Test Bank For Harrison s principles of internal medicine self assessment and board review 19 Edition

, SECTION I f




QUESTIONS


DIRECTIONS: Choose the one best response to each question.
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I-1. All of the following statements regarding practice guidelines set forth by governing agencies and
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professional organizations are true EXCEPT:
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A. Clinical practice guidelines protect caregivers against inappropriate charges of malpractice,
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fyet do not provide protection for patients from receiving substandard care.
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B. Practice guidelines have largely reached a stage of nuance allowing them to address every unique
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illness and patient presented to the modern physician.
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C. Practice guidelines provide a legal constraint to physicians, and deviation from guideline-based
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fcare invariably leaves physicians vulnerable to legal action.
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D. Where different organizations disagree regarding practice guidelines, a third-party agency has
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fbeen appointed to mitigate these disagreements such that now all major organizations’ guidelines
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fare consistent. f


E. All of the above statements are not true.
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I-2. Regarding molecular medicine, which of the following statements represents an
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fINACCURATE example of the listed area of study: f f f f f f f



A. Exposomics: An endocrinologist studies sunlight exposure and population risk of hip fracture. f f f f f f f f f f f


B. Metabolomics: A biochemist studies the rate of flux through the creatine kinase pathway f f f f f f f f f f f f


during the cardiac cycle.
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C. Metagenomics: A biologist studies the genomic alterations in molds commonly found in f f f f f f f f f f f


human dwellings.
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D. Microbiomics: A microbiologist studies the genomic variation in thermophiles, bacteria that f f f f f f f f f f


can survive extreme heat near deep ocean vents.
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E. Proteomics: A cardiologist studies desmosomal proteins and their posttranslational modifications
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in studying arrhythmogenic right ventricular dysplasia.
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I-3. Which of the following is the best definition of evidence-based medicine?
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A. A summary of existing data from existing clinical trials with a critical methodologic review
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and statistical analysis of summative data
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B. A type of research that compares the results of one approach to treating disease with
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another approach to treating the same disease
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C. Clinical decision-making support tools developed by professional organizations that
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finclude expert opinions and data from clinical trials f f f f f f f


D. Clinical decision making supported by data, preferably randomized controlled clinical trials
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E. One physician’s clinical experience in caring for multiple patients with a specific disorder
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over many years
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,I-4. Which of the following is the standard measure for determining the impact of a health condition
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f on a population?
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A. Disability-adjusted life-years f


B. Infant mortality f


C. Life expectancy f


D. Standardized mortality ratio f f


E. Years of life lost f f f




I-5. Which of the following statements regarding disease patterns worldwide is true?
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A. Childhood undernutrition is the leading risk factor for global disease burden. f f f f f f f f f f


B. In a 2006 publication, the World Health Organization (WHO) estimated that 10% of the
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total global burden of disease was due to modifiable environmental risk factors.
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C. In 2010, ischemic heart disease was the leading cause of death among adults.
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D. In the last two decades, mortality attributed to communicable diseases, maternal and perinatal
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conditions, and nutritional deficiencies has remained fairly stable, with the majority (76%) of
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mortality from these causes occurring in sub-Saharan Africa and southern Asia.
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E. While poverty status has been shown to be linked to health status on the individual level,
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the same relationship does not hold true when studying the link between national health
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indicators and gross domestic product per capita among nations.
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I-6. You are appointed to a governmental healthcare advisory subcommittee concerned with addressing
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fproblems facing the global health community. Your task is to draw general conclusions from
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f the global fight against tuberculosis (TB) and human immunodeficiency virus (HIV)/acquired
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fimmunodeficiency syndrome (AIDS) that may be applied in combatting other diseases, including f f f f f f f f f f f


fnoncommunicable diseases. Which of the following conclusions is reasonable when considering f f f f f f f f f f


fHIV/AIDS and TB as chronic diseases? f f f f f



A. Barriers to adequate healthcare and patient adherence imposed by extreme poverty must be f f f f f f f f f f f f


f concomitantly addressed to adequately treat and prevent chronic disease in developing f f f f f f f f f f


f nations.
B. Charging small fees for health services (e.g., AIDS prevention and care) supplies the patient
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f with a sense of the treatment’s value and increases compliance and overall public health.
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C. Despite adequate available tools to practice their trade locally in developing nations, many
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f physicians and nurses emigrate to developed nations to practice their respective trades, a f f f f f f f f f f f f


f phenomenon called “brain drain.” f f f


D. In developed nations where physicians are abundant, community health worker supervision
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f of the care of chronically ill patients is not effective.
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E. In the case of chronic infectious diseases, switching from one drug to another through a
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f prolonged course of treatment provides the highest cure rate by obviating the infectious agent’s f f f f f f f f f f f f f


f ability to develop resistance to any single drug. f f f f f f f




I-7. Mrs. Jones, a 22-year-old African American woman, presents to Dr. Smith, an internal medicine
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fspecialist, with a facial rash. Mrs. Jones states that the rash began after spending a day at the
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fbeach with her family. She also notes that her metacarpophalangeal and proximal
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f interphalangeal joints have been painful and swollen for the preceding 2 weeks. On examination, the f f f f f f f f f f f f f f


fjoints are swollen and tender. Laboratory analysis discloses reduced creatinine clearance,
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f proteinuria, and hemolytic anemia. Antinuclear antibodies (a test with a high negative predictive value
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ffor systemic lupus erythematosus) are detected at significant titer, and ultimately, the diagnosis of
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fsystemic lupus erythematosus is made. f f f f


Two weeks later, Mrs. Johnson, a 24-year-old African American woman, presents with a facial rash and
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f elbow pain to Dr. Smith. After a cursory interview and brief physical exam, Dr. Smith sends
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fblood work only testing for antinuclear antibodies. When the test returns negative (no antibodies
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fdetected), Dr. Smith presumes this to be a false-negative result and starts Mrs. Johnson on
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fhydroxychloroquine and prednisone for treatment of systemic lupus erythematosus. Which f f f f f f f f f


fheuristic(s) did Dr. Smith likely employ in diagnosing Mrs. Johnson with systemic lupus f f f f f f f f f f f f


f erythematosus?

, A. Availability heuristic f


B. Anchoring heuristic f


C. Bayes’ rule f


D. Confirmation bias f


E. A and B f f




I-8. You have invented a blood test, which you name “veritangin,” to determine if patients are having a
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fmyocardial infarction. You devise an experiment to determine the performance of your veritangin
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fassay by testing it versus the troponin assay, the currently accepted gold standard for determining
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fmyocardial infarction, in 100 random emergency department patients with chest pain. You choose a
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fveritangin result >1 ng/dL as positive for myocardial infarction. Your results are listed in the table
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fbelow.




Which of the following statements regarding the characteristics of the veritangin assay in this trial
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is true?
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A. The posttest probability of the veritangin test does not depend on the population studied.
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B. The sensitivity of the veritangin assay depends on the population studied and the
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disease prevalence in that population.
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C. The sensitivity of the veritangin assay will decrease by 50% if you reduce the threshold
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for a positive result to >0.5 ng/dL.
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D. The sensitivity of the veritangin test cannot be calculated based on the above data.
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E. The specificity of the veritangin assay is 0.93 (70/75).
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I-9. You are designing a clinical trial to test the use of a novel anticoagulant, clotbegone, in the
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ftreatment of deep vein thrombosis. Which of the following statements regarding the design of
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f the trial is true?
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A. An optimal study design would assign many patients to clotbegone and compare their
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f outcomes to the outcomes of prior (historical) patients not taking clotbegone. This would allow faster
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f trial completion. f


B. If the trial returns a positive result (clotbegone is superior to placebo), that means that
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f any patient with a clot would benefit from clotbegone therapy.
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C. Observing the outcomes of patients already taking clotbegone versus patients who are not is
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f preferable to assigning patients to clotbegone or placebo in a blinded fashion. The observational
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f strategy is more “real world,” applicable to the general population, and free of bias.
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D. Population selection for the trial enrollment is not important as long as careful attention to
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f randomization and blinding is observed. f f f f


E. The advantage of performing a randomized clinical trial of clotbegone over a prospective
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f observational study of clotbegone is the avoidance of treatment selection bias. f f f f f f f f f f




I-10. A receiver operating characteristic (ROC) curve is constructed for a new test developed to
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fdiagnose disease X. All of the following statements regarding the ROC curve are true EXCEPT:
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A. One criticism of the ROC curve is that it is developed for testing only one test
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or clinical parameter with exclusion of other potentially relevant data.
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B. ROC curve allows the selection of a threshold value for a test that yields the best sensitivity
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with the fewest false-positive tests.
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