When assessing a patient for possible stroke symptoms using the BE FAST acronym, what does the letter “F” represent, and why is it important?

Choice A reason: Rebound tenderness in the right lower quadrant, often at McBurney’s point, is a hallmark of appendicitis, indicating peritoneal irritation from an inflamed appendix. This sign, elicited by releasing pressure during palpation, suggests localized inflammation, requiring urgent surgical evaluation to prevent rupture and peritonitis.

Choice B reason: Pancreatitis typically presents with epigastric or left upper quadrant pain, radiating to the back, not right lower quadrant rebound tenderness. It involves pancreatic inflammation, often due to gallstones or alcohol, and is assessed via serum amylase and lipase, not RLQ findings, making this incorrect.

Choice C reason: Cholecystitis causes right upper quadrant pain and tenderness, often with Murphy’s sign, due to gallbladder inflammation. Rebound tenderness in the right lower quadrant is not characteristic, as cholecystitis affects the upper abdomen, making this choice misaligned with the clinical finding.

Choice D reason: Diverticulitis typically causes left lower quadrant pain, as diverticula are common in the sigmoid colon. Right lower quadrant rebound tenderness is not a typical finding, as it suggests appendicitis instead, making this choice incorrect for the described gastrointestinal assessment finding.

Choice A reason: White patches on the tongue and mouth with dysphagia indicate oral thrush, a Candida albicans infection, common in hospitalized patients due to immunosuppression or antibiotics. Antifungal treatment is needed to prevent esophageal spread. Accurate diagnosis ensures timely therapy, critical for relieving symptoms and avoiding complications in vulnerable patients.

Choice B reason: Bad breath (halitosis) may accompany oral issues but doesn’t cause white patches or dysphagia, which indicate thrush. Assuming bad breath misdiagnoses the condition, delaying antifungal treatment and risking progression of Candida infection, potentially leading to systemic complications in long-term hospitalized patients with compromised immunity.

Choice C reason: Oral ulcers cause painful sores, not white patches or widespread dysphagia, unlike thrush’s creamy lesions. Misidentifying as ulcers risks inappropriate treatment, delaying antifungals needed for Candida. This error could worsen swallowing difficulties, compromising nutrition and recovery in hospitalized patients with suspected oral infections.

Choice D reason: Assuming nothing ignores white patches and dysphagia, clear signs of oral thrush in hospitalized patients. Neglecting these risks untreated Candida infection, potentially spreading to the esophagus or systemically, especially in immunocompromised patients. Prompt recognition and antifungal therapy are critical to prevent complications and ensure patient comfort.