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 atypical chest pain has a low pretest
probability for coronary artery disease. The physician orders a
,stress echo despite the low probability. Which of the following
best explains the risk of this test choice?
Options
A. The test will always reduce diagnostic uncertainty and is
therefore appropriate.
B. Low pretest probability increases the chance of a false-
positive result, causing unnecessary downstream testing.
C. Because stress echo is noninvasive, it has no harms and is
justified.
D. Ordering more tests will improve patient satisfaction and
reduce medicolegal risk.
Correct Answer
B
Rationales
Correct: In patients with low pretest probability, even tests with
good specificity produce more false positives, leading to
unnecessary invasive procedures and harm. This reflects
appropriate application of Bayesian reasoning.
A (incorrect): Tests do not always reduce diagnostic uncertainty;
when pretest probability is low they often increase false
positives and harm.
C (incorrect): Noninvasive tests still carry harms—false
reassurance or false positives, costs, and potential procedural
follow-ups.
D (incorrect): More testing may temporarily increase
,satisfaction but can increase harm and does not reliably reduce
medicolegal risk.
Teaching Point
Low pretest probability → higher false positives; use Bayesian
reasoning before testing.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 55-year-old woman with poorly controlled diabetes asks
about prognosis after being told she has early-stage
nephropathy. Which physician behavior best aligns with high-
quality communication practices described in Harrison’s?
Options
A. Provide only the numeric probabilities without contextual
explanation.
B. Use clear language, elicit patient values, and check
understanding by asking her to summarize.
C. Avoid discussing uncertainties to prevent patient anxiety.
D. Delegate all prognosis discussions to the specialist.
, Correct Answer
B
Rationales
Correct: Effective clinical communication requires plain
language, eliciting patient values, and teach-back to ensure
shared understanding and informed decisions.
A (incorrect): Numeric data alone often confuse patients
without context or explanation.
C (incorrect): Avoiding uncertainty is paternalistic and
undermines informed decision-making.
D (incorrect): While collaboration is important, the primary
clinician should engage in prognosis and value conversations,
not always delegate.
Teaching Point
Use clear language, elicit values, and use teach-back for patient-
centered communication.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
3
Reference
Ch. 2 — Promoting Good Health
Question Stem
A 42-year-old man who smokes 20 cigarettes daily expresses
& 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 atypical chest pain has a low pretest
probability for coronary artery disease. The physician orders a
,stress echo despite the low probability. Which of the following
best explains the risk of this test choice?
Options
A. The test will always reduce diagnostic uncertainty and is
therefore appropriate.
B. Low pretest probability increases the chance of a false-
positive result, causing unnecessary downstream testing.
C. Because stress echo is noninvasive, it has no harms and is
justified.
D. Ordering more tests will improve patient satisfaction and
reduce medicolegal risk.
Correct Answer
B
Rationales
Correct: In patients with low pretest probability, even tests with
good specificity produce more false positives, leading to
unnecessary invasive procedures and harm. This reflects
appropriate application of Bayesian reasoning.
A (incorrect): Tests do not always reduce diagnostic uncertainty;
when pretest probability is low they often increase false
positives and harm.
C (incorrect): Noninvasive tests still carry harms—false
reassurance or false positives, costs, and potential procedural
follow-ups.
D (incorrect): More testing may temporarily increase
,satisfaction but can increase harm and does not reliably reduce
medicolegal risk.
Teaching Point
Low pretest probability → higher false positives; use Bayesian
reasoning before testing.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 55-year-old woman with poorly controlled diabetes asks
about prognosis after being told she has early-stage
nephropathy. Which physician behavior best aligns with high-
quality communication practices described in Harrison’s?
Options
A. Provide only the numeric probabilities without contextual
explanation.
B. Use clear language, elicit patient values, and check
understanding by asking her to summarize.
C. Avoid discussing uncertainties to prevent patient anxiety.
D. Delegate all prognosis discussions to the specialist.
, Correct Answer
B
Rationales
Correct: Effective clinical communication requires plain
language, eliciting patient values, and teach-back to ensure
shared understanding and informed decisions.
A (incorrect): Numeric data alone often confuse patients
without context or explanation.
C (incorrect): Avoiding uncertainty is paternalistic and
undermines informed decision-making.
D (incorrect): While collaboration is important, the primary
clinician should engage in prognosis and value conversations,
not always delegate.
Teaching Point
Use clear language, elicit values, and use teach-back for patient-
centered communication.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
3
Reference
Ch. 2 — Promoting Good Health
Question Stem
A 42-year-old man who smokes 20 cigarettes daily expresses
