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Chapter1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
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Multiple Choice ghgh
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1. Which ghghtype gh ghof ghghclinical ghghdecision-makingghghis ghghmost ghghreliable?
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B. Analytical
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2. Which ghghof ghghthe ghghfollowingghghis ghghfalse? ghghTo ghghobtain ghghadequate ghghhistory, gh gh health-care ghghproviders ghghmust ghghbe:
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3. Essential gh ghparts ghghof ghgha ghghhealth ghghhistoryinclude ghghall g h g h of ghghthe ghghfollowing ghghexcept:
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B. Historyof ghghthe gh gh present ghghillness
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4. Which ghghof ghghthe ghghfollowing ghghis gh gh false? ghghWhile ghghperformingghghthe ghghphysical g h g h examination, ghghthe ghghexaminer g h gh must ghghbe ghghableto:
A. Differentiatebetween ghghnormal gh ghand ghghabnormal gh ghfindings
B. Recall ghghknowledge ghghof ghgha ghghrange ghghof ghghconditions ghghandftheir ghghassociated ghghsigns ghghand
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C. Recognize ghghhow ghghcertain ghghconditions ghghaffect gh gh the ghghresponseghghto ghghother ghghconditions
D. Foresee ghghunpredictable gh gh findings
5. The ghghfollowingghghis ghghthe ghghleast ghghreliable ghghsource ghghof ghghinformation ghghfor gh gh diagnostic ghghstatistics:
A. Evidence-based ghghinvestigations
B. Primaryreports g h g h of ghghresearch
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D. Published ghghmeta-analyses
6. The ghghfollowing ghghcan ghghbe ghghused ghghtoghghassist ghghin ghghsound gh gh clinical ghghdecision-making:
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B. Low ghghpercentage ghghofghghpersons ghghwith ghghthe ghghgiven ghghcondition gh ghwill ghghhave ghghan
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ghghmathematical gh gh modeling ghgh to ghghexpress ghghthe ghgh likelihood g h g h of ghgh a ghgh condition ghgh in ghgh select ghgh situations, ghgh settings, gh gh and/or
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Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
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Answer Section
ghgh
MULTIPLE ghghCHOICE
1. ANS: B
Croskerry ghgh(2009) ghghdescribes ghghtwo ghghmajor ghghtypes ghghof ghghclinical ghghdiagnostic gh ghdecision-making: ghgh intuitive ghghand
ghgh analytical. ghgh Intuitive ghgh decision- ghgh making ghgh (similar ghgh to ghgh Augenblink gh gh decision-making) gh gh is ghgh based ghgh on ghgh the
ghgh experience ghgh and ghgh intuition gh gh of ghgh the gh gh clinician ghgh and ghgh is gh gh less ghgh reliable gh gh and f paired ghgh with ghgh fairly ghgh common ghgh errors.
ghgh In ghgh contrast, ghgh analytical ghgh decision-making ghgh is ghgh based ghghon ghgh careful ghgh consideration ghgh and ghgh has ghgh greater ghgh reliabilitywith
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PTS: 1
2. ANS: D
To ghghobtain ghghadequate ghghhistory, ghghproviders ghghmust ghghbe ghghwell ghghorganized, ghghattentive ghghto ghghthe ghghpatient’s ghghverbal ghghand
ghghnonverbal ghgh language, ghghand ghghable ghgh to ghgh accurately ghgh interpret gh gh the ghgh patient’s ghgh responses ghgh to ghgh questions. ghgh Rather ghgh than
ghgh reading ghgh into ghgh the gh gh patient’s ghgh statements, ghgh they ghgh clarify ghgh any ghgh areas gh gh of ghgh uncertainty.
PTS: 1
3. ANS: C
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PTS: 1
4. ANS: D
While ghghperforming gh ghthe ghghphysical ghghexamination, ghghthe ghghexaminer ghghmust ghghbe ghghable ghghto ghghdifferentiate ghghbetween gh ghnormal
ghgh and ghgh abnormal ghgh findings, ghgh recall ghgh knowledge gh gh of ghgh a ghgh range gh gh of ghgh conditions, gh gh including ghgh their ghgh associated ghgh signs
ghgh and ghgh symptoms, ghgh recognize ghgh how ghgh certain gh gh conditions ghgh affectthe ghghresponse ghgh to ghghother ghgh conditions, ghgh and ghgh distinguish
ghgh the ghgh relevance ghgh of ghgh varied ghgh abnormal ghgh findings.
PTS: 1
5. ANS: C
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analyses. ghghAnother gh ghsource ghghof ghghstatistics, ghghthe ghghone ghghthat ghghhas ghghbeen ghghmost ghghwidelyused ghghand ghghavailable g h g h for
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PTS: 1
6. ANS: D
To ghghassist ghghin ghghclinical ghghdecision-making, ghgha ghghnumber ghghof ghghevidence-based ghghresources ghghhave ghghbeen ghghdeveloped ghghto ghghassist
ghghthe ghgh clinician. gh gh Resources, gh gh such ghgh as ghghalgorithms ghgh and ghgh clinical ghgh practice ghgh guidelines, ghgh assist ghgh in ghgh clinical
ghgh reasoning ghgh when gh gh properlyapplied.
PTS: 1
7. ANS: A
The ghghsensitivity ghghof ghgha ghghdiagnostic ghghstudy ghghis gh ghthe ghghpercentage ghghof gh ghindividuals ghghwith ghghthe ghghtarget ghghcondition ghghwho
ghgh show ghgh an ghgh abnormal, ghgh or ghgh positive,result. ghgh Ahigh ghghsensitivityindicates ghghthat ghgh a ghghgreater ghgh percentage ghgh of ghghpersons
ghgh with ghghthe ghgh given ghgh condition ghgh will gh gh have ghghan ghgh abnormal gh gh result.
PTS: 1
8. ANS: B
The ghghspecificity gh ghof ghgha ghghdiagnostic ghghstudy ghghis ghghthe ghghpercentage ghghof ghghnormal, ghghhealthy ghgh individuals ghghwho ghghhave ghgha
ghgh normal ghgh result. ghgh The ghgh greater ghgh thef specificity, ghgh the gh gh greater gh gh the ghgh percentage ghgh of ghgh individuals ghgh who ghgh will ghgh have
ghgh negative, gh gh or ghgh normal, gh gh results ghgh if ghgh they ghgh do ghgh not ghgh have ghgh the gh gh target ghgh condition.
PTS: 1
9. ANS: A
The ghghlikelihood ghghratio ghgh is ghghthe ghghprobability ghghthat ghgha ghghpositive ghghtest ghghresult ghghwill ghghbe ghghassociated gh ghwith ghgha gh ghperson
ghgh who ghgh has ghgh the ghgh target ghgh condition ghgh and ghgh af negative ghgh result gh gh will ghgh be ghgh associated ghgh with ghgh a ghgh healthy ghgh person. ghgh A
ghgh likelihood ghgh ratio ghgh above ghgh 1 ghgh indicates ghgh that ghgh a ghgh positive ghgh result gh gh is ghgh associated ghgh with ghghthe ghghdisease; ghgh a ghgh likelihood
g h g h ratio ghghless ghgh than ghgh1 ghgh indicates ghghthat ghgh a ghgh negative g h g h result ghgh is ghgh associated gh gh with ghghan gh gh absence ghgh of ghghthe ghgh disease.
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7th Edition Dains ghgh ghgh
Chapter1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
ghgh ghgh ghgh f ghgh ghgh ghgh ghgh ghgh
Multiple Choice ghgh
Identify thechoice thatbest completesthe statement oranswers
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1. Which ghghtype gh ghof ghghclinical ghghdecision-makingghghis ghghmost ghghreliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which ghghof ghghthe ghghfollowingghghis ghghfalse? ghghTo ghghobtain ghghadequate ghghhistory, gh gh health-care ghghproviders ghghmust ghghbe:
A. Methodical ghghand ghghsystematic
B. Attentive ghghto ghghthe ghghpatient’s ghghverbal ghghand ghghnonverbal
ghghlanguage
C. Able gh ghtoghghaccuratelyinterpret gh gh the ghghpatient’s
ghgh responses
D. Adept gh gh at ghghreading ghghintothe ghghpatient’s ghghstatements
3. Essential gh ghparts ghghof ghgha ghghhealth ghghhistoryinclude ghghall g h g h of ghghthe ghghfollowing ghghexcept:
A. Chief ghghcomplaint
B. Historyof ghghthe gh gh present ghghillness
C. Current ghghvital ghghsigns
D. All gh gh ofghghthe ghghabove gh ghare ghghessential
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4. Which ghghof ghghthe ghghfollowing ghghis gh gh false? ghghWhile ghghperformingghghthe ghghphysical g h g h examination, ghghthe ghghexaminer g h gh must ghghbe ghghableto:
A. Differentiatebetween ghghnormal gh ghand ghghabnormal gh ghfindings
B. Recall ghghknowledge ghghof ghgha ghghrange ghghof ghghconditions ghghandftheir ghghassociated ghghsigns ghghand
ghghsymptoms
C. Recognize ghghhow ghghcertain ghghconditions ghghaffect gh gh the ghghresponseghghto ghghother ghghconditions
D. Foresee ghghunpredictable gh gh findings
5. The ghghfollowingghghis ghghthe ghghleast ghghreliable ghghsource ghghof ghghinformation ghghfor gh gh diagnostic ghghstatistics:
A. Evidence-based ghghinvestigations
B. Primaryreports g h g h of ghghresearch
C. Estimation ghghbased ghghon ghghaghghprovider’s
ghghexperience
D. Published ghghmeta-analyses
6. The ghghfollowing ghghcan ghghbe ghghused ghghtoghghassist ghghin ghghsound gh gh clinical ghghdecision-making:
A. Algorithmpublished ghghin gh gh a ghghpeer-reviewed ghghjournal
ghgh article
B. Clinical ghghpractice ghghguidelines
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D. All gh ghof ghghthefabove
7. If ghgha ghghdiagnostic ghghstudyhas ghghhigh ghghsensitivity, g h g h this ghghindicates ghgha:
A. High ghghpercentage ghghofghghpersons ghghwith ghghthe ghghgiven ghghcondition gh ghwill ghghhaveghghan
ghghabnormal ghghresult
B. Low ghghpercentage ghghofghghpersons ghghwith ghghthe ghghgiven ghghcondition gh ghwill ghghhave ghghan
ghghabnormal ghghresult
C. Low ghghlikelihood ghghof ghghnormalghghresult ghghin ghghpersons ghghwithout ghgha ghghgiven ghghcondition
D. None ghghof ghghtheabove
8. If ghgha gh ghdiagnostic ghghstudyhas gh gh high ghghspecificity, g h g h this ghghindicates ghgha:
A. Low ghghpercentage gh gh of ghghhealthyindividuals gh gh will ghghshow ghgha ghghnormalghghresult
B. High gh gh percentage gh gh of ghghhealthyindividuals ghghwill ghghshow ghgha ghghnormal
ghgh result
C. High gh gh percentage gh gh ofindividuals ghgh with ghgh a ghghdisorder ghghwill ghghshow ghgha
ghghnormal ghghresult
D. Low ghghpercentage ghghofghghindividuals ghghwith ghgha ghghdisorder ghghwill gh ghshow ghghan
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9. Aflikelihood gh gh ratio ghghabove gh gh 1 ghghindicates ghghthat ghgha ghghdiagnostic ghghtest ghghshowing ghgha:
A. Positive gh gh result ghghis ghghstronglyassociated gh ghwith ghghthe ghghdisease
B. Negative ghghresult ghghis ghghstronglyassociated ghghwith gh ghabsence gh gh of
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C. Positive gh ghresult ghghis ghghweaklyassociated gh gh with ghghthe ghghdisease
D. Negativeresult ghgh is gh gh weaklyassociated g h gh with ghghabsence ghghof
ghghthe ghgh disease
,10. Which ghghof ghghthe ghghfollowing ghghclinical ghghreasoningghghtools ghghis ghghdefined ghghas ghghevidence-based ghghresource ghghbased ghghon
ghghmathematical gh gh modeling ghgh to ghghexpress ghghthe ghgh likelihood g h g h of ghgh a ghgh condition ghgh in ghgh select ghgh situations, ghgh settings, gh gh and/or
ghghpatients?
, A. Clinical ghghpractice
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B. Clinicalghghdecision ghghrule
C. Clinical ghghalgorithm
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ghgh ghgh ghgh ghgh ghgh ghgh ghgh ghgh ghgh ghgh
Answer Section
ghgh
MULTIPLE ghghCHOICE
1. ANS: B
Croskerry ghgh(2009) ghghdescribes ghghtwo ghghmajor ghghtypes ghghof ghghclinical ghghdiagnostic gh ghdecision-making: ghgh intuitive ghghand
ghgh analytical. ghgh Intuitive ghgh decision- ghgh making ghgh (similar ghgh to ghgh Augenblink gh gh decision-making) gh gh is ghgh based ghgh on ghgh the
ghgh experience ghgh and ghgh intuition gh gh of ghgh the gh gh clinician ghgh and ghgh is gh gh less ghgh reliable gh gh and f paired ghgh with ghgh fairly ghgh common ghgh errors.
ghgh In ghgh contrast, ghgh analytical ghgh decision-making ghgh is ghgh based ghghon ghgh careful ghgh consideration ghgh and ghgh has ghgh greater ghgh reliabilitywith
ghgh rare gh gh errors.
PTS: 1
2. ANS: D
To ghghobtain ghghadequate ghghhistory, ghghproviders ghghmust ghghbe ghghwell ghghorganized, ghghattentive ghghto ghghthe ghghpatient’s ghghverbal ghghand
ghghnonverbal ghgh language, ghghand ghghable ghgh to ghgh accurately ghgh interpret gh gh the ghgh patient’s ghgh responses ghgh to ghgh questions. ghgh Rather ghgh than
ghgh reading ghgh into ghgh the gh gh patient’s ghgh statements, ghgh they ghgh clarify ghgh any ghgh areas gh gh of ghgh uncertainty.
PTS: 1
3. ANS: C
Vitalghghsigns ghghare ghghpart ghghofghghthe ghghphysical ghghexamination ghghportion ghghofghghpatient ghghassessment, ghghnot ghghpart gh ghofthe ghghhealth ghghhistory.
PTS: 1
4. ANS: D
While ghghperforming gh ghthe ghghphysical ghghexamination, ghghthe ghghexaminer ghghmust ghghbe ghghable ghghto ghghdifferentiate ghghbetween gh ghnormal
ghgh and ghgh abnormal ghgh findings, ghgh recall ghgh knowledge gh gh of ghgh a ghgh range gh gh of ghgh conditions, gh gh including ghgh their ghgh associated ghgh signs
ghgh and ghgh symptoms, ghgh recognize ghgh how ghgh certain gh gh conditions ghgh affectthe ghghresponse ghgh to ghghother ghgh conditions, ghgh and ghgh distinguish
ghgh the ghgh relevance ghgh of ghgh varied ghgh abnormal ghgh findings.
PTS: 1
5. ANS: C
Sources ghghfor ghghdiagnostic ghghstatistics ghghinclude ghghtextbooks, gh ghprimary ghghreports ghghof ghghresearch, gh ghand ghghpublished gh ghmeta-
analyses. ghghAnother gh ghsource ghghof ghghstatistics, ghghthe ghghone ghghthat ghghhas ghghbeen ghghmost ghghwidelyused ghghand ghghavailable g h g h for
ghgh application g h g h to ghghthe ghghreasoning ghghprocess, ghgh is ghghthe ghghestimation gh gh based ghghon ghgh a ghgh provider’s ghgh experience, ghgh although ghgh these
ghgh are ghgh rarely ghgh accurate. ghgh Over ghgh the gh gh past ghgh decade, ghgh the ghgh availability ghgh of gh gh evidence ghgh on ghgh which gh gh to ghgh base ghgh clinical
ghgh reasoningis ghghimproving, g h g h and ghghthere ghghis gh gh an ghgh increasing ghghexpectation ghgh that ghgh clinical gh gh reasoning ghghbe ghgh based ghgh on
ghghscientific ghgh evidence.
Evidence-based ghghstatistics ghghare gh gh also ghghincreasinglybeing ghghused ghghto ghghdevelop g h g h resources ghghto ghghfacilitate g h g h clinical g h g h decision-making.
PTS: 1
6. ANS: D
To ghghassist ghghin ghghclinical ghghdecision-making, ghgha ghghnumber ghghof ghghevidence-based ghghresources ghghhave ghghbeen ghghdeveloped ghghto ghghassist
ghghthe ghgh clinician. gh gh Resources, gh gh such ghgh as ghghalgorithms ghgh and ghgh clinical ghgh practice ghgh guidelines, ghgh assist ghgh in ghgh clinical
ghgh reasoning ghgh when gh gh properlyapplied.
PTS: 1
7. ANS: A
The ghghsensitivity ghghof ghgha ghghdiagnostic ghghstudy ghghis gh ghthe ghghpercentage ghghof gh ghindividuals ghghwith ghghthe ghghtarget ghghcondition ghghwho
ghgh show ghgh an ghgh abnormal, ghgh or ghgh positive,result. ghgh Ahigh ghghsensitivityindicates ghghthat ghgh a ghghgreater ghgh percentage ghgh of ghghpersons
ghgh with ghghthe ghgh given ghgh condition ghgh will gh gh have ghghan ghgh abnormal gh gh result.
PTS: 1
8. ANS: B
The ghghspecificity gh ghof ghgha ghghdiagnostic ghghstudy ghghis ghghthe ghghpercentage ghghof ghghnormal, ghghhealthy ghgh individuals ghghwho ghghhave ghgha
ghgh normal ghgh result. ghgh The ghgh greater ghgh thef specificity, ghgh the gh gh greater gh gh the ghgh percentage ghgh of ghgh individuals ghgh who ghgh will ghgh have
ghgh negative, gh gh or ghgh normal, gh gh results ghgh if ghgh they ghgh do ghgh not ghgh have ghgh the gh gh target ghgh condition.
PTS: 1
9. ANS: A
The ghghlikelihood ghghratio ghgh is ghghthe ghghprobability ghghthat ghgha ghghpositive ghghtest ghghresult ghghwill ghghbe ghghassociated gh ghwith ghgha gh ghperson
ghgh who ghgh has ghgh the ghgh target ghgh condition ghgh and ghgh af negative ghgh result gh gh will ghgh be ghgh associated ghgh with ghgh a ghgh healthy ghgh person. ghgh A
ghgh likelihood ghgh ratio ghgh above ghgh 1 ghgh indicates ghgh that ghgh a ghgh positive ghgh result gh gh is ghgh associated ghgh with ghghthe ghghdisease; ghgh a ghgh likelihood
g h g h ratio ghghless ghgh than ghgh1 ghgh indicates ghghthat ghgh a ghgh negative g h g h result ghgh is ghgh associated gh gh with ghghan gh gh absence ghgh of ghghthe ghgh disease.
