Chapter m1.mAssessmentm andm Clinicalm Decision-Making:m Overview
Multiplem Choice
Identifym them choicem thatm bestm completesm them statementm orm answersm them question.
1. Which mtypemof mclinicalmdecision-makingmismmostmreliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which mof mthemfollowingmismfalse?mTo mobtain madequate mhistory,mhealth-
caremprovidersmmustmbe:
A. Methodicalmand m systematic
B. Attentive mto mthempatient’smverbalmand
nonverbalm language
C. Ablemto maccurately minterpretmthempatient’s
responses
D. Adeptmatmreadingminto mthempatient’s
statements
3. Essentialmpartsmof mamhealth mhistory minclude mallmof mthemfollowingmexcept:
A. Chief mcomplaint
B. History mof mthempresentmillness
C. Currentmvitalmsigns
D. Allmof mthemabovemaremessentialmhistory
components
4.
Which mof mthemfollowingmismfalse?mWhilemperformingmthemphysicalmexamina
tion,mthemexaminermmustmbemablemto:
A. Differentiate mbetween m normalm and
abnormalm findings
B. Recallmknowledge mof mamrangemof mconditions
and mtheirmassociated msignsmand msymptoms
C. Recognize mhowmcertain mconditionsmaffect
themresponse mto mothermconditions
D. Foresee m unpredictable m findings
5.
Themfollowingmismthemleastmreliablemsourcemof minformation mformdiagnostic mstatistic
s:
A. Evidence-based m investigations
B. Primary mreportsmof mresearch
C. Estimation mbased mon mamprovider’s
experience
D. Published m meta-analyses
, 6. Themfollowingmcan mbemused mto massistmin msound mclinicalmdecision-making:
A. Algorithm mpublished min mampeer-reviewed
journalmarticle
B. Clinicalm practicem guidelines
C. Evidence-based m research
D. Allmof mthemabove
7. If mamdiagnostic mstudy mhasmhigh msensitivity,mthismindicatesma:
A. High mpercentage mof mpersonsmwith mthemgiven
condition mwillmhaveman mabnormalmresult
B. Lowmpercentage mof mpersonsmwith mthemgiven
condition mwillmhaveman mabnormalmresult
C. Lowmlikelihood mof mnormalmresultmin
personsmwithoutmamgiven mcondition
D. None mof mthemabove
8. If mamdiagnostic mstudy mhasmhigh mspecificity,mthismindicatesma:
A. Lowmpercentage mof mhealthy mindividuals
willmshowmamnormalmresult
B. High mpercentage mof mhealthy mindividuals
willmshowmamnormalmresult
C. High mpercentage mof mindividualsmwith ma
disordermwillmshowmamnormalmresult
D. Lowmpercentage mof mindividualsmwith ma
disordermwillmshowman mabnormalmresult
9. Amlikelihood mratio mabove m1 mindicatesmthatmamdiagnostic mtestmshowingma:
A. Positivemresultmismstrongly massociated mwith
themdisease
B. Negativemresultmismstrongly massociated mwith
absence mof mthemdisease
C. Positivemresultmismweakly massociated mwith
themdisease
D. Negativemresultmismweakly massociated mwith
absence mof mthemdisease
10. Which mof mthemfollowingmclinicalmreasoningmtoolsmismdefined masmevidence-
mbased mresource mbased mon mmathematicalmmodelingmto mexpress mthe mlikelihood mof ma mconditi
on min mselectmsituations,msettings,mand/ormpatients?
A. Clinicalm practicem guideline
B. Clinicalm decision m rule
C. Clinicalm algorithm
D. Clinicalm recommendation
Chapter m1.mAssessmentm andm Clinicalm Decision-Making:m Overview
,Answer mSection
MULTIPLEmCHOICE
1. ANS:m m B
Croskerry m(2009)mdescribesmtwo mmajormtypesmof mclinicalmdiagnostic mdecision-
making:mintuitivemand manalytical.mIntuitivemdecision-
makingm(similarmto mAugenblink mdecision-
mmaking)mismbased mon mthe mexperience mand mintuition mofmthe mclinician mand mismless mreliable m
and mpaired mwith mfairly mcommon merrors.mIn mcontrast,manalyticalmdecision-
makingmismbased mon mcarefulmconsideration mand mhasmgreatermreliability mwith mraremerrors.
PTS: 1
2. ANS:m m D
To mobtain madequate mhistory,mprovidersmmustmbemwellmorganized,mattentivemto mthempatient’sm
verbalmand mnonverbalmlanguage,mand mablemto maccurately minterpretmthempatient’smresponsesmt
o mquestions.mRathermthan mreadingminto mthempatient’smstatements,mthey mclarify manymareasmofm
uncertainty.
PTS: 1
3. ANS:m m C
Vitalmsignsmarempartmof mthemphysicalmexamination mportion mof mpatientmassessment, mnotmpartm
of mthemhealth mhistory.
PTS: 1
4. ANS:m m D
Whilemperformingmthemphysicalmexamination, mthemexaminermmustmbemablemto mdifferentiat
embetween mnormalmand mabnormalmfindings,mrecallmknowledge mofmamrangemofmconditions,m
includingmtheirmassociated msignsmand msymptoms, mrecognize mhowmcertain mconditionsmaffe
ctmthemresponse mto mothermconditions, mand mdistinguish mthemrelevancemofmvaried mabnormalm
findings.
PTS: 1
5. ANS:m m C
Sourcesmformdiagnostic mstatisticsminclude mtextbooks,mprimary mreportsmofmresearch,mand mpub
lished mmeta-
analyses.mAnothermsource mofmstatistics,mthemonemthatmhasmbeenmmostmwidely mused mand mavail
ablemformapplication mto mthemreasoningmprocess,mismthemestimation mbasedmon mamprovider’smex
perience,malthough mthesemaremrarely maccurate.mOvermthempastmdecade,mthemavailability mof mev
idencemon mwhich mto mbasemclinicalmreasoningmismimproving,mand mtheremisman mincreasingmexp
ectation mthatmclinicalmreasoningmbembased mon mscientificmevidence.mEvidence-
mbased mstatistics mare malso mincreasingly mbeingmused mto mdevelop mresources mto mfacilitate mclinic
almdecision-making.
PTS: 1
6. ANS:m m D
, To massistmin mclinicalmdecision-making,mamnumbermof mevidence-
based mresourcesmhavembeenmdeveloped mto massistmthemclinician.mResources,msuchmasmalgori
thmsmand mclinicalmpracticemguidelines,massistmin mclinicalmreasoningmwhen mproperly mappli
ed.
PTS: 1
7. ANS:m m A
Themsensitivity mof mamdiagnostic mstudy mismthempercentage mof mindividualsmwith mthemtargetmc
ondition mwho mshowman mabnormal,mormpositive,mresult.mAmhigh msensitivity mindicatesmthatm
amgreatermpercentage mof mpersonsmwith mthemgiven mcondition mwillmhaveman mabnormalmresult
.
PTS: 1
8. ANS:m m B
Themspecificity mof mamdiagnostic mstudy mismthempercentage mof mnormal,mhealthy mindividualsmwh
o mhavemamnormalmresult.mThemgreatermthemspecificity,mthemgreatermthempercentage mof mindivid
ualsmwho mwillmhavemnegative,mormnormal,mresultsmif mthey mdo mnotmhavemthemtargetmcondition.
PTS: 1
9. ANS:m m A
Themlikelihood mratio mismthemprobability mthatmampositive mtestmresultmwillmbemassociated mwith m
amperson mwho mhasmthemtargetmcondition mand mamnegativemresultmwillmbemassociated mwith mamhe
althy mperson.mAmlikelihood mratio mabove m1 mindicatesmthatmampositive mresultmismassociated mwit
h mthemdisease;mamlikelihood mratio mlessmthan m1 mindicatesmthatmamnegativemresultmismassociated
mwith man mabsence mof mthe mdisease.
PTS: 1
10. ANS:m m B
Clinicalmdecision m(ormprediction)mrulesmprovidemanothermsupportmformclinicalmreasoning.mC
linicalmdecision mrulesmaremevidence-
based mresourcesmthatmprovidemprobabilistic mstatementsmregardingmthemlikelihood mthatmamco
ndition mexistsmif mcertain mvariablesmaremmetmwith mregard mto mthemprognosismof mpatientsmwith m
specificmfindings.mDecision mrulesmusemmathematicalmmodelsmand maremspecific mto mcertain msi
tuations,msettings,mand/ormpatientmcharacteristics.
PTS: 1
Multiplem Choice
Identifym them choicem thatm bestm completesm them statementm orm answersm them question.
1. Which mtypemof mclinicalmdecision-makingmismmostmreliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which mof mthemfollowingmismfalse?mTo mobtain madequate mhistory,mhealth-
caremprovidersmmustmbe:
A. Methodicalmand m systematic
B. Attentive mto mthempatient’smverbalmand
nonverbalm language
C. Ablemto maccurately minterpretmthempatient’s
responses
D. Adeptmatmreadingminto mthempatient’s
statements
3. Essentialmpartsmof mamhealth mhistory minclude mallmof mthemfollowingmexcept:
A. Chief mcomplaint
B. History mof mthempresentmillness
C. Currentmvitalmsigns
D. Allmof mthemabovemaremessentialmhistory
components
4.
Which mof mthemfollowingmismfalse?mWhilemperformingmthemphysicalmexamina
tion,mthemexaminermmustmbemablemto:
A. Differentiate mbetween m normalm and
abnormalm findings
B. Recallmknowledge mof mamrangemof mconditions
and mtheirmassociated msignsmand msymptoms
C. Recognize mhowmcertain mconditionsmaffect
themresponse mto mothermconditions
D. Foresee m unpredictable m findings
5.
Themfollowingmismthemleastmreliablemsourcemof minformation mformdiagnostic mstatistic
s:
A. Evidence-based m investigations
B. Primary mreportsmof mresearch
C. Estimation mbased mon mamprovider’s
experience
D. Published m meta-analyses
, 6. Themfollowingmcan mbemused mto massistmin msound mclinicalmdecision-making:
A. Algorithm mpublished min mampeer-reviewed
journalmarticle
B. Clinicalm practicem guidelines
C. Evidence-based m research
D. Allmof mthemabove
7. If mamdiagnostic mstudy mhasmhigh msensitivity,mthismindicatesma:
A. High mpercentage mof mpersonsmwith mthemgiven
condition mwillmhaveman mabnormalmresult
B. Lowmpercentage mof mpersonsmwith mthemgiven
condition mwillmhaveman mabnormalmresult
C. Lowmlikelihood mof mnormalmresultmin
personsmwithoutmamgiven mcondition
D. None mof mthemabove
8. If mamdiagnostic mstudy mhasmhigh mspecificity,mthismindicatesma:
A. Lowmpercentage mof mhealthy mindividuals
willmshowmamnormalmresult
B. High mpercentage mof mhealthy mindividuals
willmshowmamnormalmresult
C. High mpercentage mof mindividualsmwith ma
disordermwillmshowmamnormalmresult
D. Lowmpercentage mof mindividualsmwith ma
disordermwillmshowman mabnormalmresult
9. Amlikelihood mratio mabove m1 mindicatesmthatmamdiagnostic mtestmshowingma:
A. Positivemresultmismstrongly massociated mwith
themdisease
B. Negativemresultmismstrongly massociated mwith
absence mof mthemdisease
C. Positivemresultmismweakly massociated mwith
themdisease
D. Negativemresultmismweakly massociated mwith
absence mof mthemdisease
10. Which mof mthemfollowingmclinicalmreasoningmtoolsmismdefined masmevidence-
mbased mresource mbased mon mmathematicalmmodelingmto mexpress mthe mlikelihood mof ma mconditi
on min mselectmsituations,msettings,mand/ormpatients?
A. Clinicalm practicem guideline
B. Clinicalm decision m rule
C. Clinicalm algorithm
D. Clinicalm recommendation
Chapter m1.mAssessmentm andm Clinicalm Decision-Making:m Overview
,Answer mSection
MULTIPLEmCHOICE
1. ANS:m m B
Croskerry m(2009)mdescribesmtwo mmajormtypesmof mclinicalmdiagnostic mdecision-
making:mintuitivemand manalytical.mIntuitivemdecision-
makingm(similarmto mAugenblink mdecision-
mmaking)mismbased mon mthe mexperience mand mintuition mofmthe mclinician mand mismless mreliable m
and mpaired mwith mfairly mcommon merrors.mIn mcontrast,manalyticalmdecision-
makingmismbased mon mcarefulmconsideration mand mhasmgreatermreliability mwith mraremerrors.
PTS: 1
2. ANS:m m D
To mobtain madequate mhistory,mprovidersmmustmbemwellmorganized,mattentivemto mthempatient’sm
verbalmand mnonverbalmlanguage,mand mablemto maccurately minterpretmthempatient’smresponsesmt
o mquestions.mRathermthan mreadingminto mthempatient’smstatements,mthey mclarify manymareasmofm
uncertainty.
PTS: 1
3. ANS:m m C
Vitalmsignsmarempartmof mthemphysicalmexamination mportion mof mpatientmassessment, mnotmpartm
of mthemhealth mhistory.
PTS: 1
4. ANS:m m D
Whilemperformingmthemphysicalmexamination, mthemexaminermmustmbemablemto mdifferentiat
embetween mnormalmand mabnormalmfindings,mrecallmknowledge mofmamrangemofmconditions,m
includingmtheirmassociated msignsmand msymptoms, mrecognize mhowmcertain mconditionsmaffe
ctmthemresponse mto mothermconditions, mand mdistinguish mthemrelevancemofmvaried mabnormalm
findings.
PTS: 1
5. ANS:m m C
Sourcesmformdiagnostic mstatisticsminclude mtextbooks,mprimary mreportsmofmresearch,mand mpub
lished mmeta-
analyses.mAnothermsource mofmstatistics,mthemonemthatmhasmbeenmmostmwidely mused mand mavail
ablemformapplication mto mthemreasoningmprocess,mismthemestimation mbasedmon mamprovider’smex
perience,malthough mthesemaremrarely maccurate.mOvermthempastmdecade,mthemavailability mof mev
idencemon mwhich mto mbasemclinicalmreasoningmismimproving,mand mtheremisman mincreasingmexp
ectation mthatmclinicalmreasoningmbembased mon mscientificmevidence.mEvidence-
mbased mstatistics mare malso mincreasingly mbeingmused mto mdevelop mresources mto mfacilitate mclinic
almdecision-making.
PTS: 1
6. ANS:m m D
, To massistmin mclinicalmdecision-making,mamnumbermof mevidence-
based mresourcesmhavembeenmdeveloped mto massistmthemclinician.mResources,msuchmasmalgori
thmsmand mclinicalmpracticemguidelines,massistmin mclinicalmreasoningmwhen mproperly mappli
ed.
PTS: 1
7. ANS:m m A
Themsensitivity mof mamdiagnostic mstudy mismthempercentage mof mindividualsmwith mthemtargetmc
ondition mwho mshowman mabnormal,mormpositive,mresult.mAmhigh msensitivity mindicatesmthatm
amgreatermpercentage mof mpersonsmwith mthemgiven mcondition mwillmhaveman mabnormalmresult
.
PTS: 1
8. ANS:m m B
Themspecificity mof mamdiagnostic mstudy mismthempercentage mof mnormal,mhealthy mindividualsmwh
o mhavemamnormalmresult.mThemgreatermthemspecificity,mthemgreatermthempercentage mof mindivid
ualsmwho mwillmhavemnegative,mormnormal,mresultsmif mthey mdo mnotmhavemthemtargetmcondition.
PTS: 1
9. ANS:m m A
Themlikelihood mratio mismthemprobability mthatmampositive mtestmresultmwillmbemassociated mwith m
amperson mwho mhasmthemtargetmcondition mand mamnegativemresultmwillmbemassociated mwith mamhe
althy mperson.mAmlikelihood mratio mabove m1 mindicatesmthatmampositive mresultmismassociated mwit
h mthemdisease;mamlikelihood mratio mlessmthan m1 mindicatesmthatmamnegativemresultmismassociated
mwith man mabsence mof mthe mdisease.
PTS: 1
10. ANS:m m B
Clinicalmdecision m(ormprediction)mrulesmprovidemanothermsupportmformclinicalmreasoning.mC
linicalmdecision mrulesmaremevidence-
based mresourcesmthatmprovidemprobabilistic mstatementsmregardingmthemlikelihood mthatmamco
ndition mexistsmif mcertain mvariablesmaremmetmwith mregard mto mthemprognosismof mpatientsmwith m
specificmfindings.mDecision mrulesmusemmathematicalmmodelsmand maremspecific mto mcertain msi
tuations,msettings,mand/ormpatientmcharacteristics.
PTS: 1
