Harrison's Principles of Internal Medicine (Vol.1
& Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo; J.
Larry Jameson
TEST BANK
h. 1 — The Practice of Medicine
1. Question Stem: A 68-year-old man with type 2 diabetes
and ischemic heart disease is admitted for decompensated
heart failure. The team must decide whether to proceed
with invasive coronary angiography now or stabilize
,medically first. Which approach best reflects the principles
of contemporary shared decision-making in clinical
practice?
Options:
A. Proceed with angiography immediately because invasive
management reduces long-term mortality in all ischemic
heart-failure patients.
B. Stabilize medically first without discussion since the
patient’s comorbidities make invasive care high risk.
C. Discuss risks, benefits, alternatives, and patient goals
with the patient and family, then make a recommendation
aligned with his values.
D. Defer the decision to the subspecialist and document
that a specialist will decide.
Correct Answer: C
Rationales — Correct: C encourages informed, patient-
centered shared decision-making—presenting options,
risks, and the patient’s goals to reach a recommendation.
This aligns with modern medical professionalism and
ethical practice.
Rationales — Incorrect: A is incorrect because invasive
therapy is not universally appropriate without considering
risks and patient values. B is incorrect—unilateral decision-
making ignores patient autonomy. D is incorrect—
delegation without patient involvement fails to meet
standards of physician responsibility.
Teaching Point: Shared decision-making combines
, evidence, clinician expertise, and patient values.
Citation: Loscalzo et al. (2022). Harrison’s Principles of
Internal Medicine (21st Ed.). Ch. 1.
Ch. 2 — Promoting Good Health
2) Question Stem: A community clinic serving underserved
patients launches a brief counseling program to reduce tobacco
use. Which intervention, based on evidence-informed
preventive medicine principles, is most likely to produce
population-level risk reduction?
Options:
A. One-time distribution of printed cessation pamphlets at
intake.
B. System-level integration: screening for tobacco use, brief
clinician counseling, and offering pharmacotherapy/referral.
C. A monthly lecture series on health risks of smoking open to
the public.
D. Relying on patients to request help when they are ready to
quit.
Correct Answer: B
Rationales — Correct: B uses systematic screening and
evidence-based interventions (brief counseling +
pharmacotherapy/referral), which increases reach and
effectiveness at the population level.
Rationales — Incorrect: A is passive and has low efficacy. C may
raise awareness but typically produces limited behavior change
, without linkage to treatment. D underutilizes opportunities;
proactive strategies are more effective.
Teaching Point: Systematic screening plus brief counseling and
treatment increases cessation rates.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 2.
Ch. 3 — Vaccine Opposition and Hesitancy
3) Question Stem: A pediatrician encounters parents who
express safety concerns and request alternative vaccine
schedules. Which communication strategy best reduces
hesitancy while maintaining trust?
Options:
A. Ignore concerns and state that vaccines are required.
B. Provide empathetic listening, acknowledge concerns, correct
misinformation with clear evidence, and offer a strong
recommendation.
C. Acquiesce to the alternative schedule to preserve the
therapeutic relationship.
D. Refer the family to online vaccine resources without
discussion.
Correct Answer: B
Rationales — Correct: B combines empathy, correction of
misinformation, and a strong clinician recommendation—
approaches shown to reduce hesitancy and improve uptake.
Rationales — Incorrect: A is dismissive and undermines trust. C
& Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo; J.
Larry Jameson
TEST BANK
h. 1 — The Practice of Medicine
1. Question Stem: A 68-year-old man with type 2 diabetes
and ischemic heart disease is admitted for decompensated
heart failure. The team must decide whether to proceed
with invasive coronary angiography now or stabilize
,medically first. Which approach best reflects the principles
of contemporary shared decision-making in clinical
practice?
Options:
A. Proceed with angiography immediately because invasive
management reduces long-term mortality in all ischemic
heart-failure patients.
B. Stabilize medically first without discussion since the
patient’s comorbidities make invasive care high risk.
C. Discuss risks, benefits, alternatives, and patient goals
with the patient and family, then make a recommendation
aligned with his values.
D. Defer the decision to the subspecialist and document
that a specialist will decide.
Correct Answer: C
Rationales — Correct: C encourages informed, patient-
centered shared decision-making—presenting options,
risks, and the patient’s goals to reach a recommendation.
This aligns with modern medical professionalism and
ethical practice.
Rationales — Incorrect: A is incorrect because invasive
therapy is not universally appropriate without considering
risks and patient values. B is incorrect—unilateral decision-
making ignores patient autonomy. D is incorrect—
delegation without patient involvement fails to meet
standards of physician responsibility.
Teaching Point: Shared decision-making combines
, evidence, clinician expertise, and patient values.
Citation: Loscalzo et al. (2022). Harrison’s Principles of
Internal Medicine (21st Ed.). Ch. 1.
Ch. 2 — Promoting Good Health
2) Question Stem: A community clinic serving underserved
patients launches a brief counseling program to reduce tobacco
use. Which intervention, based on evidence-informed
preventive medicine principles, is most likely to produce
population-level risk reduction?
Options:
A. One-time distribution of printed cessation pamphlets at
intake.
B. System-level integration: screening for tobacco use, brief
clinician counseling, and offering pharmacotherapy/referral.
C. A monthly lecture series on health risks of smoking open to
the public.
D. Relying on patients to request help when they are ready to
quit.
Correct Answer: B
Rationales — Correct: B uses systematic screening and
evidence-based interventions (brief counseling +
pharmacotherapy/referral), which increases reach and
effectiveness at the population level.
Rationales — Incorrect: A is passive and has low efficacy. C may
raise awareness but typically produces limited behavior change
, without linkage to treatment. D underutilizes opportunities;
proactive strategies are more effective.
Teaching Point: Systematic screening plus brief counseling and
treatment increases cessation rates.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 2.
Ch. 3 — Vaccine Opposition and Hesitancy
3) Question Stem: A pediatrician encounters parents who
express safety concerns and request alternative vaccine
schedules. Which communication strategy best reduces
hesitancy while maintaining trust?
Options:
A. Ignore concerns and state that vaccines are required.
B. Provide empathetic listening, acknowledge concerns, correct
misinformation with clear evidence, and offer a strong
recommendation.
C. Acquiesce to the alternative schedule to preserve the
therapeutic relationship.
D. Refer the family to online vaccine resources without
discussion.
Correct Answer: B
Rationales — Correct: B combines empathy, correction of
misinformation, and a strong clinician recommendation—
approaches shown to reduce hesitancy and improve uptake.
Rationales — Incorrect: A is dismissive and undermines trust. C
