In Kona’s case, which presenting sign is explicitly listed?

• A. Epistaxis
• B. Cough
• C. Vomiting
• D. Diarrhea

Answer: (A)

The main idea being tested is identifying what was directly stated as the reason Kona sought care. In this case, the vignette explicitly mentions a nosebleed as what brought Kona to attention—the presenting sign that was recorded at presentation. That direct statement makes epistaxis the best answer because it is the only sign clearly documented as the initial complaint.

The other symptoms listed—cough, vomiting, diarrhea—are not described as Kona’s presenting sign in the vignette, so they aren’t the explicit presenting feature the question is asking about. Recognizing what's explicitly stated helps avoid assuming symptoms not documented, and it also guides what initial concerns or workup to consider (for example, a presenting nosebleed can raise questions about bleeding risk or nasal/ENT problems).