Harrison's Principles of Internal Medicine (Vol.1
& Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo; J.
Larry Jameson
TEST BANK
1
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 55-year-old man with newly diagnosed type 2 diabetes asks
whether his physician’s cultural background affects the
,treatment plan. Which clinician behavior best demonstrates
professionalism and fosters patient-centered care?
Options
A. Rely primarily on habit and standard protocols to avoid bias.
B. Elicit the patient’s values and collaboratively agree on goals.
C. Defer all treatment choices to the patient without guidance.
D. Emphasize that the clinician’s training supersedes patient
preferences.
Correct Answer
B
Rationales
Correct: Eliciting values and collaboratively setting goals
respects patient autonomy and demonstrates professionalism
in individualized care.
A: Relying solely on habit ignores individual context and may
perpetuate bias.
C: Deferring all choices avoids shared decision-making and may
leave patients unsupported.
D: Asserting clinician primacy undermines respect and informed
consent.
Teaching Point
Professionalism = respect, shared decision-making, and eliciting
patient values.
,Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2
Reference
Ch. 2 — Promoting Good Health
Question Stem
A community health nurse plans an intervention to reduce
cardiovascular risk. Which population-level strategy will most
effectively reduce population incidence of ischemic heart
disease?
Options
A. Intensive risk counseling for a small high-risk group.
B. Mass sodium reduction in processed foods.
C. Offering cholesterol screening clinics once yearly.
D. Distributing leaflets about exercise to clinic patients.
Correct Answer
B
Rationales
Correct: A population-wide reduction in sodium shifts risk
across the entire population and yields greater incidence
reduction than targeting only high-risk individuals.
A: Intensive counseling helps individuals but affects fewer
people overall.
,C: Screening alone does not change population incidence
without effective interventions.
D: Leaflets have low reach and effectiveness compared with
structural interventions.
Teaching Point
Population interventions that shift risk factors often yield the
largest public-health benefit.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 2.
3
Reference
Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem
A pediatrician encounters parents hesitant about the MMR
vaccine who cite safety fears from internet sources. Which
response best addresses hesitancy and promotes vaccination?
Options
A. Provide a long list of technical safety data to convince them.
B. Dismiss their concerns as misinformation and proceed with
vaccination.
C. Acknowledge concerns, elicit specific fears, and offer clear
risk comparisons.
,D. Agree to delay vaccination until the parents feel completely
comfortable.
Correct Answer
C
Rationales
Correct: Acknowledging concerns, eliciting specifics, and
offering clear comparative risks builds trust and addresses
cognitive and emotional drivers of hesitancy.
A: Overwhelming technical data can confuse and alienate; not
tailored.
B: Dismissing concerns damages trust and reduces uptake.
D: Delay increases risk and misses opportunity to vaccinate on
schedule.
Teaching Point
Address vaccine hesitancy by listening, tailoring information,
and comparing risks clearly.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 3.
4
Reference
Ch. 4 — Decision-Making in Clinical Medicine
,Question Stem
A 68-year-old woman with prior stroke and atrial fibrillation is
being considered for anticoagulation. How should clinicians
integrate patient values with evidence when the bleeding risk
and stroke prevention benefits conflict?
Options
A. Use decision aids and discuss absolute benefits and harms
with the patient.
B. Base the decision solely on clinician judgment and risk
scores.
C. Decide against anticoagulation whenever bleeding risk is
elevated.
D. Require family members to make the decision to avoid
patient stress.
Correct Answer
A
Rationales
Correct: Decision aids presenting absolute risks/benefits
facilitate shared decision-making and respect patient values
when tradeoffs exist.
B: Clinician judgment is essential but should be combined with
patient preferences, not sole determinant.
C: Automatically withholding therapy when risk is elevated
ignores individual values and potential net benefit.
D: Family decision without patient involvement undermines
autonomy unless patient lacks capacity.
,Teaching Point
Use decision aids to present absolute benefits/harms and
support shared decisions.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
5
Reference
Ch. 5 — Precision Medicine and Clinical Care
Question Stem
A patient with metastatic colon cancer has a tumor with a KRAS
mutation. Which therapy is least likely to be effective based on
tumor genomics?
Options
A. Anti-EGFR monoclonal antibody therapy.
B. Standard cytotoxic chemotherapy (e.g., FOLFOX).
C. Supportive care and symptom management.
D. Consideration of a clinical trial targeting KRAS pathway.
Correct Answer
A
Rationales
Correct: Activating KRAS mutations confer resistance to anti-
EGFR antibodies, making that therapy unlikely to work.
,B: Cytotoxic chemotherapy may still be effective independent of
KRAS status.
C: Supportive care remains appropriate for symptom control
regardless of genomics.
D: Targeted trials against KRAS pathway may offer benefit given
specific mutation.
Teaching Point
Oncologic precision medicine: KRAS mutations predict anti-
EGFR resistance.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 5.
6
Reference
Ch. 6 — Screening and Prevention of Disease
Question Stem
A primary care nurse explains mammography screening to a 48-
year-old woman. Which statement best reflects balancing
benefits and harms of screening in this age group?
Options
A. “Screening always reduces breast cancer deaths, so annual
mammograms are mandatory.”
B. “Screening may reduce mortality but also causes false
positives and overdiagnosis; discuss tradeoffs.”
,C. “Mammography is ineffective before age 50 and should not
be done.”
D. “A single negative mammogram rules out future breast
cancer for years.”
Correct Answer
B
Rationales
Correct: Screening has potential mortality benefit but also risks
(false positives, overdiagnosis); shared decision-making is
needed.
A: Overstates benefit and removes patient choice; not accurate.
C: Mammography can detect cancer before 50; blanket
exclusion is incorrect.
D: A negative test does not rule out future cancer; interval
cancers occur.
Teaching Point
Screening requires balancing mortality benefit against false
positives and overdiagnosis.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 6.
7
, Reference
Ch. 7 — Global Diversity of Health System Financing and
Delivery
Question Stem
A health policymaker must choose between a tax-funded
system and private insurance model to expand coverage. Which
feature most reliably increases equitable access?
Options
A. Relying on market competition among insurers.
B. Universal, publicly funded coverage with minimal user fees.
C. Employer-based coverage tied to full-time employment.
D. Premium subsidies for low-income individuals only.
Correct Answer
B
Rationales
Correct: Universal public funding and low user fees reduce
financial barriers and promote equity in access across
populations.
A: Competition can improve efficiency but may leave gaps and
complexity that worsen equity.
C: Employer-based coverage excludes unemployed and informal
workers, limiting equity.
D: Subsidies help, but targeted programs may still leave gaps
and administrative barriers.
& Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo; J.
Larry Jameson
TEST BANK
1
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 55-year-old man with newly diagnosed type 2 diabetes asks
whether his physician’s cultural background affects the
,treatment plan. Which clinician behavior best demonstrates
professionalism and fosters patient-centered care?
Options
A. Rely primarily on habit and standard protocols to avoid bias.
B. Elicit the patient’s values and collaboratively agree on goals.
C. Defer all treatment choices to the patient without guidance.
D. Emphasize that the clinician’s training supersedes patient
preferences.
Correct Answer
B
Rationales
Correct: Eliciting values and collaboratively setting goals
respects patient autonomy and demonstrates professionalism
in individualized care.
A: Relying solely on habit ignores individual context and may
perpetuate bias.
C: Deferring all choices avoids shared decision-making and may
leave patients unsupported.
D: Asserting clinician primacy undermines respect and informed
consent.
Teaching Point
Professionalism = respect, shared decision-making, and eliciting
patient values.
,Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2
Reference
Ch. 2 — Promoting Good Health
Question Stem
A community health nurse plans an intervention to reduce
cardiovascular risk. Which population-level strategy will most
effectively reduce population incidence of ischemic heart
disease?
Options
A. Intensive risk counseling for a small high-risk group.
B. Mass sodium reduction in processed foods.
C. Offering cholesterol screening clinics once yearly.
D. Distributing leaflets about exercise to clinic patients.
Correct Answer
B
Rationales
Correct: A population-wide reduction in sodium shifts risk
across the entire population and yields greater incidence
reduction than targeting only high-risk individuals.
A: Intensive counseling helps individuals but affects fewer
people overall.
,C: Screening alone does not change population incidence
without effective interventions.
D: Leaflets have low reach and effectiveness compared with
structural interventions.
Teaching Point
Population interventions that shift risk factors often yield the
largest public-health benefit.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 2.
3
Reference
Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem
A pediatrician encounters parents hesitant about the MMR
vaccine who cite safety fears from internet sources. Which
response best addresses hesitancy and promotes vaccination?
Options
A. Provide a long list of technical safety data to convince them.
B. Dismiss their concerns as misinformation and proceed with
vaccination.
C. Acknowledge concerns, elicit specific fears, and offer clear
risk comparisons.
,D. Agree to delay vaccination until the parents feel completely
comfortable.
Correct Answer
C
Rationales
Correct: Acknowledging concerns, eliciting specifics, and
offering clear comparative risks builds trust and addresses
cognitive and emotional drivers of hesitancy.
A: Overwhelming technical data can confuse and alienate; not
tailored.
B: Dismissing concerns damages trust and reduces uptake.
D: Delay increases risk and misses opportunity to vaccinate on
schedule.
Teaching Point
Address vaccine hesitancy by listening, tailoring information,
and comparing risks clearly.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 3.
4
Reference
Ch. 4 — Decision-Making in Clinical Medicine
,Question Stem
A 68-year-old woman with prior stroke and atrial fibrillation is
being considered for anticoagulation. How should clinicians
integrate patient values with evidence when the bleeding risk
and stroke prevention benefits conflict?
Options
A. Use decision aids and discuss absolute benefits and harms
with the patient.
B. Base the decision solely on clinician judgment and risk
scores.
C. Decide against anticoagulation whenever bleeding risk is
elevated.
D. Require family members to make the decision to avoid
patient stress.
Correct Answer
A
Rationales
Correct: Decision aids presenting absolute risks/benefits
facilitate shared decision-making and respect patient values
when tradeoffs exist.
B: Clinician judgment is essential but should be combined with
patient preferences, not sole determinant.
C: Automatically withholding therapy when risk is elevated
ignores individual values and potential net benefit.
D: Family decision without patient involvement undermines
autonomy unless patient lacks capacity.
,Teaching Point
Use decision aids to present absolute benefits/harms and
support shared decisions.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
5
Reference
Ch. 5 — Precision Medicine and Clinical Care
Question Stem
A patient with metastatic colon cancer has a tumor with a KRAS
mutation. Which therapy is least likely to be effective based on
tumor genomics?
Options
A. Anti-EGFR monoclonal antibody therapy.
B. Standard cytotoxic chemotherapy (e.g., FOLFOX).
C. Supportive care and symptom management.
D. Consideration of a clinical trial targeting KRAS pathway.
Correct Answer
A
Rationales
Correct: Activating KRAS mutations confer resistance to anti-
EGFR antibodies, making that therapy unlikely to work.
,B: Cytotoxic chemotherapy may still be effective independent of
KRAS status.
C: Supportive care remains appropriate for symptom control
regardless of genomics.
D: Targeted trials against KRAS pathway may offer benefit given
specific mutation.
Teaching Point
Oncologic precision medicine: KRAS mutations predict anti-
EGFR resistance.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 5.
6
Reference
Ch. 6 — Screening and Prevention of Disease
Question Stem
A primary care nurse explains mammography screening to a 48-
year-old woman. Which statement best reflects balancing
benefits and harms of screening in this age group?
Options
A. “Screening always reduces breast cancer deaths, so annual
mammograms are mandatory.”
B. “Screening may reduce mortality but also causes false
positives and overdiagnosis; discuss tradeoffs.”
,C. “Mammography is ineffective before age 50 and should not
be done.”
D. “A single negative mammogram rules out future breast
cancer for years.”
Correct Answer
B
Rationales
Correct: Screening has potential mortality benefit but also risks
(false positives, overdiagnosis); shared decision-making is
needed.
A: Overstates benefit and removes patient choice; not accurate.
C: Mammography can detect cancer before 50; blanket
exclusion is incorrect.
D: A negative test does not rule out future cancer; interval
cancers occur.
Teaching Point
Screening requires balancing mortality benefit against false
positives and overdiagnosis.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 6.
7
, Reference
Ch. 7 — Global Diversity of Health System Financing and
Delivery
Question Stem
A health policymaker must choose between a tax-funded
system and private insurance model to expand coverage. Which
feature most reliably increases equitable access?
Options
A. Relying on market competition among insurers.
B. Universal, publicly funded coverage with minimal user fees.
C. Employer-based coverage tied to full-time employment.
D. Premium subsidies for low-income individuals only.
Correct Answer
B
Rationales
Correct: Universal public funding and low user fees reduce
financial barriers and promote equity in access across
populations.
A: Competition can improve efficiency but may leave gaps and
complexity that worsen equity.
C: Employer-based coverage excludes unemployed and informal
workers, limiting equity.
D: Subsidies help, but targeted programs may still leave gaps
and administrative barriers.
