lOMoARcPSD| 126 567 13
, lOMoARcPSD| 126 567 13
Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care
ij ij ij ij ij ij ij ij ij ij ij
7th Edition Dains ij ij ij
Chapter 1: Clinical Reasoning, DifferentialDiagnosis, Evidence-Based Practice, and Symptom Analysis
ij ij ij ij ij ij ij ij ij ij
Multiple Choice
ij ij
Identify the choice that best completes the statement oranswers the question.
ij ij ij ij ij ij ij ij ij ij ij
1. Which type of clinical decision-making is most reliable? ij ij ij ij ij ij ij
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
ij ij ij ij ij ij ij ij ij ij ij ij ij
A. Methodical and systematic ij ij
B. Attentive to the patient‘s verbal and nonverbal language ij ij ij ij ij ij ij
C. Able to accuratelyinterpret the patient‘s responses
ij ij ij ij ij ij
D. Adept at reading intothe patient‘s statements
ij ij ij ij ij ij
3. Essential parts of a health historyinclude all of the following except: ij ij ij ij ij ij ij ij ij ij ij
A. Chief complaint ij
B. Historyof the present illness ij ij ij ij
C. Current vital signs ij ij
D. All of the above are essential history components
ij ij ij ij ij ij ij
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
A. Differentiate between normal and abnormal findings ij ij ij ij ij
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ij ij ij ij ij ij ij ij ij ij ij ij
C. Recognize how certain conditions affect the response to other conditions ij ij ij ij ij ij ij ij ij
D. Foresee unpredictable findings ij ij
5. The following is the least reliable source of information for diagnostic statistics:
ij ij ij ij ij ij ij ij ij ij ij
A. Evidence-based investigations ij
B. Primaryreports of research ij ij ij
C. Estimation based on a provider‘s experience ij ij ij ij ij
D. Published meta-analyses ij
6. The following can be used to assist in sound clinical decision-making:
ij ij ij ij ij ij ij ij ij ij
A. Algorithmpublished in a peer-reviewed journal article ij ij ij ij ij ij
B. Clinical practice guidelines ij ij
C. Evidence-based research ij
D. All of the above
ij ij ij
7. If a diagnostic studyhas high sensitivity, this indicates a:
ij ij ij ij ij ij ij ij ij
A. High percentage of persons with the given condition will have an abnormal result
ij ij ij ij ij ij ij ij ij ij ij ij
B. Low percentage of persons with the given condition will have an abnormal result
ij ij ij ij ij ij ij ij ij ij ij ij
C. Low likelihood of normal result in persons without a given condition
ij ij ij ij ij ij ij ij ij ij
D. None of the above ij ij ij
8. If a diagnostic studyhas high specificity, this indicates a:
ij ij ij ij ij ij ij ij ij
A. Low percentage of healthyindividuals will show a normal result
ij ij ij ij ij ij ij ij ij
B. High percentage of healthyindividuals will show a normal result
ij ij ij ij ij ij ij ij ij
C. High percentage of individuals with a disorder will show a normal result
ij ij ij ij ij ij ij ij ij ij ij
D. Low percentage of individuals with a disorder will show an abnormal result
ij ij ij ij ij ij ij ij ij ij ij
9. Alikelihood ratio above 1 indicates that a diagnostic test showing a:
ij ij ij ij ij ij ij ij ij ij ij
A. Positive result is stronglyassociated with the disease ij ij ij ij ij ij ij
B. Negative result is stronglyassociated with absence of the diseaseij ij ij ij ij ij ij ij ij
C. Positive result is weaklyassociated with the disease ij ij ij ij ij ij ij
D. Negative result is weaklyassociated with absence of the disease ij ij ij ij ij ij ij ij ij
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
to express the likelihood of a condition in select situations, settings, and/or patients?
ij ij ij ij ij ij ij ij ij ij ij ij ij
, lOMoARcPSD| 126 567 13
A. Clinical practice guideline ij ij
B. Clinical decision rule ij ij
C. Clinical algorithm ij
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ij ij ij ij ij 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 ij ij ij ij ij ij ij ij
making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable and
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
reliability with rare errors.
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
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
to accurately interpret the patient‘s responses to questions. Rather than reading into the patient‘s statements, they clarify any
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
areas of uncertainty.
ij ij ij
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings,
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
the response to other conditions, and distinguish the relevance of varied abnormal findings.
ij ij ij 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-analyses. Another source of
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
statistics, the one that has been most widelyused and available for application to the reasoning process, is the estimation based on a
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
provider‘s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence.
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
ij ij ij ij ij ij ij ij ij ij ij ij ij
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician.
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positive,
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij 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
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
condition.
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
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
with the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
, lOMoARcPSD| 126 567 13
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain
ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij ij
situations, settings, and/or patient characteristics.
ij ij ij ij ij
PTS: 1
