EPIC COGITO FUNDAMENTALS
EXAM PREP BUNDLE 2026: CASE-
BASED Q&A : QUESTIONS AND
RATIONALES/GRADED A+
UPDATE 100% CORRECT
SECTION 1: FOUNDATIONS OF CLINICAL COGNITION &
DECISION-MAKING (Questions 1-20)
Question 1
A 72-year-old patient with diabetes presents with acute confusion, fever, and
hypotension. Bedside glucose reads "HIGH." What is the priority cognitive
framework?
A) Delirium workup only
B) Hyperosmolar hyperglycemic state vs. diabetic ketoacidosis
C) Stroke alert
D) Urinary tract infection treatment
Correct Answer: B
Rationale: HHS and DKA are life-threatening emergencies in diabetics presenting with
altered mental status. The "HIGH" glucose reading demands immediate differentiation
between these two conditions, as management differs (fluid resuscitation first in HHS
vs. insulin first in DKA).
Question 2
,A medical student uses the "CRASH" mnemonic for stroke assessment. Which
cognitive bias is most likely to occur?
A) Anchoring bias
B) Confirmation bias
C) Availability heuristic
D) Overconfidence bias
Correct Answer: A
Rationale: Mnemonics like CRASH can lead to anchoring bias, where the clinician
fixates on stroke and misses alternative diagnoses (e.g., hypoglycemia, seizure,
metabolic encephalopathy).
Question 3
A 45-year-old presents with chest pain. ECG shows ST elevations. The EPIC decision
support recommends aspirin and cath lab activation. This represents which level of
clinical cognition?
A) System 1 (intuitive) processing
B) System 2 (analytical) processing
C) Heuristic reasoning
D) Dual-process conflict
Correct Answer: A
Rationale: Pattern recognition of STEMI on ECG triggering immediate action is classic
System 1 (fast, automatic, intuitive) processing. The EPIC alert reinforces this automatic
response.
Question 4
A resident dismisses a high-risk pulmonary embolism because "the patient is young
and healthy." This demonstrates:
A) Base rate neglect
B) Gambler's fallacy
C) Sunk cost fallacy
D) Framing effect
Correct Answer: A
Rationale: Base rate neglect occurs when specific case information (young, healthy)
overrides the statistical prevalence of PE in symptomatic patients. Age alone does not
rule out PE.
,Question 5
Case: A 60-year-old with hypertension and hyperlipidemia reports episodic dizziness.
BP is 150/90. Which cognitive forcing strategy is most appropriate?
A) "What else could cause these symptoms?"
B) "Trust your initial impression"
C) "Order a complete metabolic panel only"
D) "Discharge with reassurance"
Correct Answer: A
Rationale: Cognitive forcing strategies explicitly prompt differential expansion. Asking
"what else?" combats premature closure, especially in older patients with multiple
cardiovascular risk factors.
Question 6
A physician reviews EPIC's BestPractice Advisory suggesting a C. diff test for a post-
antibiotic diarrhea patient. The physician ignores it due to "never being right before."
This is:
A) Automation bias
B) Outcome bias
C) Status quo bias
D) Commission bias
Correct Answer: A
Rationale: Automation bias is over-reliance or under-reliance on decision support
based on past experiences. Ignoring a valid alert due to previous false alarms is a
classic example.
Question 7
A 28-year-old with headache and normal neuro exam is diagnosed with migraine.
Three days later, she returns with ruptured aneurysm. The missed diagnosis primarily
results from:
A) Premature closure
B) Ascertainment bias
C) Recency bias
D) Representativeness heuristic
, Correct Answer: A
Rationale: Premature closure—stopping at the first plausible diagnosis (migraine)—is
among the most common cognitive errors in medicine, especially when initial
presentation is atypical for serious pathology.
Question 8
Which EPIC Cogito tool best helps clinicians avoid diagnostic momentum bias?
A) SmartForm documentation
B) Patient timeline with prior encounters
C) In-basket messaging
D) Haiku mobile app
Correct Answer: B
Rationale: Diagnostic momentum occurs when a prior diagnosis is carried forward
uncritically. EPIC's patient timeline allows review of original presentation and test
results, enabling re-evaluation.
Question 9
A 50-year-old with back pain had an MRI showing mild degenerative changes. The
surgeon recommends fusion based on "what we always do." This reflects:
A) Bandwagon bias
B) Aggregate bias
C) Visceral bias
D) Gender bias
Correct Answer: A
Rationale: Bandwagon bias (follow the herd) describes practice patterns adopted
because "everyone does it," not based on evidence. Lumbar fusion for nonspecific back
pain with mild degenerative changes is often not indicated.
Question 10
A patient with non-specific abdominal pain is admitted. The attending asks, "If this
patient had appendicitis, what would I expect to find?" This uses:
A) Bayesian reasoning
B) The rule-out strategy
EXAM PREP BUNDLE 2026: CASE-
BASED Q&A : QUESTIONS AND
RATIONALES/GRADED A+
UPDATE 100% CORRECT
SECTION 1: FOUNDATIONS OF CLINICAL COGNITION &
DECISION-MAKING (Questions 1-20)
Question 1
A 72-year-old patient with diabetes presents with acute confusion, fever, and
hypotension. Bedside glucose reads "HIGH." What is the priority cognitive
framework?
A) Delirium workup only
B) Hyperosmolar hyperglycemic state vs. diabetic ketoacidosis
C) Stroke alert
D) Urinary tract infection treatment
Correct Answer: B
Rationale: HHS and DKA are life-threatening emergencies in diabetics presenting with
altered mental status. The "HIGH" glucose reading demands immediate differentiation
between these two conditions, as management differs (fluid resuscitation first in HHS
vs. insulin first in DKA).
Question 2
,A medical student uses the "CRASH" mnemonic for stroke assessment. Which
cognitive bias is most likely to occur?
A) Anchoring bias
B) Confirmation bias
C) Availability heuristic
D) Overconfidence bias
Correct Answer: A
Rationale: Mnemonics like CRASH can lead to anchoring bias, where the clinician
fixates on stroke and misses alternative diagnoses (e.g., hypoglycemia, seizure,
metabolic encephalopathy).
Question 3
A 45-year-old presents with chest pain. ECG shows ST elevations. The EPIC decision
support recommends aspirin and cath lab activation. This represents which level of
clinical cognition?
A) System 1 (intuitive) processing
B) System 2 (analytical) processing
C) Heuristic reasoning
D) Dual-process conflict
Correct Answer: A
Rationale: Pattern recognition of STEMI on ECG triggering immediate action is classic
System 1 (fast, automatic, intuitive) processing. The EPIC alert reinforces this automatic
response.
Question 4
A resident dismisses a high-risk pulmonary embolism because "the patient is young
and healthy." This demonstrates:
A) Base rate neglect
B) Gambler's fallacy
C) Sunk cost fallacy
D) Framing effect
Correct Answer: A
Rationale: Base rate neglect occurs when specific case information (young, healthy)
overrides the statistical prevalence of PE in symptomatic patients. Age alone does not
rule out PE.
,Question 5
Case: A 60-year-old with hypertension and hyperlipidemia reports episodic dizziness.
BP is 150/90. Which cognitive forcing strategy is most appropriate?
A) "What else could cause these symptoms?"
B) "Trust your initial impression"
C) "Order a complete metabolic panel only"
D) "Discharge with reassurance"
Correct Answer: A
Rationale: Cognitive forcing strategies explicitly prompt differential expansion. Asking
"what else?" combats premature closure, especially in older patients with multiple
cardiovascular risk factors.
Question 6
A physician reviews EPIC's BestPractice Advisory suggesting a C. diff test for a post-
antibiotic diarrhea patient. The physician ignores it due to "never being right before."
This is:
A) Automation bias
B) Outcome bias
C) Status quo bias
D) Commission bias
Correct Answer: A
Rationale: Automation bias is over-reliance or under-reliance on decision support
based on past experiences. Ignoring a valid alert due to previous false alarms is a
classic example.
Question 7
A 28-year-old with headache and normal neuro exam is diagnosed with migraine.
Three days later, she returns with ruptured aneurysm. The missed diagnosis primarily
results from:
A) Premature closure
B) Ascertainment bias
C) Recency bias
D) Representativeness heuristic
, Correct Answer: A
Rationale: Premature closure—stopping at the first plausible diagnosis (migraine)—is
among the most common cognitive errors in medicine, especially when initial
presentation is atypical for serious pathology.
Question 8
Which EPIC Cogito tool best helps clinicians avoid diagnostic momentum bias?
A) SmartForm documentation
B) Patient timeline with prior encounters
C) In-basket messaging
D) Haiku mobile app
Correct Answer: B
Rationale: Diagnostic momentum occurs when a prior diagnosis is carried forward
uncritically. EPIC's patient timeline allows review of original presentation and test
results, enabling re-evaluation.
Question 9
A 50-year-old with back pain had an MRI showing mild degenerative changes. The
surgeon recommends fusion based on "what we always do." This reflects:
A) Bandwagon bias
B) Aggregate bias
C) Visceral bias
D) Gender bias
Correct Answer: A
Rationale: Bandwagon bias (follow the herd) describes practice patterns adopted
because "everyone does it," not based on evidence. Lumbar fusion for nonspecific back
pain with mild degenerative changes is often not indicated.
Question 10
A patient with non-specific abdominal pain is admitted. The attending asks, "If this
patient had appendicitis, what would I expect to find?" This uses:
A) Bayesian reasoning
B) The rule-out strategy
