, ol
lOMoARcPSD|126 567
ol 13
Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care 6t
ol ol ol ol ol ol ol ol ol ol ol ol
h Edition Dains ol ol
Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
ol ol ol ol ol ol ol ol ol ol
Multiple Choice ol
Identify the choice that best completes the statement or answers the question.
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1. Which type of clinical decision-making is most reliable?
ol ol ol ol ol ol ol
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
ol ol ol ol ol ol ol ol ol ol ol ol ol
A. Methodical and systematic ol ol
B. Attentive to the patient’s verbal and nonverbal language
ol ol ol ol ol ol ol
C. Able to accurately interpret the patient’s responses
ol ol ol ol ol ol
D. Adept at reading into the patient’s statements
ol ol ol ol ol ol
3. Essential parts of a health history include all of the following except:
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A. Chief complaint ol
B. History of the present illness ol ol ol ol
C. Current vital signs ol ol
D. All of the above are essential history components
ol ol ol ol ol ol ol
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
A. Differentiate between normal and abnormal findings ol ol ol ol ol
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ol ol ol ol ol ol ol ol ol ol ol ol
C. Recognize how certain conditions affect the response to other conditions
ol ol ol ol ol ol ol ol ol
D. Foresee unpredictable findings ol ol
5. The following is the least reliable source of information for diagnostic statistics:
ol ol ol ol ol ol ol ol ol ol ol
A. Evidence-based investigations ol
B. Primary reports of research ol ol ol
C. Estimation based on a provider’s experience ol ol ol ol ol
D. Published meta-analyses ol
6. The following can be used to assist in sound clinical decision-making:
ol ol ol ol ol ol ol ol ol ol
A. Algorithm published in a peer-reviewed journal article ol ol ol ol ol ol
B. Clinical practice guidelines ol ol
C. Evidence-based research ol
D. All of the above
ol ol ol
7. If a diagnostic study has high sensitivity, this indicates a:
ol ol ol ol ol ol ol ol ol
A. High percentage of persons with the given condition will have an abnormal result
ol ol ol ol ol ol ol ol ol ol ol ol
B. Low percentage of persons with the given condition will have an abnormal result
ol ol ol ol ol ol ol ol ol ol ol ol
C. Low likelihood of normal result in persons without a given condition
ol ol ol ol ol ol ol ol ol ol
D. None of the above ol ol ol
8. If a diagnostic study has high specificity, this indicates a:
ol ol ol ol ol ol ol ol ol
A. Low percentage of healthy individuals will show a normal result
ol ol ol ol ol ol ol ol ol
B. High percentage of healthy individuals will show a normal result
ol ol ol ol ol ol ol ol ol
C. High percentage of individuals with a disorder will show a normal result
ol ol ol ol ol ol ol ol ol ol ol
D. Low percentage of individuals with a disorder will show an abnormal result
ol ol ol ol ol ol ol ol ol ol ol
9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
ol ol ol ol ol ol ol ol ol ol ol
A. Positive result is strongly associated with the disease
ol ol ol ol ol ol ol
B. Negative result is strongly associated with absence of the disease
ol ol ol ol ol ol ol ol ol
C. Positive result is weakly associated with the disease
ol ol ol ol ol ol ol
D. Negative result is weakly associated with absence of the disease
ol ol ol ol ol ol ol ol ol
10. Which of the following clinical reasoning tools is defined as evidence-
ol ol ol ol ol ol ol ol ol ol
based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or pati
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ents?
, lOMoARcPSD|126ol 567
ol 13
A. Clinical practice guideline ol ol
B. Clinical decision rule ol ol
C. Clinical algorithm ol
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ol ol ol ol ol ol ol ol ol ol
Answer Section
ol
MULTIPLE CHOICE ol
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
ol ol ol ol ol ol ol ol ol ol ol ol ol ol
making (similar to Augenblink decision-
ol ol ol ol ol
making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In con
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
trast, analytical decision-making is based on careful consideration and has greater reliability with rare errors.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal language, and able to
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any area
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
s of uncertainty.
ol ol
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, r
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ecall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect t
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
he response to other conditions, and distinguish the relevance of varied abnormal findings.
ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
ol ol ol ol ol ol ol ol ol ol ol ol
analyses. Another source of statistics, the one that has been most widely used and available for application to the reasoning process
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
, is the estimation based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
evidence on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be bas
ol ol ol ol ol ol ol ol o l ol ol ol ol ol ol ol ol ol ol
ed on scientific evidence.
ol ol ol
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-
ol ol ol ol ol ol ol ol
based resources have been developed to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
in clinical reasoning when properly applied.
ol ol ol ol ol ol
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive, r
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
esult. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater the s
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
pecificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target con
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
dition.
PTS: 1
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target condition and a
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated w
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ith the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
, ol
lOMoARcPSD|126 567
ol 13
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to cert
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ain situations, settings, and/or patient characteristics.
ol ol ol ol ol
PTS: 1
lOMoARcPSD|126 567
ol 13
Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care 6t
ol ol ol ol ol ol ol ol ol ol ol ol
h Edition Dains ol ol
Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
ol ol ol ol ol ol ol ol ol ol
Multiple Choice ol
Identify the choice that best completes the statement or answers the question.
ol ol ol ol ol ol ol ol ol ol ol
1. Which type of clinical decision-making is most reliable?
ol ol ol ol ol ol ol
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
ol ol ol ol ol ol ol ol ol ol ol ol ol
A. Methodical and systematic ol ol
B. Attentive to the patient’s verbal and nonverbal language
ol ol ol ol ol ol ol
C. Able to accurately interpret the patient’s responses
ol ol ol ol ol ol
D. Adept at reading into the patient’s statements
ol ol ol ol ol ol
3. Essential parts of a health history include all of the following except:
ol ol ol ol ol ol ol ol ol ol ol
A. Chief complaint ol
B. History of the present illness ol ol ol ol
C. Current vital signs ol ol
D. All of the above are essential history components
ol ol ol ol ol ol ol
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
A. Differentiate between normal and abnormal findings ol ol ol ol ol
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ol ol ol ol ol ol ol ol ol ol ol ol
C. Recognize how certain conditions affect the response to other conditions
ol ol ol ol ol ol ol ol ol
D. Foresee unpredictable findings ol ol
5. The following is the least reliable source of information for diagnostic statistics:
ol ol ol ol ol ol ol ol ol ol ol
A. Evidence-based investigations ol
B. Primary reports of research ol ol ol
C. Estimation based on a provider’s experience ol ol ol ol ol
D. Published meta-analyses ol
6. The following can be used to assist in sound clinical decision-making:
ol ol ol ol ol ol ol ol ol ol
A. Algorithm published in a peer-reviewed journal article ol ol ol ol ol ol
B. Clinical practice guidelines ol ol
C. Evidence-based research ol
D. All of the above
ol ol ol
7. If a diagnostic study has high sensitivity, this indicates a:
ol ol ol ol ol ol ol ol ol
A. High percentage of persons with the given condition will have an abnormal result
ol ol ol ol ol ol ol ol ol ol ol ol
B. Low percentage of persons with the given condition will have an abnormal result
ol ol ol ol ol ol ol ol ol ol ol ol
C. Low likelihood of normal result in persons without a given condition
ol ol ol ol ol ol ol ol ol ol
D. None of the above ol ol ol
8. If a diagnostic study has high specificity, this indicates a:
ol ol ol ol ol ol ol ol ol
A. Low percentage of healthy individuals will show a normal result
ol ol ol ol ol ol ol ol ol
B. High percentage of healthy individuals will show a normal result
ol ol ol ol ol ol ol ol ol
C. High percentage of individuals with a disorder will show a normal result
ol ol ol ol ol ol ol ol ol ol ol
D. Low percentage of individuals with a disorder will show an abnormal result
ol ol ol ol ol ol ol ol ol ol ol
9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
ol ol ol ol ol ol ol ol ol ol ol
A. Positive result is strongly associated with the disease
ol ol ol ol ol ol ol
B. Negative result is strongly associated with absence of the disease
ol ol ol ol ol ol ol ol ol
C. Positive result is weakly associated with the disease
ol ol ol ol ol ol ol
D. Negative result is weakly associated with absence of the disease
ol ol ol ol ol ol ol ol ol
10. Which of the following clinical reasoning tools is defined as evidence-
ol ol ol ol ol ol ol ol ol ol
based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or pati
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ents?
, lOMoARcPSD|126ol 567
ol 13
A. Clinical practice guideline ol ol
B. Clinical decision rule ol ol
C. Clinical algorithm ol
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ol ol ol ol ol ol ol ol ol ol
Answer Section
ol
MULTIPLE CHOICE ol
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
ol ol ol ol ol ol ol ol ol ol ol ol ol ol
making (similar to Augenblink decision-
ol ol ol ol ol
making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In con
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
trast, analytical decision-making is based on careful consideration and has greater reliability with rare errors.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal language, and able to
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any area
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
s of uncertainty.
ol ol
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, r
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ecall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect t
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
he response to other conditions, and distinguish the relevance of varied abnormal findings.
ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
ol ol ol ol ol ol ol ol ol ol ol ol
analyses. Another source of statistics, the one that has been most widely used and available for application to the reasoning process
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
, is the estimation based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
evidence on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be bas
ol ol ol ol ol ol ol ol o l ol ol ol ol ol ol ol ol ol ol
ed on scientific evidence.
ol ol ol
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-
ol ol ol ol ol ol ol ol
based resources have been developed to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
in clinical reasoning when properly applied.
ol ol ol ol ol ol
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive, r
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
esult. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater the s
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
pecificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target con
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
dition.
PTS: 1
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target condition and a
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated w
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ith the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
, ol
lOMoARcPSD|126 567
ol 13
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to cert
ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol ol
ain situations, settings, and/or patient characteristics.
ol ol ol ol ol
PTS: 1
