Clinical reasoning questions.

78 clinical reasoning questions from the bank, ready to practice out loud.

Learn the ideas first · free with an account

Hypothesis-driven history and the differential Red flags and the first five minutes: can't-miss diagnoses and ABCDE STAR and CARL: structuring your story Risk stratification: scores, pretest probability, and disposition

All 78 questions

Assessing acute chest painA 52-year-old presents to the ED with sudden onset chest pain. Walk me through your initial assessment and what you'd want to know first.History taking priorityMid–senior

Differential for fatigue and rashA 28-year-old presents with three months of fatigue, intermittent joint pain, and a rash on sun-exposed areas. Walk me through your differential.Differential diagnosisMid–senior

Workup for progressive dyspneaA 65-year-old returns to clinic with worsening shortness of breath on exertion over six weeks. What tests do you order and why?Decision Relevant testsMid–senior

Risk-stratifying rectal bleedingA 45-year-old smoker presents with a single episode of bright red rectal bleeding. Walk me through how you'd risk-stratify them.Risk stratificationMid–senior

Acute confusion in hospitalized patientYou're a hospitalist. Overnight, a patient on your service has new-onset confusion. Walk me through your response.When to escalateMid–senior

Worsening chronic headachesA 35-year-old presents with chronic headaches that have worsened in pattern over a month. Walk me through your history-taking.History taking priorityMid–senior

New-onset atrial fibrillationA 70-year-old presents with new-onset atrial fibrillation. Walk me through what could be driving it.Differential diagnosisMid–senior

Positive pregnancy test with painA 30-year-old returns with a positive home pregnancy test and abdominal pain. Walk me through your workup.Decision Relevant testsMid–senior

Diabetic foot ulcer risk stratificationA 60-year-old with diabetes presents with a foot ulcer that's red and warm. Walk me through risk stratification.Risk stratificationMid–senior

Transient unilateral vision lossA patient you're seeing in primary care reports an episode of transient unilateral vision loss yesterday. Walk me through your next move.When to escalateMid–senior

Intermittent palpitationsA 25-year-old presents with palpitations that come and go over the past several months. Walk me through your initial history.History taking priorityMid–senior

Bilateral lower-extremity edemaA 50-year-old presents with new bilateral lower-extremity edema over two weeks. Walk me through your differential.Differential diagnosisMid–senior

New left bundle branch blockA patient's outpatient ECG shows a new left bundle branch block. Walk me through your decision-relevant workup.Decision Relevant testsMid–senior

Elderly fall with hip painA 78-year-old falls at home and presents with hip pain. Walk me through how you'd stratify risk before imaging.Risk stratificationMid–senior

Back pain with progressive weaknessA clinic patient reports new severe back pain with progressive lower-extremity weakness over 48 hours. Walk me through your response.When to escalateMid–senior

Young adult abdominal painA 19-year-old presents with abdominal pain and vomiting. Walk me through your initial history.History taking priorityEntry–mid

Night sweats and weight lossA 40-year-old presents with night sweats and unintentional weight loss over three months. Walk me through your differential.Differential diagnosisMid–senior

Persistent symptoms after positive monospotA 22-year-old returns with a positive monospot but persistent symptoms at five weeks. Walk me through what else you'd consider.Decision Relevant testsMid–senior

Cardiovascular risk in hypertensive patientA 55-year-old with hypertension and family history of stroke presents for an annual visit. Walk me through cardiovascular risk stratification.Risk stratificationMid–senior

Heart failure decompensationA patient with chronic heart failure reports new weight gain of 6 pounds in a week and worsening dyspnea. Walk me through your response.When to escalateMid–senior

Hematuria in elderly patientA 70-year-old presents with hematuria. Walk me through what you'd ask first.History taking priorityMid–senior

Insomnia, weight loss, tachycardiaA 35-year-old returns with three months of insomnia, weight loss, and tachycardia. Walk me through your differential.Differential diagnosisMid–senior

Back pain in cancer survivorA patient with a remote history of breast cancer returns with persistent back pain. Walk me through what changes about your workup.Decision Relevant testsMid–senior

Calf swelling after long flightA 40-year-old presents with calf swelling and tenderness three weeks after a long flight. Walk me through risk stratification.Risk stratificationMid–senior

Sudden severe headache on warfarinA patient on warfarin reports a sudden severe headache. Walk me through your response.When to escalateMid–senior

Persistent cough lasting 8 weeksA 45-year-old presents with persistent cough lasting 8 weeks. Walk me through your history-taking.History taking priorityMid–senior

Confusion and reduced intakeAn elderly patient on multiple medications presents with confusion and reduced oral intake over a week. Walk me through what you'd consider.Differential diagnosisMid–senior

Fever in patient on methotrexateA patient with rheumatoid arthritis on methotrexate presents with new fever. Walk me through your workup considerations.Decision Relevant testsMid–senior

Atypical chest pain, high riskA 60-year-old presents with chest pain that's atypical but with multiple cardiac risk factors. Walk me through risk stratification.Risk stratificationMid–senior

High fever with non-blanching rashA pediatric patient presents with high fever and a non-blanching rash. Walk me through your immediate response.When to escalateMid–senior

Right upper quadrant after mealA 32-year-old presents with acute onset right upper quadrant pain that started after a fatty meal. Walk me through your initial history.History taking priorityEntry–mid

Dysuria and urinary frequency differentialA 26-year-old presents with three days of dysuria and urinary frequency. Walk me through your differential.Differential diagnosisEntry–mid

New-onset tremor initial workupA 58-year-old with no prior medical history presents with new-onset tremor. What initial tests would you order and why?Decision Relevant testsEntry–mid

First-time seizure risk stratificationA 42-year-old presents with first-time seizure witnessed by family. Walk me through how you'd risk-stratify this patient.Risk stratificationEntry–mid

Asthma exacerbation with severe dyspneaYou're working urgent care. A patient with known asthma presents with worsening shortness of breath and speaks only in short phrases. Walk me through your response.When to escalateEntry–mid

Acute severe diarrhea post-picnicA 48-year-old presents with acute onset severe diarrhea after attending a picnic yesterday. Walk me through your initial history.History taking priorityEntry–mid

Progressive dysphagia with weight lossA 68-year-old presents with progressive dysphagia to solids over six weeks with weight loss. Walk me through your differential.Differential diagnosisEntry–mid

Acute knee swelling without traumaA 34-year-old presents with acute knee swelling after no trauma. What diagnostic tests would help you most and why?Decision Relevant testsEntry–mid

Head injury on anticoagulationA 72-year-old on anticoagulation for atrial fibrillation falls and hits their head but has no loss of consciousness. Walk me through risk stratification.Risk stratificationEntry–mid

Sudden facial droop, slurred speechA patient in your clinic develops sudden-onset facial droop and slurred speech during the visit. Walk me through your immediate response.When to escalateEntry–mid

Sudden eye pain and blurA 29-year-old presents with sudden-onset severe unilateral eye pain and blurred vision. Walk me through your initial assessment.History taking priorityEntry–mid

Evaluating AI-generated rare diagnosesA patient hands you an AI chatbot printout listing three rare diagnoses that contradict your working diagnosis of GERD. Walk me through how you'd reason through the list clinically.Differential diagnosisMid–senior

Unilateral calf swelling on telehealthDuring a telehealth visit, a 58-year-old reports two days of new unilateral calf swelling and tenderness. Walk me through what you can and can't assess remotely, and your next move.When to escalateMid–senior

Incidental pulmonary noduleA CT done for abdominal pain incidentally shows an 8 mm solid pulmonary nodule in a 55-year-old former smoker. Walk me through how you'd decide what happens next.Decision Relevant testsMid–senior

Syncope with rapid recoveryA 70-year-old faints while standing at a long ceremony, recovers within a minute, and feels fine in your office. Walk me through how you'd decide between reassurance, workup, and admission.Risk stratificationMid–senior

Vomiting on GLP-1 agonistA patient who started a GLP-1 receptor agonist for weight loss three months ago presents with persistent vomiting and epigastric pain. Walk me through your differential.Differential diagnosisMid–senior

Sepsis alert, well appearanceAn AI early-warning system flags your ward patient as high risk for sepsis, but they look well at the bedside. Walk me through how you'd reconcile the alert with your exam.When to escalateSenior–leadership

Smartwatch irregular rhythm notificationAn asymptomatic 52-year-old brings in a smartwatch notification suggesting an irregular heart rhythm. Walk me through what testing, if any, you'd order before acting on it.Decision Relevant testsMid–senior

Low back pain, normal examA 30-year-old presents with two weeks of low back pain after moving apartments, with a normal neuro exam and no red flags. Walk me through what tests you'd order and why.Decision Relevant testsEntry–mid

Recurrent falls in elderly patientAn 82-year-old on twelve medications presents after their third fall this year. Walk me through your history, starting with what you'd prioritize.History taking priorityMid–senior

Single elevated blood pressure readingA 48-year-old's blood pressure is 150/95 at a single office visit and they feel well. Walk me through how you'd decide whether and when to start treatment.Risk stratificationEntry–mid

Triaging extensive testing requestsA 26-year-old with vague fatigue requests 'a full-body workup with every test' after watching health content online. Walk me through how you'd take the history and decide what's actually indicated.History taking priorityEntry–mid

Elevated liver enzymes asymptomaticRoutine labs in an asymptomatic 40-year-old show liver enzymes about three times the upper limit of normal. Walk me through your differential and first-pass workup.Differential diagnosisMid–senior

Sudden severe headache assessmentA 42-year-old presents to the ED with sudden onset severe headache that started 90 minutes ago. Walk me through your initial assessment and what concerns you most.When to escalateEntry–mid

Transient weakness risk stratificationA 55-year-old with hypertension presents with left-sided weakness that resolved completely after 20 minutes. Walk me through your risk stratification.Risk stratificationMid–senior

Progressive leg weakness differentialA 33-year-old woman presents with a six-week history of progressive weakness in her legs and numbness in her feet. Walk me through your differential diagnosis.Differential diagnosisMid–senior

Head injury on anticoagulationA 68-year-old on warfarin falls at home and hits their head. They seem fine but their family brought them in. Walk me through your assessment.Risk stratificationEntry–mid

Fever with neck stiffnessA 19-year-old college student presents with fever, severe headache, and neck stiffness that started this morning. Walk me through your immediate next steps.When to escalateEntry–mid

Progressive difficulty swallowingA 58-year-old presents with progressive dysphagia to solids over three months and a 15-pound weight loss. Walk me through your workup priorities.Decision Relevant testsMid–senior

COPD exacerbation admission decisionA 72-year-old with COPD presents with increasing dyspnea and a productive cough over four days. Walk me through your decision to admit versus discharge.Risk stratificationMid–senior

RLQ pain, missed periodA 26-year-old presents with sudden onset right lower quadrant pain and missed her last period. Walk me through your initial diagnostic approach.History taking priorityEntry–mid

Jaundice and dark urineA 48-year-old presents with jaundice and dark urine noticed over the past week. Walk me through your differential diagnosis.Differential diagnosisMid–senior

Postoperative fever workupA postoperative patient on day two develops a fever of 38.8°C. Walk me through your diagnostic approach.Differential diagnosisEntry–senior

High glucose with nauseaA 61-year-old diabetic presents with nausea and vomiting but denies abdominal pain. Their glucose is 520. Walk me through your assessment.Decision Relevant testsMid–senior

Persistent cough and night sweatsA 37-year-old presents with a three-week history of persistent cough and night sweats. They recently immigrated from Southeast Asia. Walk me through your workup.Decision Relevant testsMid–senior

Syncope while standingA 75-year-old presents with syncope that occurred while standing in church. Walk me through the key historical features you need to establish.History taking priorityMid–senior

Flank pain radiating to groinA 29-year-old with no past medical history presents with sudden onset flank pain radiating to the groin. Walk me through your initial diagnostic steps.Decision Relevant testsEntry–mid

Altered mental status on dialysisA 66-year-old on dialysis develops altered mental status during a session. The nurse calls you urgently. Walk me through your response.When to escalateMid–senior

Bilateral hand numbness at nightA 40-year-old presents with progressive bilateral hand numbness that's worse at night and relieved by shaking the hands. Walk me through your clinical reasoning.Differential diagnosisEntry–mid

Persistent hoarseness without infectionA 53-year-old presents with a two-month history of hoarseness. They don't have a cold and otherwise feel well. Walk me through your approach.History taking priorityMid–senior

Severe headache in late pregnancyA 31-year-old pregnant woman at 32 weeks presents with a severe headache and her blood pressure is 168/110. Walk me through your immediate management.When to escalateMid–senior

Cirrhosis with confusion and ascitesA 44-year-old with known cirrhosis presents with increasing abdominal girth and new confusion. Walk me through your assessment priorities.Risk stratificationMid–senior

Calf swelling after long flightA 23-year-old presents with a painful swollen right calf after a long international flight. Walk me through your diagnostic reasoning.Decision Relevant testsEntry–mid

Inferior ST elevation myocardial infarctionA 56-year-old presents with crushing chest pain that started 30 minutes ago. Their ECG shows ST elevations in leads II, III, and aVF. Walk me through your next steps.When to escalateEntry–mid

Recurrent palpitations and tremorA 38-year-old presents with recurrent episodes of palpitations, tremor, and sweating that last about 20 minutes. Walk me through your differential.Differential diagnosisMid–senior

Painless hematuria in smokerA 70-year-old presents with painless hematuria noticed this morning. They have a 40 pack-year smoking history. Walk me through your workup strategy.Decision Relevant testsMid–senior

Back pain with urinary retentionA 47-year-old presents with a two-week history of progressive lower back pain and now reports new urinary retention. Walk me through your assessment.When to escalateMid–senior

Postoperative shortness of breathA hospitalized patient develops acute shortness of breath on postoperative day five after hip replacement. Walk me through your clinical reasoning.Differential diagnosisMid–senior