TESTBANK b
ADVANCEDHEALTHASSESSMENT&CLINICALDIAGNOSISIN
b b b b b b
PRIMARY CARE, 6TH EDITION
b b b b
Joyce E. Dains, Linda Ciofu Baumann & Pamela Scheibel
b b b b b b b b
, lOMoARcPSD|126 b 567
b 13
Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care 6th
b b b b b b b b b b b b
Edition Dains b b
Chapter1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
b b b b b b b b b b
Multiple Choice b
Identify the choice that best completes the statement oranswers the question.
b b b b b b b b b b b
1. Which type of clinical decision-making is most reliable? b b b b b b b
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
b b b b b b b b b b b b b
A. Methodical and systematic b b
B. Attentive to the patient’s verbal and nonverbal language
b b b b b b b
C. Able to accurately interpret the patient’s responses
b b b b b b
D. Adept at reading into the patient’s statements
b b b b b b
3. Essential parts of a health history include all of the following except: b b b b b b b b b b b
A. Chief complaint b
B. History of the present illness b b b b
C. Current vital signs b b
D. All of the above are essential history components
b b b b b b b
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
b b b b b b b b b b b b b b b b
A. Differentiate between normal and abnormal findings b b b b b
B. Recall knowledge of a range of conditions and their associated signs and symptoms
b b b b b b b b b b b b
C. Recognize how certain conditions affect the response to other conditions
b b b b b b b b b
D. Foresee unpredictable findings b b
5. The following is the least reliable source of information for diagnostic statistics:
b b b b b b b b b b b
A. Evidence-based investigations b
B. Primary reports of research b b b
C. Estimation based on a provider’s experience b b b b b
D. Published meta-analyses b
6. The following can be used to assist in sound clinical decision-making:
b b b b b b b b b b
A. Algorithmpublished in a peer-reviewed journal article b b b b b b
B. Clinical practice guidelines b b
C. Evidence-based research b
D. All of the above
b b b
7. If a diagnostic studyhas high sensitivity, this indicates a:
b b b b b b b b b
A. High percentage of persons with the given condition will have an abnormal result
b b b b b b b b b b b b
B. Low percentage of persons with the given condition will have an abnormal result
b b b b b b b b b b b b
C. Low likelihood of normal result in persons without a given condition
b b b b b b b b b b
D. None of the above b b b
8. If a diagnostic studyhas high specificity, this indicates a:
b b b b b b b b b
A. Low percentage of healthy individuals will show a normal result
b b b b b b b b b
B. High percentage of healthy individuals will show a normal result
b b b b b b b b b
C. High percentage of individuals with a disorder will show a normal result
b b b b b b b b b b b
D. Low percentage of individuals with a disorder will show an abnormal result
b b b b b b b b b b b
9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
b b b b b b b b b b b
A. Positive result is strongly associated with the disease
b b b b b b b
B. Negative result is strongly associated with absence of the disease
b b b b b b b b b
C. Positive result is weakly associated with the disease
b b b b b b b
D. Negative result is weakly associated with absence of the disease
b b b b b b b b b
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to
b b b b b b b b b b b b b b b b
express the likelihood of a condition in select situations, settings, and/or patients?
b b b b b b b b b b b b
, lOMoARcPSD|126 b 567
b 13
A. Clinical practice guideline b b
B. Clinical decision rule b b
C. Clinical algorithm b
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
b b b b b b b b b b
Answer Section
b
MULTIPLE CHOICEb
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
b b b b b b b b b b b b b b
making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable and
b b b b b b b b b b b b b b b b b b b b
paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater
b b b b b b b b b b b b b b b b b
reliability with rare errors.
b b b b
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 to
b b b b b b b b b b b b b b b b b b b
accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any areas of
b b b b b b b b b b b b b b b b b b b
uncertainty.
b
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
b b b b b b b b b b b b b b b b b
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, recall
b b b b b b b b b b b b b b b b b
knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect the
b b b b b b b b b b b b b b b b b b
response to other conditions, and distinguish the relevance of varied abnormal findings.
b b b b b b b b b b b b
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of
b b b b b b b b b b b b b b b
statistics, the one that has been most widelyused and available for application to the reasoning process, is the estimation based on a
b b b b b b b b b b b b b b b b b b b b b b b
provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base
b b b b b b b b b b b b b b b b b b b
clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence.
b b b b b b b b b b b b b b b b b b
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
b b b b b b b b b b b b b
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician. Resources,
b b b b b b b b b b b b b b b b b
such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
b b b b b b b b b b b b b b
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,
b b b b b b b b b b b b b b b b b b b b
result. Ahigh sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
b b b b b b b b b b b b b b b b b b b b
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
b b b b b b b b b b b b b b b b b b b b
specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target
b b b b b b b b b b b b b b b b b b b b b
condition.
b
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
b b b b b b b b b b b b b b b b b b b b b b b
negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with
b b b b b b b b b b b b b b b b b b b b b b
the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
b b b b b b b b b b b b b b b b b b b b b
, lOMoARcPSD|126 b 567
b 13
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based
b b b b b b b b b b b b b b b
resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with
b b b b b b b b b b b b b b b b b b
regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain
b b b b b b b b b b b b b b b b b b b
situations, settings, and/or patient characteristics.
b b b b b
PTS: 1
ADVANCEDHEALTHASSESSMENT&CLINICALDIAGNOSISIN
b b b b b b
PRIMARY CARE, 6TH EDITION
b b b b
Joyce E. Dains, Linda Ciofu Baumann & Pamela Scheibel
b b b b b b b b
, lOMoARcPSD|126 b 567
b 13
Test Bank for Advanced Health Assessment & Clinical Diagnosis in Primary Care 6th
b b b b b b b b b b b b
Edition Dains b b
Chapter1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
b b b b b b b b b b
Multiple Choice b
Identify the choice that best completes the statement oranswers the question.
b b b b b b b b b b b
1. Which type of clinical decision-making is most reliable? b b b b b b b
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
b b b b b b b b b b b b b
A. Methodical and systematic b b
B. Attentive to the patient’s verbal and nonverbal language
b b b b b b b
C. Able to accurately interpret the patient’s responses
b b b b b b
D. Adept at reading into the patient’s statements
b b b b b b
3. Essential parts of a health history include all of the following except: b b b b b b b b b b b
A. Chief complaint b
B. History of the present illness b b b b
C. Current vital signs b b
D. All of the above are essential history components
b b b b b b b
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
b b b b b b b b b b b b b b b b
A. Differentiate between normal and abnormal findings b b b b b
B. Recall knowledge of a range of conditions and their associated signs and symptoms
b b b b b b b b b b b b
C. Recognize how certain conditions affect the response to other conditions
b b b b b b b b b
D. Foresee unpredictable findings b b
5. The following is the least reliable source of information for diagnostic statistics:
b b b b b b b b b b b
A. Evidence-based investigations b
B. Primary reports of research b b b
C. Estimation based on a provider’s experience b b b b b
D. Published meta-analyses b
6. The following can be used to assist in sound clinical decision-making:
b b b b b b b b b b
A. Algorithmpublished in a peer-reviewed journal article b b b b b b
B. Clinical practice guidelines b b
C. Evidence-based research b
D. All of the above
b b b
7. If a diagnostic studyhas high sensitivity, this indicates a:
b b b b b b b b b
A. High percentage of persons with the given condition will have an abnormal result
b b b b b b b b b b b b
B. Low percentage of persons with the given condition will have an abnormal result
b b b b b b b b b b b b
C. Low likelihood of normal result in persons without a given condition
b b b b b b b b b b
D. None of the above b b b
8. If a diagnostic studyhas high specificity, this indicates a:
b b b b b b b b b
A. Low percentage of healthy individuals will show a normal result
b b b b b b b b b
B. High percentage of healthy individuals will show a normal result
b b b b b b b b b
C. High percentage of individuals with a disorder will show a normal result
b b b b b b b b b b b
D. Low percentage of individuals with a disorder will show an abnormal result
b b b b b b b b b b b
9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
b b b b b b b b b b b
A. Positive result is strongly associated with the disease
b b b b b b b
B. Negative result is strongly associated with absence of the disease
b b b b b b b b b
C. Positive result is weakly associated with the disease
b b b b b b b
D. Negative result is weakly associated with absence of the disease
b b b b b b b b b
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to
b b b b b b b b b b b b b b b b
express the likelihood of a condition in select situations, settings, and/or patients?
b b b b b b b b b b b b
, lOMoARcPSD|126 b 567
b 13
A. Clinical practice guideline b b
B. Clinical decision rule b b
C. Clinical algorithm b
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
b b b b b b b b b b
Answer Section
b
MULTIPLE CHOICEb
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
b b b b b b b b b b b b b b
making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is less reliable and
b b b b b b b b b b b b b b b b b b b b
paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration and has greater
b b b b b b b b b b b b b b b b b
reliability with rare errors.
b b b b
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 to
b b b b b b b b b b b b b b b b b b b
accurately interpret the patient’s responses to questions. Rather than reading into the patient’s statements, they clarify any areas of
b b b b b b b b b b b b b b b b b b b
uncertainty.
b
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
b b b b b b b b b b b b b b b b b
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, recall
b b b b b b b b b b b b b b b b b
knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affect the
b b b b b b b b b b b b b b b b b b
response to other conditions, and distinguish the relevance of varied abnormal findings.
b b b b b b b b b b b b
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source of
b b b b b b b b b b b b b b b
statistics, the one that has been most widelyused and available for application to the reasoning process, is the estimation based on a
b b b b b b b b b b b b b b b b b b b b b b b
provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base
b b b b b b b b b b b b b b b b b b b
clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on scientific evidence.
b b b b b b b b b b b b b b b b b b
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
b b b b b b b b b b b b b
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician. Resources,
b b b b b b b b b b b b b b b b b
such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
b b b b b b b b b b b b b b
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,
b b b b b b b b b b b b b b b b b b b b
result. Ahigh sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
b b b b b b b b b b b b b b b b b b b b
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
b b b b b b b b b b b b b b b b b b b b
specificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target
b b b b b b b b b b b b b b b b b b b b b
condition.
b
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
b b b b b b b b b b b b b b b b b b b b b b b
negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with
b b b b b b b b b b b b b b b b b b b b b b
the disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
b b b b b b b b b b b b b b b b b b b b b
, lOMoARcPSD|126 b 567
b 13
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-based
b b b b b b b b b b b b b b b
resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met with
b b b b b b b b b b b b b b b b b b
regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain
b b b b b b b b b b b b b b b b b b b
situations, settings, and/or patient characteristics.
b b b b b
PTS: 1
