,Chapter491.49Assessment49and49Clinical49Decision-Making:49Overview
Multiple49 Choice
Identify49the49choice49that49 best49 completes49the49statementZorZanswers49the49question.
1. Which49 type49 of49 clinical49 decision-making49 is49 most49 reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which49 of49 the49 following49 is49 false?49To49 obtain49 adequate49 history,49 health-
care49providers49 must49 be:
A. Methodical49 and49 systematic
B. Attentive49 to49 the49 patient’s49 verbal49 and49 nonverbal49 language
C. Able49 to49 accurately49 interpret49 the49 patient’s49 responses
D. Adept49 at49 reading49 into49the49 patient’s49 statements
3. Essential49 parts49 of49 a49 health49 history49 include49 all49 of49 the49 followingZexcept:
A. Chief49 complaint
B. History49 of49 the49 present49 illness
C. Current49 vital49 signs
D. All49 of49 the49 above49 are49 essential49 history49 components
4. Which49of49the49following49is49false?49While49performingZthe49physicalZexamination,49the49exam
iner49must49beable49to:
A. Differentiate49 between49 normal49 and49 abnormal49 findings
B. Recall49 knowledge49 of49 a49 range49 of49 conditions49 and49 theirZassociated49 signs49 and49 symptoms
C. Recognize49 how49 certain49 conditions49 affect49 the49 responseZto49 other49 conditions
D. Foresee49 unpredictable49 findings
5. The49 following49 is49 the49 least49 reliableZsource49 of49 information49 for49 diagnostic49 statistics:
A. Evidence-based49 investigations
B. Primary49 reports49 ofZresearch
C. Estimation49 basedZonZa49provider’sZexperience
D. Published49 meta-analyses
6. The49 followingZcan49 be49 used49 toZassist49in49 sound49 clinical49 decision-making:
A. AlgorithmZpublished49inZaZpeer-reviewed49journal49article
B. ClinicalZpractice49guidelines
C. Evidence-basedZresearch
D. All49 of49 theZabove
7. If49 a49 diagnosticZstudy49 has49 high49 sensitivity,49 this49 indicates49 a:
A. High49 percentage49 of49 persons49 with49 the49 given49 condition49 will49 have49 an49 abnormal49 result
B. Low49 percentage49 of49 persons49 with49 the49 given49 condition49 will49 have49 an49 abnormal49 result
C. Low49 likelihood49 of49 normal49 result49 in49 persons49 without49 a49 given49 condition
D. None49 of49 the49 above
, 8. If49 a49 diagnostic49 study49 has49 high49 specificity,49 this49 indicates49 a:
A. Low49 percentage49 of49 healthy49 individuals49 will49 show49 a49 normal49 result
B. High49 percentage49 of49 healthy49 individuals49 will49 show49 a49 normal49 result
C. High49 percentage49 of49 individuals49 with49 a49 disorder49 will49 show49 a49 normal49 result
D. Low49 percentage49 of49 individuals49 with49 a49 disorder49 will49 show49 an49 abnormal49 result
9. A49likelihood49 ratio49 above49149 indicates49 that49 a49 diagnostic49 test49 showing49 a:
A. Positive49 result49 is49 strongly49 associated49 with49 the49 disease
B. Negative49 result49 is49 strongly49 associated49 with49 absence49 of49 the49 disease
C. Positive49 result49 is49 weakly49 associated49 with49 the49 disease
D. Negative49 result49 is49 weakly49 associated49 with49 absence49 of49 the49 disease
4 9 4 9 10.4 9 Which4 9 of4 9 the4 9 following4 9 clinical4 9 reasoning4 9 tools4 9 is4 9 defined4 9 as4 9 evidence-
based49 resource49 based49 on49 mathematical49 modeling49 to49 express49 the49 likelihood49of49 a49 con
dition49 in49selec49t49situations,49settings,49and/orpatients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
D. Clinical recommendation
, Chapter 1. Assessment and Clinical Decision-
Answer49Section
MULTIPLE49 CHOICE
1. ANS:4 9 4 9 B
Croskerry49 (2009)49 describes49 two49 major49 types49 of49 clinical49 diagnostic49 decision-
making:49intuitive49and49analytical.49Intuitive49decision-
making49(similar49to49Augenblink49decision-
49making)49is49based49on49the49experience49and49intuition49of49the49clinician49and49is49less49reliab
le49and49paired49with49fairly49common49errors.49In49contrast,49analytical49decision-
making49 is49 based49 on49 careful49 consideration49 and49 has49 greater49 reliabilitywith49 rare49 errors.
PTS: 1
2. ANS:4 9 4 9 D
To49obtain49adequate49history,49providers49must49be49well49organized,49attentiveZto49the49patient’
sZverbal49an49dnonverbal49language,49and49able49to49accurately49interpret49the49patient’sZresponse
s49to49questions.49Rather49than49reading49into49the49patient’s49statements,49they49clarify49any49are
as49ofZuncertainty.
PTS: 1
3. ANS:4 9 4 9 C
Vital49signs49are49part49of49the49physical49examination49portionZof49patient49assessment,49not49part49of4
9the49healt49hhistory.
PTS: 1
4. ANS:4 9 4 9 D
While49performing49the49physical49examination,49the49examinerZmust49be49able49to49differentiate49
betweenn49ormal49and49abnormal49findings,49recallZknowledge49ofZa49range49of49conditions,49inclu
ding49theirZassociat49ed49signs49and49symptoms,49recognize49how49certain49conditions49affect49the4
9response49to49other49conditions,49and49distinguish49the49relevance49ofZvaried49abnormalZfindings.
PTS: 1
5. ANS:4 9 4 9 C
Sources49for49diagnosticZstatistics49include49textbooks,49primary49reports49of49research,49and49
published49meta-
analyses.49Another49source49ofZstatistics,49the49one49that49has49been49most49widely49used49and49
available49for49applicationZtoZthe49reasoningZprocess,49is49the49estimation49based49on49a49provide
r’s49experience,49althoug4 9 h49theseZare49rarely49accurate.ZOver49the49past49decade,49the49availab
ility49of49evidence49on49which49to49base49clinical49reasoning49is49improving,49and49there49is49an4
9increasing49expectation49that49clinical49reasoningbe49based49on49scientificZevidence.49Evidence-
based49statisticsZareZalso49increasingly49being49used49to49develop49resources49to49facilitate49clini
cal49decisi49on-making.
PTS: 1
6. ANS:4 9 4 9 D
To49 assist49 in49 clinical49 decision-making,49 a49 number49 of49 evidence-
based49resources49have49been49developedto49assist49the49clinician.49Resources,49such49as49algorith
ms49and49cli49nical49practice49guidelines,49assist49in49clinical49reasoning49when49properly49applied.
hhhhhhhhhh
Multiple49 Choice
Identify49the49choice49that49 best49 completes49the49statementZorZanswers49the49question.
1. Which49 type49 of49 clinical49 decision-making49 is49 most49 reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which49 of49 the49 following49 is49 false?49To49 obtain49 adequate49 history,49 health-
care49providers49 must49 be:
A. Methodical49 and49 systematic
B. Attentive49 to49 the49 patient’s49 verbal49 and49 nonverbal49 language
C. Able49 to49 accurately49 interpret49 the49 patient’s49 responses
D. Adept49 at49 reading49 into49the49 patient’s49 statements
3. Essential49 parts49 of49 a49 health49 history49 include49 all49 of49 the49 followingZexcept:
A. Chief49 complaint
B. History49 of49 the49 present49 illness
C. Current49 vital49 signs
D. All49 of49 the49 above49 are49 essential49 history49 components
4. Which49of49the49following49is49false?49While49performingZthe49physicalZexamination,49the49exam
iner49must49beable49to:
A. Differentiate49 between49 normal49 and49 abnormal49 findings
B. Recall49 knowledge49 of49 a49 range49 of49 conditions49 and49 theirZassociated49 signs49 and49 symptoms
C. Recognize49 how49 certain49 conditions49 affect49 the49 responseZto49 other49 conditions
D. Foresee49 unpredictable49 findings
5. The49 following49 is49 the49 least49 reliableZsource49 of49 information49 for49 diagnostic49 statistics:
A. Evidence-based49 investigations
B. Primary49 reports49 ofZresearch
C. Estimation49 basedZonZa49provider’sZexperience
D. Published49 meta-analyses
6. The49 followingZcan49 be49 used49 toZassist49in49 sound49 clinical49 decision-making:
A. AlgorithmZpublished49inZaZpeer-reviewed49journal49article
B. ClinicalZpractice49guidelines
C. Evidence-basedZresearch
D. All49 of49 theZabove
7. If49 a49 diagnosticZstudy49 has49 high49 sensitivity,49 this49 indicates49 a:
A. High49 percentage49 of49 persons49 with49 the49 given49 condition49 will49 have49 an49 abnormal49 result
B. Low49 percentage49 of49 persons49 with49 the49 given49 condition49 will49 have49 an49 abnormal49 result
C. Low49 likelihood49 of49 normal49 result49 in49 persons49 without49 a49 given49 condition
D. None49 of49 the49 above
, 8. If49 a49 diagnostic49 study49 has49 high49 specificity,49 this49 indicates49 a:
A. Low49 percentage49 of49 healthy49 individuals49 will49 show49 a49 normal49 result
B. High49 percentage49 of49 healthy49 individuals49 will49 show49 a49 normal49 result
C. High49 percentage49 of49 individuals49 with49 a49 disorder49 will49 show49 a49 normal49 result
D. Low49 percentage49 of49 individuals49 with49 a49 disorder49 will49 show49 an49 abnormal49 result
9. A49likelihood49 ratio49 above49149 indicates49 that49 a49 diagnostic49 test49 showing49 a:
A. Positive49 result49 is49 strongly49 associated49 with49 the49 disease
B. Negative49 result49 is49 strongly49 associated49 with49 absence49 of49 the49 disease
C. Positive49 result49 is49 weakly49 associated49 with49 the49 disease
D. Negative49 result49 is49 weakly49 associated49 with49 absence49 of49 the49 disease
4 9 4 9 10.4 9 Which4 9 of4 9 the4 9 following4 9 clinical4 9 reasoning4 9 tools4 9 is4 9 defined4 9 as4 9 evidence-
based49 resource49 based49 on49 mathematical49 modeling49 to49 express49 the49 likelihood49of49 a49 con
dition49 in49selec49t49situations,49settings,49and/orpatients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
D. Clinical recommendation
, Chapter 1. Assessment and Clinical Decision-
Answer49Section
MULTIPLE49 CHOICE
1. ANS:4 9 4 9 B
Croskerry49 (2009)49 describes49 two49 major49 types49 of49 clinical49 diagnostic49 decision-
making:49intuitive49and49analytical.49Intuitive49decision-
making49(similar49to49Augenblink49decision-
49making)49is49based49on49the49experience49and49intuition49of49the49clinician49and49is49less49reliab
le49and49paired49with49fairly49common49errors.49In49contrast,49analytical49decision-
making49 is49 based49 on49 careful49 consideration49 and49 has49 greater49 reliabilitywith49 rare49 errors.
PTS: 1
2. ANS:4 9 4 9 D
To49obtain49adequate49history,49providers49must49be49well49organized,49attentiveZto49the49patient’
sZverbal49an49dnonverbal49language,49and49able49to49accurately49interpret49the49patient’sZresponse
s49to49questions.49Rather49than49reading49into49the49patient’s49statements,49they49clarify49any49are
as49ofZuncertainty.
PTS: 1
3. ANS:4 9 4 9 C
Vital49signs49are49part49of49the49physical49examination49portionZof49patient49assessment,49not49part49of4
9the49healt49hhistory.
PTS: 1
4. ANS:4 9 4 9 D
While49performing49the49physical49examination,49the49examinerZmust49be49able49to49differentiate49
betweenn49ormal49and49abnormal49findings,49recallZknowledge49ofZa49range49of49conditions,49inclu
ding49theirZassociat49ed49signs49and49symptoms,49recognize49how49certain49conditions49affect49the4
9response49to49other49conditions,49and49distinguish49the49relevance49ofZvaried49abnormalZfindings.
PTS: 1
5. ANS:4 9 4 9 C
Sources49for49diagnosticZstatistics49include49textbooks,49primary49reports49of49research,49and49
published49meta-
analyses.49Another49source49ofZstatistics,49the49one49that49has49been49most49widely49used49and49
available49for49applicationZtoZthe49reasoningZprocess,49is49the49estimation49based49on49a49provide
r’s49experience,49althoug4 9 h49theseZare49rarely49accurate.ZOver49the49past49decade,49the49availab
ility49of49evidence49on49which49to49base49clinical49reasoning49is49improving,49and49there49is49an4
9increasing49expectation49that49clinical49reasoningbe49based49on49scientificZevidence.49Evidence-
based49statisticsZareZalso49increasingly49being49used49to49develop49resources49to49facilitate49clini
cal49decisi49on-making.
PTS: 1
6. ANS:4 9 4 9 D
To49 assist49 in49 clinical49 decision-making,49 a49 number49 of49 evidence-
based49resources49have49been49developedto49assist49the49clinician.49Resources,49such49as49algorith
ms49and49cli49nical49practice49guidelines,49assist49in49clinical49reasoning49when49properly49applied.
hhhhhhhhhh
