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
Ch. 1 — The Practice of Medicine
1. Question Stem
A 68-year-old man with intermittent exertional chest
discomfort and no known coronary disease asks whether a
noninvasive stress test is worthwhile. His pretest
probability of coronary disease is estimated at 5%. Which
, principle best guides whether to order the test?
Options
A. Order the stress test because symptoms alone justify
testing in older adults.
B. Order the stress test because sensitivity is high and a
negative test rules out disease.
C. Avoid testing because low pretest probability makes
positive predictive value low and false positives likely.
D. Avoid testing because imaging modalities are
contraindicated in all patients over 65.
Correct Answer
C
Rationales
Correct: When pretest probability is low, even sensitive tests
have low positive predictive value and produce false positives
that lead to harm; testing should be guided by pretest
probability and potential impact on management.
A: Symptoms matter, but pretest probability integrates
symptoms plus risk factors—symptoms alone do not mandate
testing.
B: High sensitivity with low pretest probability reduces PPV; a
negative test may help rule out disease but the overall yield and
harms of false positives must be considered.
D: Age alone is not an absolute contraindication to imaging;
decision depends on clinical context and risks.
,Teaching Point
Pretest probability guides testing — low probability → high risk
of false positives.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
Ch. 1 — The Practice of Medicine
2) Question Stem
A patient with multiple chronic conditions presents to the clinic
with one urgent problem and several chronic issues. Using a
patient-centered prioritization approach, which action best
reflects good practice?
Options
A. Address all chronic issues in detail during the visit regardless
of time.
B. Focus on the urgent problem, negotiate which chronic issue
to address next, and arrange follow-up.
C. Defer the urgent problem to a specialist and use the visit to
optimize chronic care.
D. Complete only documentation and ask the patient to return
without addressing any problems.
Correct Answer
B
Rationales
Correct: Patient-centered prioritization balances urgency,
, patient goals, and feasibility—resolve acute needs, set limited
goals for chronic care, and plan follow-up.
A: Trying to solve everything in one visit often reduces care
quality and patient safety.
C: Deferring urgent problems risks harm and fragments care;
primary clinician should manage or stabilize.
D: Avoiding action is unsafe and undermines trust and
continuity of care.
Teaching Point
Prioritize acute issues, negotiate limited chronic goals, and
schedule timely follow-up.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
Ch. 2 — Promoting Good Health
3) Question Stem
A 45-year-old patient with obesity asks for the most effective
clinician strategy to support sustained behavior change for
weight loss. According to health promotion principles, which
approach is best?
Options
A. Provide a didactic 30-minute lecture on calorie counting.
B. Use brief motivational interviewing to elicit patient’s own
reasons and set short-term goals.
C. Prescribe a very low-calorie diet without further counseling.
& 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
Ch. 1 — The Practice of Medicine
1. Question Stem
A 68-year-old man with intermittent exertional chest
discomfort and no known coronary disease asks whether a
noninvasive stress test is worthwhile. His pretest
probability of coronary disease is estimated at 5%. Which
, principle best guides whether to order the test?
Options
A. Order the stress test because symptoms alone justify
testing in older adults.
B. Order the stress test because sensitivity is high and a
negative test rules out disease.
C. Avoid testing because low pretest probability makes
positive predictive value low and false positives likely.
D. Avoid testing because imaging modalities are
contraindicated in all patients over 65.
Correct Answer
C
Rationales
Correct: When pretest probability is low, even sensitive tests
have low positive predictive value and produce false positives
that lead to harm; testing should be guided by pretest
probability and potential impact on management.
A: Symptoms matter, but pretest probability integrates
symptoms plus risk factors—symptoms alone do not mandate
testing.
B: High sensitivity with low pretest probability reduces PPV; a
negative test may help rule out disease but the overall yield and
harms of false positives must be considered.
D: Age alone is not an absolute contraindication to imaging;
decision depends on clinical context and risks.
,Teaching Point
Pretest probability guides testing — low probability → high risk
of false positives.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
Ch. 1 — The Practice of Medicine
2) Question Stem
A patient with multiple chronic conditions presents to the clinic
with one urgent problem and several chronic issues. Using a
patient-centered prioritization approach, which action best
reflects good practice?
Options
A. Address all chronic issues in detail during the visit regardless
of time.
B. Focus on the urgent problem, negotiate which chronic issue
to address next, and arrange follow-up.
C. Defer the urgent problem to a specialist and use the visit to
optimize chronic care.
D. Complete only documentation and ask the patient to return
without addressing any problems.
Correct Answer
B
Rationales
Correct: Patient-centered prioritization balances urgency,
, patient goals, and feasibility—resolve acute needs, set limited
goals for chronic care, and plan follow-up.
A: Trying to solve everything in one visit often reduces care
quality and patient safety.
C: Deferring urgent problems risks harm and fragments care;
primary clinician should manage or stabilize.
D: Avoiding action is unsafe and undermines trust and
continuity of care.
Teaching Point
Prioritize acute issues, negotiate limited chronic goals, and
schedule timely follow-up.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
Ch. 2 — Promoting Good Health
3) Question Stem
A 45-year-old patient with obesity asks for the most effective
clinician strategy to support sustained behavior change for
weight loss. According to health promotion principles, which
approach is best?
Options
A. Provide a didactic 30-minute lecture on calorie counting.
B. Use brief motivational interviewing to elicit patient’s own
reasons and set short-term goals.
C. Prescribe a very low-calorie diet without further counseling.
