TEST BANK FOR ADVANCED ASSESSMENT INTERPRETING
FINDINGS AND FORMULATING DIFFERENTIAL DIAGNOSES
5th EDITION GOOLSBY CHAPTERS 1 - 22 | COMPLETE
, Chapter1. AssessmentandClinical Decision Making: An Overview
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Multiple Choice
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Identify the choice that best completes the statement or accurate answer:->s the question.
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1. Whichtype of clinical decision-makingis most reliable? jf jf jf jf fj jf jf
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which ofthefollowingis false?Toobtain adequatehistory, health-careproviders must be:
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A. Methodical and systematic jf jf
B. Attentive to the patient’s verbal and nonverbal language
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C. Able to accuratelyinterpret the patient’s responses
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D. Adept at readingintothe patient’s statements
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3. Essential parts ofa health historyinclude all ofthe following except: jf jf fj jf jf fj jf jf jf jf jf
A. Chief complaint jf
B. Historyof thepresentillness fj fj jf jf
C. Currentvital signs jf jf
D. All ofthe above areessential historycomponents
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4. Which ofthe following is false? While performing the physical examination, the examiner must be ableto:
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A. Differentiate between normal and abnormal findings jf jf jf jf jf
B. Recall knowledge of arange of conditions and their associated signs and symptoms
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C. Recognize how certain conditions affect theresponse to other conditions
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D. Foresee unpredictable findings jf jf
5. The followingis theleast reliablesource ofinformation for diagnosticstatistics:
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A. Evidence-based investigations jf
B. Primaryreports of research jf jf
C. Estimation based on aprovider’s experience jf jf jf fj jf
D. Published meta-analyses jf
6. The following canbeusedtoassist insound clinical decision-making:
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A. Algorithmpublished in a peer-reviewed journal article jf jf jf jf jf
B. Clinical practice guidelines jf j f
C. Evidence-based research jf
D. All of the above
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7. If a diagnostic studyhas high sensitivity, this indicates a:
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A. High percentage of persons withthegiven condition will have anabnormal result
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B. Lowpercentage of persons with thegivencondition will have anabnormal result
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C. Lowlikelihood ofnormal result in persons without a given condition
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D. None of theabove jf jf fj
8. If a diagnosticstudyhas high specificity, this indicates a:
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A. Low percentage of healthyindividuals will showa normal result
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B. High percentage ofhealthyindividuals will showa normal result
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C. High percentageofindividuals with adisorder will showa normal result
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D. Lowpercentage ofindividuals withadisorder will showanabnormal result
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9. Alikelihood ratio above 1 indicates that adiagnostic test showinga: jf jf jf jf jf jf jf jf jf jf
A. Positive result is strongly associated with the sickness
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B. Negativeresult is stronglyassociated with absence of the sickness
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C. Positiveresult is weakly associated with the sickness
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D. Negativeresult is weaklyassociated with absence of the sickness
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, 10. Whichofthe followingclinical reasoningtools is defined asevidence-based resource based on mathematical modeling
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A. Clinical practice guideline jf jf
B. Clinical decision rule jf jf
C. Clinical algorithm jf
Chapter1:Clinicalreasoning, differentialdiagnosis,evidence-basedpractice,andsymptom ana
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Accurate answer:-> Section
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MULTIPLE CHOICE jf
1. ACCURATE ANSWER:->: B jf
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-
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making) is based on the experience and intuition of the clinician and is less reliable andpaired with fairly common errors. In contrast, an
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alytical decision-making is basedon careful consideration and has greater reliabilitywith rare errors.
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2. ACCURATE ANSWER:->: D jf
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal language, and ableto
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accurately interpret the patient’s responses to questions.Rather than reading into the patient’s statements, they clarify any areas of
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uncertainty.
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3. ACCURATE ANSWER:->: C jf
Vitalsigns are part ofthe physical examination portion ofpatient assessment, not part of the health history.
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4. ACCURATE ANSWER:->: D jf
Whileperformingthe physical examination,theexaminer must beable todifferentiate betweennormal andabnormal findings, recall kno
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wledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affectthe respons
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e to other conditions, and distinguish the relevance of varied abnormal findings.
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5. ACCURATE ANSWER:->: C jf
Sources for diagnostic statistics include textbooks, primary reportsof research, and published meta-
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analyses. Another source of statistics, the onethathas been most widelyused and available for application tothe reasoningprocess, isthe
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estimation based ona provider’s experience, although these are rarelyaccurate. Over the past decade, the availability of evidence on which t
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o base clinical reasoningisimproving,andthereis anincreasingexpectationthat clinical reasoningbe based onscientific evidence.
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Evidence-based statistics are alsoincreasinglybeing used todevelop resources to facilitate clinical decision-making.
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6. ACCURATE ANSWER:->: D jf
To assist inclinical decision-making, a number of evidence-
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based resources have been developed to assist the clinician. Resources, such asalgorithms and clinical practice guidelines, assist incl
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inical reasoning when properlyapplied.
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7. ACCURATE ANSWER:->: A jf
The sensitivityof a diagnostic studyis the percentage of individuals with the target condition who show an abnormal, or positive,result. Ah
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ighsensitivityindicatesthata greater percentage of persons with the given condition will have anabnormal result.
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8. ACCURATE ANSWER:->: B jf
The specificity of a diagnostic study is the percentageof normal, healthy individuals who have a normal result. The greater the spe
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cificity, the greater the percentageof individuals who will have negative, or normal, results if they do not have the target conditi
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on.
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9. ACCURATE ANSWER:->: A jf
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target condition and a ne
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gativeresult will be associated witha healthyperson. Alikelihoodratioabove 1 indicates that a positiveresultisassociated withthe sicknes
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s; alikelihood ratioless than1 indicates that a negative result is associated with an absence ofthesickness.
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, POINTS: 1
10. ACCURATE ANSWER:->: B
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Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
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based resourcesthat provide probabilisticstatements regarding thelikelihood that a conditionexists if certainvariables are met wi
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th regard tothe prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain s
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ituations, settings, and/or patient characteristics.
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