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
1)
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 68-year-old man with multiple chronic conditions presents for
,routine care. He asks whether an aggressive new diagnostic
workup would improve his outcomes. Which principle should
most strongly guide the clinician's decision-making for this
patient’s care plan?
Options
A. Apply all available diagnostic tests to avoid missing any
disease.
B. Prioritize interventions most likely to improve the patient’s
goals and quality of life.
C. Defer decisions to the patient's family if patient has multiple
comorbidities.
D. Use guideline-recommended care for average-risk adults
regardless of comorbidities.
Correct Answer
B
Rationales
• Correct (B): Clinical decision-making in practice requires
aligning diagnostic and therapeutic choices with the
patient's values, prognosis, and likely benefit; prioritize
interventions that meaningfully improve goals and quality
of life.
• A (incorrect): Ordering all tests increases harm (false
positives, iatrogenic complications) and is not patient-
centered.
, • C (incorrect): Deferring to family is only appropriate when
the patient lacks capacity; otherwise the patient's
preferences govern.
• D (incorrect): Guidelines apply to typical patients; they
must be individualized for those with multiple
comorbidities and different goals.
Teaching Point
Individualize care to patient goals and likely benefit.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2)
Reference
Ch. 2 — Promoting Good Health
Question Stem
A primary care nurse develops a preventive plan for a 45-year-
old woman with obesity and family history of coronary artery
disease. Which intervention provides the greatest population-
level reduction in cardiovascular risk when implemented
broadly?
Options
A. Annual coronary calcium scoring for all adults >40.
B. Intensive one-time genetic screening for all patients.
, C. Community-level programs to reduce tobacco use and
increase physical activity.
D. Universal high-intensity statin therapy for adults over 40.
Correct Answer
C
Rationales
• Correct (C): Population health measures that reduce
tobacco use and increase activity yield large, sustained
reductions in cardiovascular morbidity and mortality
across communities.
• A (incorrect): Coronary calcium scoring is useful selectively
but not a primary population strategy and may lead to
unnecessary downstream testing.
• B (incorrect): Genetic screening is not yet appropriate as a
universal primary prevention strategy for cardiovascular
disease.
• D (incorrect): Universal pharmacotherapy ignores risk
stratification, potential harm, and cost; not optimal for
population health.
Teaching Point
Population interventions (tobacco cessation, activity) have the
largest public-health impact.
& 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
1)
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 68-year-old man with multiple chronic conditions presents for
,routine care. He asks whether an aggressive new diagnostic
workup would improve his outcomes. Which principle should
most strongly guide the clinician's decision-making for this
patient’s care plan?
Options
A. Apply all available diagnostic tests to avoid missing any
disease.
B. Prioritize interventions most likely to improve the patient’s
goals and quality of life.
C. Defer decisions to the patient's family if patient has multiple
comorbidities.
D. Use guideline-recommended care for average-risk adults
regardless of comorbidities.
Correct Answer
B
Rationales
• Correct (B): Clinical decision-making in practice requires
aligning diagnostic and therapeutic choices with the
patient's values, prognosis, and likely benefit; prioritize
interventions that meaningfully improve goals and quality
of life.
• A (incorrect): Ordering all tests increases harm (false
positives, iatrogenic complications) and is not patient-
centered.
, • C (incorrect): Deferring to family is only appropriate when
the patient lacks capacity; otherwise the patient's
preferences govern.
• D (incorrect): Guidelines apply to typical patients; they
must be individualized for those with multiple
comorbidities and different goals.
Teaching Point
Individualize care to patient goals and likely benefit.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2)
Reference
Ch. 2 — Promoting Good Health
Question Stem
A primary care nurse develops a preventive plan for a 45-year-
old woman with obesity and family history of coronary artery
disease. Which intervention provides the greatest population-
level reduction in cardiovascular risk when implemented
broadly?
Options
A. Annual coronary calcium scoring for all adults >40.
B. Intensive one-time genetic screening for all patients.
, C. Community-level programs to reduce tobacco use and
increase physical activity.
D. Universal high-intensity statin therapy for adults over 40.
Correct Answer
C
Rationales
• Correct (C): Population health measures that reduce
tobacco use and increase activity yield large, sustained
reductions in cardiovascular morbidity and mortality
across communities.
• A (incorrect): Coronary calcium scoring is useful selectively
but not a primary population strategy and may lead to
unnecessary downstream testing.
• B (incorrect): Genetic screening is not yet appropriate as a
universal primary prevention strategy for cardiovascular
disease.
• D (incorrect): Universal pharmacotherapy ignores risk
stratification, potential harm, and cost; not optimal for
population health.
Teaching Point
Population interventions (tobacco cessation, activity) have the
largest public-health impact.
