9 free AEMT practice questions: Differential Diagnosis Basics

Narrow the list to one cause before starting treatment: Narrowing to one cause before treatment is how classroom test questions train you to answer. Ruling out causes of abdominal pain takes imaging and lab work you do not have in the field. Waiting for that certainty leaves the time sensitive causes untreated.

Choose the most common cause and treat only that one: The most common cause usually is the right one. A differential exists so a rare, deadly cause does not get missed. Missing a deadly cause and over-treating a harmless one do not cost the same.

Report the most likely cause to the hospital as the finding: A single cause makes a radio report sound clean. Naming one cause turns your working list into a conclusion you cannot make in the field. The hospital can repeat your exam, but the hospital cannot rebuild the list you were holding or your reasons. Give the hospital your differential, not just the most likely cause.

A seizure with a postictal period: A seizure is more likely when the patient bit the side of the tongue, was incontinent, or was seen having rhythmic shaking. None of those are here. A patient coming out of a seizure is confused and sleepy and clears slowly, over 5 to 30 minutes. Clearing in 30 seconds is far too fast for a postictal period.

A stroke with resolving symptoms: a real event and a real reason to transport. A stroke causes focal findings. This patient had no weakness and no speech change at any point.

An episode of low blood glucose: Low blood glucose does cause collapse and confusion, and it stays on the list until you measure it. Low blood glucose does not correct itself within 30 seconds without treatment. The fast recovery argues against hypoglycemia.

Acute pulmonary edema, since rhonchi mean fluid has reached the alveoli: Acute pulmonary edema is the right impression, but the reason given is backwards. Rhonchi come from secretions in the large airways. Fluid in the alveoli makes crackles, and crackles are what this patient has.

An exacerbation of the lung disease, since the patient has carried it for years: A long COPD history does make an exacerbation a fair guess in a patient this short of breath. The history tells you what the patient has had for years. Tonight the patient has crackles and an onset over hours, and both point to pulmonary edema.

An exacerbation of the lung disease, since crackles are its expected sound: A COPD exacerbation can put an older patient in severe distress, the same as pulmonary edema. The sound of an exacerbation is rhonchi, not crackles. Rhonchi are coarse and low pitched, and they often clear after a cough.

Whether the patient fell from a standing position: A fall from standing does fit a faint, and the position is worth documenting. A seizure can drop a standing patient too. Falling from standing does not point to either one by itself.

Whether the skin was pale at the moment of the collapse: Pale skin at the moment of collapse is a real sign of a faint. Here the pallor would come second hand from a relative, and pallor is a soft finding. Pale skin does not settle the question the way a timed recovery does.

Whether the patient was briefly confused after the collapse: Confusion right after the collapse is abnormal, and confusion is the finding everyone notices first. Patients are confused after a faint and after a seizure. How long the confusion lasts is what separates them.

Whether the respiratory rate has passed 24 breaths in a minute: A rate of 34 is abnormal and needs attention. Anxiety and an acidosis both push the rate well past 24. A cutoff number cannot separate them.

Whether the patient can speak in full sentences between breaths: Speaking in full sentences is a quick check of how hard a patient is working to breathe. Both of these patients can usually still speak in full sentences. The ability to speak does not pick between them.

Whether an emotional trigger can be identified on scene: The argument makes anxiety look like the whole explanation. A trigger makes anxiety more likely, but a trigger does not settle the question. A patient can be upset and have an acidosis at the same time.

Treat for shock and take no further pressures before arrival: Treating the patient instead of the number is the right instinct, and treating for shock fits this patient. Taking no more pressures throws away the trend. In a patient with chest pressure, the trend tells you whether your treatment is working.

Accept it, since a measured value outranks an impression: A measured number usually does carry more weight than an impression. This number came from a poor technique, and the number disagrees with everything else about the patient. A number like that gets repeated before you accept it.

Document it and recheck at the routine fifteen minute interval: Rechecking every fifteen minutes is right for a stable patient. This patient is gray and sweating with a weak radial pulse, so the patient is not stable. A pressure that disagrees with the patient gets repeated now, not at the next routine check.

The dispatch text, since it is the first information received: The dispatch text comes first, and it does shape what you expect to find. The dispatch text comes from a caller who may not have seen the patient. Dispatch information is a first guess, not evidence.

The patient, since the patient reports feeling only a little warm: What the patient says is always worth hearing, and it belongs in your report. The patient says only a little warm. The cool, pale, sweaty skin, the weak pulse, and the blood pressure of 88/60 say this patient is much sicker than a little warm. When the story and the findings disagree, the findings usually win.

The relative, since the relative knows the patient from day to day: Family often knows the patient's normal in a way you cannot learn anywhere else, and that history is useful. History from anyone is still the least reliable source on the call. Here the relative says overheating, and your findings say shock.

Establish intravenous access so dextrose can be given without delay: Vascular access does have to happen before dextrose, and it needs to happen on this call. Access comes after the airway and ventilation. A patient who is not moving air will not live long enough for the sugar to matter.

Give oral glucose between the cheek and the gum: Oral glucose is a real treatment for low blood sugar, and it is quick to grab. This patient is unresponsive with snoring respirations. Anything you put in this patient's mouth puts the airway at risk.

Recheck the glucose on a second site to confirm the reading: Rechecking a glucose that does not match the patient is a good habit, and glucometers do misread. A reading of 38 matches an unresponsive patient with type 1 diabetes. The breathing is the emergency no matter what a second reading says.

A normal neurologic exam and the absence of both fever and head trauma make a tension headache the most likely cause, so transport priority can remain routine: Tension headache is the most common headache you will see. A normal neuro exam with no fever fits a tension headache. A tension headache usually feels like a tight band around the head. The pain builds slowly over hours, and the patient has often had headaches like it before. This headache started suddenly at full strength while the patient was resting. A tension headache does not start that way. Treating a tension headache as a possible bleed only costs you a high-priority transport. Missing a bleed can cost the patient's life.

Because the vital signs and the neurologic exam are both unremarkable at this time, subarachnoid hemorrhage can reasonably be removed from active consideration: Normal vital signs and a normal neuro exam are what you expect early in a subarachnoid hemorrhage. Those findings describe how the patient is doing right now, not what is causing the headache. Using them to drop the bleed from your list is the same mistake option A makes.

The elevated blood pressure reading confirms a hypertensive emergency as the underlying cause and should be the finding that guides transport priority: A hypertensive emergency is a very high blood pressure with signs of organ damage. Those signs include altered mental status, pulmonary edema, chest pain from ischemia or a dissection, or a new neuro deficit. A pressure of 148/92 is only mildly high, too low to count as a hypertensive emergency even with those signs. Blood pressure often goes up as a response to a problem inside the head, not as the cause of it.