LOW pre-test probability patients

D-dimer has high sensitivity but low specificity; a negative result rules out PE in low-probability patients, avoiding unnecessary CT-PA.

A 35-year-old presents with fatigue, pallor, and a mean corpuscular volume (MCV) of 70 fL. The MOST likely diagnosis is:

Answer: Iron deficiency anemia

Microcytic anemia (MCV <80 fL) with fatigue and pallor in a young adult is most commonly caused by iron deficiency.