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

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  • 25. september 2024
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  • 978 1259642883
  • 2024
  • test bank for harrison s principles of internal
  • harrison s principles of internal medicine self
  • self assessment and board review 19 edition
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, SECTION I q




General Considerations in Clinical Medicine q q q q




qqqqqqqqqqqqqqqqqqqqqqqqqqqqqq

qqqq QUESTIONS


DIRECTIONS: Choose the one best response to each question.
q q q q q q q q




I-1. All of the following statements regarding practice guidelines set forth by governing agencies and professional
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qorganizations are true EXCEPT: q q q



A. Clinical practice guidelines protect caregivers against inappropriate charges of malpractice, yetdo not
q q q q q q q q q q q


provide protection for patients from receiving substandard care.
q q q q q q q q


B. Practice guidelines have largely reached a stage of nuance allowing them to address every uniqueillness and
q q q q q q q q q q q q q q q


patient presented to the modern physician.
q q q q q q


C. Practice guidelines provide a legal constraint to physicians, and deviation from guideline-basedcare
q q q q q q q q q q q


invariably leaves physicians vulnerable to legal action.
q q q q q q q


D. Where different organizations disagree regarding practice guidelines, a third-party agency has been
q q q q q q q q q q q


appointed to mitigate these disagreements such that now all major organizations’ guidelines are consistent.
q q q q q q q q q q q q q q


E. All of the above statements are not true.
q q q q q q q




I-2. Regarding molecular medicine, which of the following statements represents an INACCURATE example of the
q q q q q q q q q q q q q q


qlisted area of study:
q q q



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


B. Metabolomics: A biochemist studies the rate of flux through the creatine kinase pathway during the cardiac
q q q q q q q q q q q q q q q


cycle.
q


C. Metagenomics: A biologist studies the genomic alterations in molds commonly found in humandwellings.
q q q q q q q q q q q q


D. Microbiomics: A microbiologist studies the genomic variation in thermophiles, bacteria that cansurvive
q q q q q q q q q q q


extreme heat near deep ocean vents.
q q q q q q


E. Proteomics: A cardiologist studies desmosomal proteins and their posttranslational modifications in
q q q q q q q q q q


studying arrhythmogenic right ventricular dysplasia.
q q q q q




I-3. Which of the following is the best definition of evidence-based medicine?
q q q q q q q q q q q



A. A summary of existing data from existing clinical trials with a critical methodologic review andstatistical
q q q q q q q q q q q q q q


analysis of summative data
q q q q


B. A type of research that compares the results of one approach to treating disease with anotherapproach to
q q q q q q q q q q q q q q q q


treating the same disease
q q q q


C. Clinical decision-making support tools developed by professional organizations that includeexpert opinions
q q q q q q q q q q


and data from clinical trials
q q q q q


D. Clinical decision making supported by data, preferably randomized controlled clinical trials
q q q q q q q q q q


E. One physician’s clinical experience in caring for multiple patients with a specific disorder over many years
q q q q q q q q q q q q q q q


I-4. Which of the following is the standard measure for determining the impact of a health condition on a
q q q q q q q q q q q q q q q q q q


qpopulation?
A. Disability-adjusted life-years q


B. Infant mortality q


C. Life expectancy
q


D. Standardized mortality ratio q q


E. Years of life lost q q q

,I-5. Which of the following statements regarding disease patterns worldwide is true?
q q q q q q q q q q q



A. Childhood undernutrition is the leading risk factor for global disease burden.
q q q q q q q q q q


B. In a 2006 publication, the World Health Organization (WHO) estimated that 10% of the totalglobal burden
q q q q q q q q q q q q q q q


qof disease was due to modifiable environmental risk factors.
q q q q q q q q


C. In 2010, ischemic heart disease was the leading cause of death among adults.
q q q q q q q q q q q q


D. In the last two decades, mortality attributed to communicable diseases, maternal and perinatalconditions,
q q q q q q q q q q q q


qand nutritional deficiencies has remained fairly stable, with the majority (76%) of mortality from these
q q q q q q q q q q q q q q


qcauses occurring in sub-Saharan Africa and southern Asia.
q q q q q q q


E. While poverty status has been shown to be linked to health status on the individual level, thesame
q q q q q q q q q q q q q q q q


qrelationship does not hold true when studying the link between national health indicators and gross
q q q q q q q q q q q q q q


qdomestic product per capita among nations. q q q q q




I-6. You are appointed to a governmental healthcare advisory subcommittee concerned with addressing problems
q q q q q q q q q q q q q


q facing the global health community. Your task is to draw general conclusions from the global fight against
q q q q q q q q q q q q q q q q


q tuberculosis (TB) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) that
q q q q q q q q q q


q may be applied in combatting other diseases, including noncommunicable diseases. Which of the following
q q q q q q q q q q q q q


q conclusions is reasonable when considering HIV/AIDS and TB as chronic diseases?
q q q q q q q q q q



A. Barriers to adequate healthcare and patient adherence imposed by extreme poverty must beconcomitantly
q q q q q q q q q q q q


addressed to adequately treat and prevent chronic disease in developing nations.
q q q q q q q q q q q


B. Charging small fees for health services (e.g., AIDS prevention and care) supplies the patient witha sense of
q q q q q q q q q q q q q q q q


the treatment’s value and increases compliance and overall public health.
q q q q q q q q q q


C. Despite adequate available tools to practice their trade locally in developing nations, manyphysicians and
q q q q q q q q q q q q q


nurses emigrate to developed nations to practice their respective trades, a phenomenon called “brain
q q q q q q q q q q q q q q


drain.”
q


D. In developed nations where physicians are abundant, community health worker supervision ofthe care of
q q q q q q q q q q q q q


chronically ill patients is not effective.
q q q q q q


E. In the case of chronic infectious diseases, switching from one drug to another through aprolonged course of
q q q q q q q q q q q q q q q q


treatment provides the highest cure rate by obviating the infectious agent’s ability to develop resistance to
q q q q q q q q q q q q q q q q


any single drug.
q q q




I-7. Mrs. Jones, a 22-year-old African American woman, presents to Dr. Smith, an internal medicine specialist, with
q q q q q q q q q q q q q q q q


q a facial rash. Mrs. Jones states that the rash began after spending a day at the beach with her family. She also
q q q q q q q q q q q q q q q q q q q q q


q notes that her metacarpophalangeal and proximal interphalangeal joints have been painful and swollen for the
q q q q q q q q q q q q q q


q preceding 2 weeks. On examination, the joints are swollen and tender. Laboratory analysis discloses reduced
q q q q q q q q q q q q q q


q creatinine clearance, proteinuria, and hemolytic anemia. Antinuclear antibodies (a test with a high negative
q q q q q q q q q q q q q


q predictive value for systemic lupus erythematosus) are detected at significant titer, and ultimately, the
q q q q q q q q q q q q q


q diagnosis of systemic lupus erythematosus is made.
q q q q q q


Two weeks later, Mrs. Johnson, a 24-year-old African American woman, presents with a facial rash and elbow
q q q q q q q q q q q q q q q q


q pain to Dr. Smith. After a cursory interview and brief physical exam, Dr. Smith sends blood work only testing for
q q q q q q q q q q q q q q q q q q q


q antinuclear antibodies. When the test returns negative (no antibodies detected), Dr. Smith presumes this to be
q q q q q q q q q q q q q q q


q a false-negative result and starts Mrs. Johnson on hydroxychloroquine and prednisone for treatment of
q q q q q q q q q q q q q


q systemic lupus erythematosus. Which heuristic(s) did Dr. Smith likely employ in diagnosing Mrs. Johnson with
q q q q q q q q q q q q q q


q systemic lupus erythematosus? q q


A. Availability heuristic q


B. Anchoring heuristic q


C. Bayes’ rule q


D. Confirmation bias q




E. A and B q q




I-8. You have invented a blood test, which you name “veritangin,” to determine if patients are having a myocardial
q q q q q q q q q q q q q q q q q q


q infarction. You devise an experiment to determine the performance of your veritangin assay by testing it versus
q q q q q q q q q q q q q q q q


q the troponin assay, the currently accepted gold standard for determining myocardial infarction, in 100 random
q q q q q q q q q q q q q q


q emergency department patients with chest pain. You choose a veritangin result >1 ng/dL as positive for
q q q q q q q q q q q q q q q


q myocardial infarction. Your results are listed in the table below.
q q q q q q q q q

, Which of the following statements regarding the characteristics of the veritangin assay in this trial is true?
q q q q q q q q q q q q q q q q



A. The posttest probability of the veritangin test does not depend on the population studied.
q q q q q q q q q q q q q


B. The sensitivity of the veritangin assay depends on the population studied and the diseaseprevalence in that
q q q q q q q q q q q q q q q


population.
q


C. The sensitivity of the veritangin assay will decrease by 50% if you reduce the threshold for apositive result
q q q q q q q q q q q q q q q q q


to >0.5 ng/dL.
q q q


D. The sensitivity of the veritangin test cannot be calculated based on the above data.
q q q q q q q q q q q q q


E. The specificity of the veritangin assay is 0.93 (70/75).
q q q q q q q q




I-9. You are designing a clinical trial to test the use of a novel anticoagulant, clotbegone, in the treatment of deep
q q q q q q q q q q q q q q q q q q q q


q vein thrombosis. Which of the following statements regarding the design of the trial is true?
q q q q q q q q q q q q q q



A. An optimal study design would assign many patients to clotbegone and compare their outcomesto the
q q q q q q q q q q q q q q


outcomes of prior (historical) patients not taking clotbegone. This would allow faster trial completion.
q q q q q q q q q q q q q q


B. If the trial returns a positive result (clotbegone is superior to placebo), that means that anypatient with a
q q q q q q q q q q q q q q q q q


clot would benefit from clotbegone therapy.
q q q q q q


C. Observing the outcomes of patients already taking clotbegone versus patients who are not ispreferable to
q q q q q q q q q q q q q q


assigning patients to clotbegone or placebo in a blinded fashion. The observational strategy is more “real
q q q q q q q q q q q q q q q q


world,” applicable to the general population, and free of bias.
q q q q q q q q q q


D. Population selection for the trial enrollment is not important as long as careful attention torandomization
q q q q q q q q q q q q q q


and blinding is observed.
q q q q


E. The advantage of performing a randomized clinical trial of clotbegone over a prospectiveobservational
q q q q q q q q q q q q


study of clotbegone is the avoidance of treatment selection bias.
q q q q q q q q q q




I-10. A receiver operating characteristic (ROC) curve is constructed for a new test developed to diagnose disease X.
q q q q q q q q q q q q q q q q q


qAll of the following statements regarding the ROC curve are true EXCEPT:
q q q q q q q q q q q



A. One criticism of the ROC curve is that it is developed for testing only one test or clinicalparameter with
q q q q q q q q q q q q q q q q q q


exclusion of other potentially relevant data.
q q q q q q


B. ROC curve allows the selection of a threshold value for a test that yields the best sensitivity withthe fewest
q q q q q q q q q q q q q q q q q q


false-positive tests.
q q


C. The axes of the ROC curve are sensitivity versus 1 – specificity.
q q q q q q q q q q q


D. The ideal ROC curve will have a value of 0.5.
q q q q q q q q q


E. The value of the ROC curve is calculated as the area under the curve generated from the true-positive rate
q q q q q q q q q q q q q q q q q q


versus the false-positive rate.
q q q q




I-11. When considering a potential screening test, what end points should be considered to assess the potential
q q q q q q q q q q q q q q q q


qgain from a proposed intervention?
q q q q



A. Absolute and relative impact of screening on the disease outcome
q q q q q q q q q


B. Cost per life-year saved q q q


C. Increase in the average life expectancy for the entire population
q q q q q q q q q


D. Number of subjects screened to alter the outcome in one individual
q q q q q q q q q q


E. All of the aboveq q q




I-12. You are appointed to an advisory committee in the WHO tasked with making recommendations regarding
q q q q q q q q q q q q q q q


qbreast cancer screening and prevention. In regard to screening and preventing breast cancer in women, which
q q q q q q q q q q q q q q q


qof the following potential recommendations from your committee would be valid?
q q q q q q q q q q

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