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Test bank-Advanced Health Assessment & Clinical
XR XR XR XR XR
XR Diagnosis in Primary Care 7th Edition Dains-100% XR XR XR XR XR XR
Topscores-2023-2024 XR X
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Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
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Multiple Choice
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Identify the choice that best completes the statement or answers the question.
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ii XR 1. Which type of clinical decision-making is most reliable? ii ii ii ii i ii ii
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
ii XR 2. Which of the following is false? To obtain adequate history, health-care providers must be:
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A. Methodical and systematic ii ii
B. Attentive to the patient‘s verbal and nonverbal language ii ii ii ii ii ii ii
C. Able to accurately interpret the patient‘s responses
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D. Adept at reading into the patient‘s statements
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ii XR 3. Essential parts of a health history include all of the following except: ii ii ii ii ii ii ii ii
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A. Chief complaint ii
B. History of the present illness i ii ii iRi
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C. Current vital signs ii ii
D. All of the above are essential history components
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ii XR 4. Which of the following is false? While performing the physical examination, the examiner must be able to:
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A. Differentiate between normal and abnormal findings ii ii ii ii ii
B. Recall knowledge of a range of conditions and their associated signs and symptoms
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C. Recognize how certain conditions affect the response to other conditions ii ii iXRi i ii
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D. Foresee unpredictable findings ii ii
ii XR 5. The following is the least reliable source o f information for diagnostic statistics:
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A. Evidence-based investigations i
B. Primary reports of research i ii
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C. Estimation based on a provider‘s experience ii ii ii ii ii
D. Published meta-analyses i
ii XR 6. The following can be used to assist in sound clinical decision-making:
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A. Algorithmpublished in a peer-reviewed journal article i iXRi iRi
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B. Clinical practice guidelines ii ii
C. Evidence-based research ii
D. All of the above
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ii XR 7. If a diagnostic study has high sensitivity, this indicates a:
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A. High percentage of persons with the given condition will have an abnormal result
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B. Low percentage of persons with the given condition will have an abnormal result
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C. Low likelihood of normal result in persons without a given condition
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D. None of the above ii ii ii
ii XR 8. If a diagnostic study has high specificity, this indicates a:
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A. Low percentage of healthy individuals will show a normal result
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B. High percentage of healthy individuals will show a normal result
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C. High percentage of individuals with a disorder will show a normal result
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D. Low percentage of individuals with a disorder will show an abnormal result
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ii XR 9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
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A. Positive result is strongly associated with the disease
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B. Negative result is strongly associated with absence of the disease
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C. Positive result is weakly associated with the disease
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D. Negative result is weakly associated with absence of the disease
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ii XR 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling
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to express the likelihood of a condition in select situations, settings, and/or patients?
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A. Clinical practice guideline ii iXRi
B. Clinical decision rule ii ii
C. Clinical algorithm ii
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
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Answer Section
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MULTIPLE CHOICE ii
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
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making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable
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andpaired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater
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reliability with rare errors.
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2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient‘s verbal and nonverbal language, and
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ableto accurately interpret the patient‘s responses to questions. Rather than reading into the patient‘s statements, they clarify
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any areas of uncertainty.
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3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
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4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings,
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recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions
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affectthe response to other conditions, and distinguish the relevance of varied abnormal findings.
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5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of
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statistics, the one that has been most widely used and available for application to the reasoning process, is the estimation based ona
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provider‘s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base
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clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence.
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Evidence-based statistics are also increasinglybeing used to develop resources to facilitate clinical decision-making.
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6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the
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clinician.Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly
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applied.
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7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or
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positive,result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal
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result.
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8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater
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thespecificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the
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target condition.
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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
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anegative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated
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with the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
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10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
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basedresources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met
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with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to
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certain situations, settings, and/or patient characteristics.
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