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
Reference — Ch. 1 — The Practice of Medicine
Question Stem
A 67-year-old man with multiple chronic illnesses presents
with new-onset fatigue. His primary care physician considers
,an extensive diagnostic workup but is concerned about harms
of overtesting in frail older adults. Which approach most
appropriately balances benefit and harm when deciding
whether to pursue further testing?
Options
A. Order the full panel of tests to avoid missing rare
conditions.
B. Use the patient’s health goals and estimated life expectancy
to guide testing decisions.
C. Defer all testing because age and comorbidities make
intervention unlikely to help.
D. Rely on specialist referral before any diagnostic testing.
Correct Answer
B
Rationales
Correct: Using the patient’s goals and estimated life
expectancy aligns diagnostic intensity with likely benefit and
patient values, minimizing disproportionate harm from
overtesting. This individualized approach reflects principles of
prudent clinical practice.
A: Ordering exhaustive tests without regard to benefit
increases false positives and harms from cascade testing.
C: Blanket deferral ignores patient autonomy and may omit
actionable conditions; decisions should be individualized.
D: Routine referral prior to targeted testing can delay care and
increase costs without guaranteed benefit.
Teaching Point
,Align diagnostic intensity with patient goals and expected
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 45-year-old woman with prediabetes asks for help reducing
her risk of progression to diabetes. Which counseling strategy
is most likely to produce sustained behavioral change?
Options
A. Provide a brochure describing the 7-step diet plan.
B. Deliver a brief, clinician-led motivational interview focusing
on patient goals.
C. Advise strict calorie counting with weekly clinic
surveillance.
D. Emphasize the long-term risks of diabetes complications to
motivate change.
Correct Answer
B
Rationales
Correct: Motivational interviewing elicits the patient’s own
reasons for change and has greater effectiveness for sustained
lifestyle modification than didactic advice alone. It fosters
, autonomy and concrete goal setting.
A: Brochures alone rarely change behavior without follow-up
and personalized support.
C: Strict calorie counting with intensive surveillance may be
effective for some but often reduces adherence and is less
patient-centered.
D: Fear-based messages can backfire and are less effective
than collaborative goal-setting.
Teaching Point
Motivational interviewing enhances lasting health behavior
change by aligning goals.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 2.
3.
Reference — Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem
A pediatrician is counseling a hesitant parent who fears
vaccine safety after hearing anecdotal stories online. Which
communication strategy most effectively addresses hesitancy
while maintaining trust?
Options
A. Present large statistical tables of trial data to prove safety.
B. Use presumptive recommendation combined with
addressing specific concerns empathetically.
& 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
Reference — Ch. 1 — The Practice of Medicine
Question Stem
A 67-year-old man with multiple chronic illnesses presents
with new-onset fatigue. His primary care physician considers
,an extensive diagnostic workup but is concerned about harms
of overtesting in frail older adults. Which approach most
appropriately balances benefit and harm when deciding
whether to pursue further testing?
Options
A. Order the full panel of tests to avoid missing rare
conditions.
B. Use the patient’s health goals and estimated life expectancy
to guide testing decisions.
C. Defer all testing because age and comorbidities make
intervention unlikely to help.
D. Rely on specialist referral before any diagnostic testing.
Correct Answer
B
Rationales
Correct: Using the patient’s goals and estimated life
expectancy aligns diagnostic intensity with likely benefit and
patient values, minimizing disproportionate harm from
overtesting. This individualized approach reflects principles of
prudent clinical practice.
A: Ordering exhaustive tests without regard to benefit
increases false positives and harms from cascade testing.
C: Blanket deferral ignores patient autonomy and may omit
actionable conditions; decisions should be individualized.
D: Routine referral prior to targeted testing can delay care and
increase costs without guaranteed benefit.
Teaching Point
,Align diagnostic intensity with patient goals and expected
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 45-year-old woman with prediabetes asks for help reducing
her risk of progression to diabetes. Which counseling strategy
is most likely to produce sustained behavioral change?
Options
A. Provide a brochure describing the 7-step diet plan.
B. Deliver a brief, clinician-led motivational interview focusing
on patient goals.
C. Advise strict calorie counting with weekly clinic
surveillance.
D. Emphasize the long-term risks of diabetes complications to
motivate change.
Correct Answer
B
Rationales
Correct: Motivational interviewing elicits the patient’s own
reasons for change and has greater effectiveness for sustained
lifestyle modification than didactic advice alone. It fosters
, autonomy and concrete goal setting.
A: Brochures alone rarely change behavior without follow-up
and personalized support.
C: Strict calorie counting with intensive surveillance may be
effective for some but often reduces adherence and is less
patient-centered.
D: Fear-based messages can backfire and are less effective
than collaborative goal-setting.
Teaching Point
Motivational interviewing enhances lasting health behavior
change by aligning goals.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 2.
3.
Reference — Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem
A pediatrician is counseling a hesitant parent who fears
vaccine safety after hearing anecdotal stories online. Which
communication strategy most effectively addresses hesitancy
while maintaining trust?
Options
A. Present large statistical tables of trial data to prove safety.
B. Use presumptive recommendation combined with
addressing specific concerns empathetically.
