,TestBankforAdvancedHealthAssessment&ClinicalDiagnosisinPrimaryCare6t h Ed
ij ij ij ij ij ij ij ij ij ij ij ij ij ij
ition Dains ij
Chapter1:ClinicalReasoning, Differential Diagnosis, Evidence-BasedPractice, and Symptom Analysis
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MultipleChoice
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Identifythechoicethatbestcompletesthestatementoranswersthequestion.
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1. Which type ofclinical decision-making is most reliable? ij ij ij ij ol ol ij
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which ofthe following is false?To obtain adequate history, health-care providers must be:
ij ij ol ij ij ij ij ol ij ij ij ol ij
A. Methodical and systematic ij ij
B. Attentiveto the patient’s verbal and nonverballanguage ij ol ol ij ij ij ij
C. Ableto accuratelyinterpret the patient’s responses
ij ol ij ij ij ol
D. Adept at reading into thepatient’s statements
ij ij ij ol ij
3. Essential partsof a health historyinclude all ofthe following except: ol ij ij ol ij ij ij ij ij ij ol
A. Chief complaint ol
B. Historyofthe present illness ij ij ij
C. Currentvital signs ij ij
D. All of the above are essential historycomponents
ij ol ij ij ij ol ij
4. Which ofthe following is false? Whileperforming thephysical examination, theexaminer must be ableto:
ij ij ij ij ij ij ij ol ij i j ol ij ij ij ol ij
A. Differentiate between normaland abnormalfindings ol ol ij ol ij
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ol ij ij ol ol ij ij ol ij ol ol ol
C. Recognize how certain conditionsaffect theresponse to other conditions ij ij ol ij ij ij ol ol ij
D. Foreseeunpredictable findings ij ij
5. Thefollowingis the leastreliablesource ofinformation for diagnosticstatistics:
ij ij ol ol ij ij ij ij ij ij ij
A. Evidence-based investigations ol
B. Primaryreports of research ol ij
C. Estimationbased on a provider’s experience ij ol ij ol ol
D. Published meta-analyses ol
6. Thefollowingcan be used to assist in sound clinical decision-making:
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A. Algorithm published in apeer-reviewed journal article ol ij ij ol ol
B. Clinicalpractice guidelines ij
C. Evidence-based research ol
D. All oftheabove
ij ij ij
7. Ifadiagnosticstudyhas high sensitivity, thisindicates a:
ij ij ol ij ij ij ij
A. High percentage of persons with the given condition will havean abnormal result
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B. Lowpercentage of persons with the given condition will have an abnormal result
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C. Lowlikelihood ofnormal result in persons without a given condition
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D. None of theabove ij ol ij
8. Ifadiagnosticstudyhas high specificity, this indicates a:
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A. Lowpercentage ofhealthyindividuals will showanormalresult
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B. High percentage of healthyindividuals will show a normal result
ij ij ij ij ol ij ij ij ij
C. Highpercentage of individuals with adisorderwill showa normal result
ij ij ol ij ij ij ij ij ij ij
D. Lowpercentage ofindividuals with adisorder will showan abnormal result
ij ij ij ij ij ij ij ij ij ol ij
9. A likelihood ratio above 1 indicatesthat a diagnostic test showing a:
ol ij ij ij ij ij ij ol ol ij ol
A. Positive result is stronglyassociated with the disease
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B. Negativeresultis stronglyassociated with absence of the disease
ij ij ol ij ij ij ij ol ij
C. Positive result isweaklyassociated with thediseaseij ij ij ij ij ij ij
D. Negative result is weaklyassociated with absence ofthe disease
ij ij ol ij ij ij ij ij
10. Whichof thefollowing clinical reasoningtools isdefinedas evidence- ij ol ij ij ij ij ol ij ij ol
based resourcebased on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or pati ents?
ol ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
, A. Clinicalpractice guideline ij ij
B. Clinicaldecision rule ol
C. Clinical algorithm ij
Chapter1:Clinicalreasoning,differentialdiagnosis,evidence-basedpractice,andsymptomana ij ij ij ij ij
Answer Section
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MULTIPLE CHOICE
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1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
ij ij ij ij ij ij ol ij ij ij ij ij ij ij
making (similar to Augenblink decision- ol ij ol ij
making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In con trast,
ij ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
analytical decision-making is based on careful consideration and has greater reliability with rare errors.
ij ij ij ij ij ij ij ij ij ij ij ij ij
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 acc
ij ij ij ol ij ij ij ol ij ij ij ij ol ol ol ij ij ol ij ij
urately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any area s of un
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ol ol
certainty.
PTS: 1
3. ANS: C
Vitalsigns are partof thephysical examination portion of patient assessment, not part of thehealth history.
ij ol ol ij ol ij ij ij ol ol ij ij ol ij ol ij ij
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, r ec
ij ij ij ij ij ij ij ij ij ij ij ij ij ol ij ij ij ij
all knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect t he res
ij ij ij ij ol ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij
ponse to other conditions, and distinguish the relevance of varied abnormal findings.
ol ij ij ij ij ij ij ij ij ij ij
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
ij ij ij ij ol ij ij ij ij ij ij ij
analyses. Another source of statistics,the one thathas been most widelyused and available for application to thereasoningprocess
ij ij ij ij ij ol ol ij ol ol ij ol ij ij ij ol ol ij ij
,is theestimation based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of evide
ij ol ij ij ij ij ij ij ij ol ij ij ij ij ij ij ij ij ij ij ij
nce on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be bas ed on scie
ij ij ol ij ij ij ol ij i j ij ol ij ij ij ij ij ij ij ol ij ol ij
ntific evidence. ij
Evidence-based statistics are also increasinglybeing used to develop resourcesto facilitate clinical decision-making.
ol ij ij ij ol ol ol ol ij ij ij ij
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-
ij ij ol ij ij ol ij ol
based resourceshavebeen developed toassist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in cli
ol ij ij ij ol ij ol ij ij ij ij ij ij ij ij ij ij ij ol
nical reasoning when properly applied.
ij ij ol ij
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is thepercentage of individuals with the target condition who show an abnormal, orpositive, r esult
ij ij ij ij ij ij ij ij ij ij ij ij ol ij ij ij ij ol ij ij ij ij
. Ahigh sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
ij ol ij ij ij ij ij ij ij ol ij ij ij ij ij ol ol ij
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 peci
ij ij ij ij ij ij ij ij ij ol ij ij ol ij ij ij ij ij ij ij ij ij
ficity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target con dition.
ij ij ij ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij ol ij ij ij
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 neg
ij ol ij ij ij ij ij ij ij ij ij ij ij ij ij ol ij ol ij ol ij ij ol oli j
ative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated w ith the
ij ij ij ij ol ij ij ij ij ij ol ij ij ij ij ij ol ij ij ij ij ij ol ij
disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ij ij ol ij ij ij ij ij ij ij ij ij ol ij ij ij ij ol ij
, PTS: i 1 j i j i j
10. ANS: B
Clinicaldecision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
ij ij ij ij ol ij ij ij ij ij ij ij ol ij ij
based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met wi
ij ij ij ij ij ij ij ol ol ij ol ij ij ij ij ij ij ij
th regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to cert ain si
ol ij ij ij ij ij ij ol ij ij ij ij ij ij ij ij ij ol ij ij ij
tuations, settings, and/or patient characteristics.
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PTS: i j i j i j 1
ij ij ij ij ij ij ij ij ij ij ij ij ij ij
ition Dains ij
Chapter1:ClinicalReasoning, Differential Diagnosis, Evidence-BasedPractice, and Symptom Analysis
ij ij ij ol ij ij ij ij ij
MultipleChoice
ij
Identifythechoicethatbestcompletesthestatementoranswersthequestion.
ij ij ij ij ij ij ij
1. Which type ofclinical decision-making is most reliable? ij ij ij ij ol ol ij
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which ofthe following is false?To obtain adequate history, health-care providers must be:
ij ij ol ij ij ij ij ol ij ij ij ol ij
A. Methodical and systematic ij ij
B. Attentiveto the patient’s verbal and nonverballanguage ij ol ol ij ij ij ij
C. Ableto accuratelyinterpret the patient’s responses
ij ol ij ij ij ol
D. Adept at reading into thepatient’s statements
ij ij ij ol ij
3. Essential partsof a health historyinclude all ofthe following except: ol ij ij ol ij ij ij ij ij ij ol
A. Chief complaint ol
B. Historyofthe present illness ij ij ij
C. Currentvital signs ij ij
D. All of the above are essential historycomponents
ij ol ij ij ij ol ij
4. Which ofthe following is false? Whileperforming thephysical examination, theexaminer must be ableto:
ij ij ij ij ij ij ij ol ij i j ol ij ij ij ol ij
A. Differentiate between normaland abnormalfindings ol ol ij ol ij
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ol ij ij ol ol ij ij ol ij ol ol ol
C. Recognize how certain conditionsaffect theresponse to other conditions ij ij ol ij ij ij ol ol ij
D. Foreseeunpredictable findings ij ij
5. Thefollowingis the leastreliablesource ofinformation for diagnosticstatistics:
ij ij ol ol ij ij ij ij ij ij ij
A. Evidence-based investigations ol
B. Primaryreports of research ol ij
C. Estimationbased on a provider’s experience ij ol ij ol ol
D. Published meta-analyses ol
6. Thefollowingcan be used to assist in sound clinical decision-making:
ij ij ij ol ol ol ij ij ij ol
A. Algorithm published in apeer-reviewed journal article ol ij ij ol ol
B. Clinicalpractice guidelines ij
C. Evidence-based research ol
D. All oftheabove
ij ij ij
7. Ifadiagnosticstudyhas high sensitivity, thisindicates a:
ij ij ol ij ij ij ij
A. High percentage of persons with the given condition will havean abnormal result
ij ij ol ij ol ij ol ij ij ij ol ij
B. Lowpercentage of persons with the given condition will have an abnormal result
ij ij ol ij ol ij ij ol ij ij ol ij
C. Lowlikelihood ofnormal result in persons without a given condition
ij ij ij ij ol ol ol ol ij
D. None of theabove ij ol ij
8. Ifadiagnosticstudyhas high specificity, this indicates a:
ij ij ol ol ij ij ol
A. Lowpercentage ofhealthyindividuals will showanormalresult
ij ij ij ij ol ij ij ij
B. High percentage of healthyindividuals will show a normal result
ij ij ij ij ol ij ij ij ij
C. Highpercentage of individuals with adisorderwill showa normal result
ij ij ol ij ij ij ij ij ij ij
D. Lowpercentage ofindividuals with adisorder will showan abnormal result
ij ij ij ij ij ij ij ij ij ol ij
9. A likelihood ratio above 1 indicatesthat a diagnostic test showing a:
ol ij ij ij ij ij ij ol ol ij ol
A. Positive result is stronglyassociated with the disease
ij ij ol ol ij ij
B. Negativeresultis stronglyassociated with absence of the disease
ij ij ol ij ij ij ij ol ij
C. Positive result isweaklyassociated with thediseaseij ij ij ij ij ij ij
D. Negative result is weaklyassociated with absence ofthe disease
ij ij ol ij ij ij ij ij
10. Whichof thefollowing clinical reasoningtools isdefinedas evidence- ij ol ij ij ij ij ol ij ij ol
based resourcebased on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or pati ents?
ol ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
, A. Clinicalpractice guideline ij ij
B. Clinicaldecision rule ol
C. Clinical algorithm ij
Chapter1:Clinicalreasoning,differentialdiagnosis,evidence-basedpractice,andsymptomana ij ij ij ij ij
Answer Section
ij
MULTIPLE CHOICE
ij
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
ij ij ij ij ij ij ol ij ij ij ij ij ij ij
making (similar to Augenblink decision- ol ij ol ij
making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In con trast,
ij ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
analytical decision-making is based on careful consideration and has greater reliability with rare errors.
ij ij ij ij ij ij ij ij ij ij ij ij ij
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 acc
ij ij ij ol ij ij ij ol ij ij ij ij ol ol ol ij ij ol ij ij
urately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any area s of un
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ol ol
certainty.
PTS: 1
3. ANS: C
Vitalsigns are partof thephysical examination portion of patient assessment, not part of thehealth history.
ij ol ol ij ol ij ij ij ol ol ij ij ol ij ol ij ij
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, r ec
ij ij ij ij ij ij ij ij ij ij ij ij ij ol ij ij ij ij
all knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect t he res
ij ij ij ij ol ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij
ponse to other conditions, and distinguish the relevance of varied abnormal findings.
ol ij ij ij ij ij ij ij ij ij ij
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
ij ij ij ij ol ij ij ij ij ij ij ij
analyses. Another source of statistics,the one thathas been most widelyused and available for application to thereasoningprocess
ij ij ij ij ij ol ol ij ol ol ij ol ij ij ij ol ol ij ij
,is theestimation based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of evide
ij ol ij ij ij ij ij ij ij ol ij ij ij ij ij ij ij ij ij ij ij
nce on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be bas ed on scie
ij ij ol ij ij ij ol ij i j ij ol ij ij ij ij ij ij ij ol ij ol ij
ntific evidence. ij
Evidence-based statistics are also increasinglybeing used to develop resourcesto facilitate clinical decision-making.
ol ij ij ij ol ol ol ol ij ij ij ij
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-
ij ij ol ij ij ol ij ol
based resourceshavebeen developed toassist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in cli
ol ij ij ij ol ij ol ij ij ij ij ij ij ij ij ij ij ij ol
nical reasoning when properly applied.
ij ij ol ij
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is thepercentage of individuals with the target condition who show an abnormal, orpositive, r esult
ij ij ij ij ij ij ij ij ij ij ij ij ol ij ij ij ij ol ij ij ij ij
. Ahigh sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
ij ol ij ij ij ij ij ij ij ol ij ij ij ij ij ol ol ij
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 peci
ij ij ij ij ij ij ij ij ij ol ij ij ol ij ij ij ij ij ij ij ij ij
ficity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target con dition.
ij ij ij ij ij ol ij ij ij ij ij ij ij ij ij ij ij ij ol ij ij ij
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 neg
ij ol ij ij ij ij ij ij ij ij ij ij ij ij ij ol ij ol ij ol ij ij ol oli j
ative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated w ith the
ij ij ij ij ol ij ij ij ij ij ol ij ij ij ij ij ol ij ij ij ij ij ol ij
disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ij ij ol ij ij ij ij ij ij ij ij ij ol ij ij ij ij ol ij
, PTS: i 1 j i j i j
10. ANS: B
Clinicaldecision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
ij ij ij ij ol ij ij ij ij ij ij ij ol ij ij
based resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met wi
ij ij ij ij ij ij ij ol ol ij ol ij ij ij ij ij ij ij
th regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to cert ain si
ol ij ij ij ij ij ij ol ij ij ij ij ij ij ij ij ij ol ij ij ij
tuations, settings, and/or patient characteristics.
ij ij ij ij
PTS: i j i j i j 1
