Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 35-year-old primigravida at 34 weeks gestation presents to the emergency department with sudden onset severe abdominal pain and vaginal bleeding. Vital signs show BP 145/92 mmHg, HR 112 bpm, RR 20/min. The resident notes in the EHR that the patient was labeled as 'frequent complainerâmultiple prior ED visits for abdominal pain, mostly benign' from visits 6 months ago. The resident orders routine labs and abdominal imaging as an outpatient workup rather than immediately consulting obstetrics. Four hours later, the patient becomes hypotensive and is emergently taken to the OR where placental abruption with massive hemorrhage is discovered. The infant is born with severe hypoxic-ischemic encephalopathy. Which cognitive bias most directly contributed to the delayed recognition of this life-threatening condition?
Answer choices
- AConfirmation biasâthe resident actively searched for benign explanations consistent with the prior label
- BAvailability heuristicâthe resident overweighted the recent frequency of benign abdominal pain presentations
- CRepresentativeness heuristicâthe resident assumed the patient's current symptoms matched her previous diagnostic category
- DAnchoring biasâthe resident relied excessively on the outdated 'frequent complainer' label despite clear red flags in the current presentationCorrect answer
- EPremature closureâthe resident formed a diagnosis too early and failed to consider alternative explanations
- FHindsight biasâthe resident recognized only after delivery that the initial vital signs were clinically significant
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