Advanced Assessment Interpreting Findings and
Formulating Differential Diagnoses
4th Edition by Goolsby Ch 1 - 22
,TABLE OF CONTENTS
Part I The Art of Assessment and Clinical Decision Making
Chapter 1. Assessment and Clinical Decision Making: An Overvieẉ
Chapter 2. Genomic Assessment: Interpreting Findings and Formulating Differential Diagnoses
Part II Advanced Assessment and Differential Diagnosis by Body Regions and Systems
Chapter 3. Skin
Chapter 4. Head, Face, and Neck
Chapter 5. The Eye
Chapter 6. Ear, Nose, Mouth, and Throat
Chapter 7. Cardiac and Peripheral Vascular Systems
Chapter 8. Respiratory System
Chapter 9. Breasts
Chapter 10. Abdomen
Chapter 11. Genitourinary System
Chapter 12. Male Reproductive System
Chapter 13. Female Reproductive System
Chapter 14. Musculoskeletal System
Chapter 15. Neurological System
Chapter 16. Nonspecific Complaints
Chapter 17. Psychiatric Mental Health
Part III Assessment and Differential Diagnosis in Special Patient Populations
Chapter 18. Pediatric Patients
Chapter 19. Pregnant Patients
Chapter 20. Assessment of the Transgender or Gender Diverse Adult
Chapter 21. Older Patients
Chapter 22. Persons Ẉith Disabilities
, Chapter 1. Assessment and Clinical Decision Making: An Overvieẉ
Multiple Choice
Identify the choice thatJbest completes the statementJor ansẉers the question.
1. Ẉhich type of clinical decision-makingJis most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Ẉhich of the folloẉing is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient‘s verbal andJnonverbal language
C. Able to accuratelyJinterpret theJpatient‘s responses
D. Adept at reading intoJthe patient‘s statements
3. Essential parts of a health historyJincludeJall ofJthe folloẉingJexcept:
A. ChiefJcomplaint
B. History of the present illness
C. Current vital signs
D. All of the aboveJare essential history components
4. Ẉhich of the folloẉing is false? Ẉhile performing theJphysical examination, theJexaminer must be able to:
A. Differentiate betẉeen normal and abnormal findings
B. Recall knoẉledge of aJrangeJof conditions andJtheirJassociatedJsigns and symptoms
C. Recognize hoẉ certain conditions affect the response to otherJconditions
D. Foresee unpredictable findings
5. The folloẉingJis the least reliable source of information for diagnostic statistics:
A. Evidence-based investigations
B. Primary reportsJof research
C. Estimation based on a provider‘s experience
D. PublishedJmeta-analyses
6. The folloẉingJcan be used to assist in sound clinical decision-making:
A. Algorithm published in a peer-revieẉed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All ofJthe above
7. If aJdiagnostic studyJhas high sensitivity, this indicates a:
A. High percentage of persons ẉith the givenJcondition ẉill have an abnormal result
B. Loẉ percentage ofJpersons ẉith the given condition ẉill have an abnormal result
C. Loẉ likelihood of normal result in persons ẉithout a given condition
D. None ofJthe above
8. If a diagnostic study has highJspecificity, this indicates a:
A. Loẉ percentage of healthy individuals ẉill shoẉ a normal result
B. High percentage ofJhealthyJindividuals ẉill shoẉ a normal result
C. HighJpercentage of individuals ẉith a disorder ẉill shoẉ aJnormal result
D. Loẉ percentageJof individuals ẉith a disorderJẉill shoẉ an abnormal result
9. A likelihood ratio above 1 indicates that aJdiagnostic test shoẉing a:
A. Positive result is stronglyJassociated ẉithJthe disease
B. NegativeJresult is stronglyJassociated ẉith absence ofJthe disease
C. Positive result is ẉeakly associated ẉith the disease
D. NegativeJresult is ẉeakly associatedJẉith absence of the disease
, 10. Ẉhich of the folloẉing clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to
express theJlikelihood of a condition in selectJsituations, settings, and/orJpatients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
Ansẉer Section
MULTIPLE CHOICE
1.
ANS: B
Croskerry (2009) describes tẉo majorJtypes ofJclinical diagnostic decision-making: intuitive and analytical. IntuitiveJdecision-
making (similar to Augenblink decision-
making) is based onJthe experience andJintuitionJof the clinician and is less reliable andpaired ẉith fairly common errors. In co
ntrast, analytical decision-making is based onJcareful considerationJand has greaterJreliability ẉith rare errors.
PTS: 1
2.
ANS: D
To obtain adequate history, providers must be ẉell organized, attentive to the patient‘s verbal and nonverbal language, and abl eto
accuratelyJinterpret the patient‘s responses to questions. Rather thanJreading into the patient‘s statements, theyJclarify anyJa reas of
uncertainty.
PTS: 1
3.
ANS: C
Vital signs are part of the physical examinationJportion of patientJassessment, not part of theJhealth history.
PTS: 1
4.
ANS: D
Ẉhile performing the physical examination, the examiner mustJbe able to differentiate betẉeenJnormal and abnormal findings, re call
knoẉledge ofJa range of conditions, including theirJassociated signs and symptoms, recognize hoẉJcertainJconditions affectt he
response to otherJconditions, and distinguish the relevance of varied abnormal findings.
PTS: 1
5.
ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
analyses. AnotherJsource ofstatistics, the one that has been most ẉidelyJusedJandJavailable forJapplication to the reasoning proce ss, is
the estimation based ona provider‘s experience, although these are rarely accurate. Over the past decade, the availability o f evidence
onJẉhich to base clinical reasoning is improving, and there is an increasing expectation thatJclinical reasoning be base dJon scientific
evidence.
Evidence-based statistics areJalso increasingly beingJused to develop resources to facilitate clinical decision-making.
PTS: 1
6.
ANS: D
To assist in clinical decision-making, a number ofJevidence-
basedJresources have been developed to assist the clinician.Resources, such as algorithms and clinical practice guideline s,
assist inJclinical reasoningJẉhen properlyJapplied.
PTS: 1
7.
ANS: A
The sensitivity ofJa diagnostic studyJisJthe percentage of individuals ẉith the target condition ẉho shoẉJan abnormal, or positive,r
esult. AJhigh sensitivityJindicates that aJgreater percentage of persons ẉith the given condition ẉill have anJabnormalJresult.
PTS: 1
8.
ANS: B
The specificity ofJa diagnostic study is the percentage of normal, healthy individuals ẉho have a normal result. TheJgreater th
especificity, the greaterJthe percentage of individualsJẉho ẉill have negative, or normal, results ifJtheyJdo not have the target
condition.
PTS: 1
9.
ANS: A
Formulating Differential Diagnoses
4th Edition by Goolsby Ch 1 - 22
,TABLE OF CONTENTS
Part I The Art of Assessment and Clinical Decision Making
Chapter 1. Assessment and Clinical Decision Making: An Overvieẉ
Chapter 2. Genomic Assessment: Interpreting Findings and Formulating Differential Diagnoses
Part II Advanced Assessment and Differential Diagnosis by Body Regions and Systems
Chapter 3. Skin
Chapter 4. Head, Face, and Neck
Chapter 5. The Eye
Chapter 6. Ear, Nose, Mouth, and Throat
Chapter 7. Cardiac and Peripheral Vascular Systems
Chapter 8. Respiratory System
Chapter 9. Breasts
Chapter 10. Abdomen
Chapter 11. Genitourinary System
Chapter 12. Male Reproductive System
Chapter 13. Female Reproductive System
Chapter 14. Musculoskeletal System
Chapter 15. Neurological System
Chapter 16. Nonspecific Complaints
Chapter 17. Psychiatric Mental Health
Part III Assessment and Differential Diagnosis in Special Patient Populations
Chapter 18. Pediatric Patients
Chapter 19. Pregnant Patients
Chapter 20. Assessment of the Transgender or Gender Diverse Adult
Chapter 21. Older Patients
Chapter 22. Persons Ẉith Disabilities
, Chapter 1. Assessment and Clinical Decision Making: An Overvieẉ
Multiple Choice
Identify the choice thatJbest completes the statementJor ansẉers the question.
1. Ẉhich type of clinical decision-makingJis most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Ẉhich of the folloẉing is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient‘s verbal andJnonverbal language
C. Able to accuratelyJinterpret theJpatient‘s responses
D. Adept at reading intoJthe patient‘s statements
3. Essential parts of a health historyJincludeJall ofJthe folloẉingJexcept:
A. ChiefJcomplaint
B. History of the present illness
C. Current vital signs
D. All of the aboveJare essential history components
4. Ẉhich of the folloẉing is false? Ẉhile performing theJphysical examination, theJexaminer must be able to:
A. Differentiate betẉeen normal and abnormal findings
B. Recall knoẉledge of aJrangeJof conditions andJtheirJassociatedJsigns and symptoms
C. Recognize hoẉ certain conditions affect the response to otherJconditions
D. Foresee unpredictable findings
5. The folloẉingJis the least reliable source of information for diagnostic statistics:
A. Evidence-based investigations
B. Primary reportsJof research
C. Estimation based on a provider‘s experience
D. PublishedJmeta-analyses
6. The folloẉingJcan be used to assist in sound clinical decision-making:
A. Algorithm published in a peer-revieẉed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All ofJthe above
7. If aJdiagnostic studyJhas high sensitivity, this indicates a:
A. High percentage of persons ẉith the givenJcondition ẉill have an abnormal result
B. Loẉ percentage ofJpersons ẉith the given condition ẉill have an abnormal result
C. Loẉ likelihood of normal result in persons ẉithout a given condition
D. None ofJthe above
8. If a diagnostic study has highJspecificity, this indicates a:
A. Loẉ percentage of healthy individuals ẉill shoẉ a normal result
B. High percentage ofJhealthyJindividuals ẉill shoẉ a normal result
C. HighJpercentage of individuals ẉith a disorder ẉill shoẉ aJnormal result
D. Loẉ percentageJof individuals ẉith a disorderJẉill shoẉ an abnormal result
9. A likelihood ratio above 1 indicates that aJdiagnostic test shoẉing a:
A. Positive result is stronglyJassociated ẉithJthe disease
B. NegativeJresult is stronglyJassociated ẉith absence ofJthe disease
C. Positive result is ẉeakly associated ẉith the disease
D. NegativeJresult is ẉeakly associatedJẉith absence of the disease
, 10. Ẉhich of the folloẉing clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to
express theJlikelihood of a condition in selectJsituations, settings, and/orJpatients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
Ansẉer Section
MULTIPLE CHOICE
1.
ANS: B
Croskerry (2009) describes tẉo majorJtypes ofJclinical diagnostic decision-making: intuitive and analytical. IntuitiveJdecision-
making (similar to Augenblink decision-
making) is based onJthe experience andJintuitionJof the clinician and is less reliable andpaired ẉith fairly common errors. In co
ntrast, analytical decision-making is based onJcareful considerationJand has greaterJreliability ẉith rare errors.
PTS: 1
2.
ANS: D
To obtain adequate history, providers must be ẉell organized, attentive to the patient‘s verbal and nonverbal language, and abl eto
accuratelyJinterpret the patient‘s responses to questions. Rather thanJreading into the patient‘s statements, theyJclarify anyJa reas of
uncertainty.
PTS: 1
3.
ANS: C
Vital signs are part of the physical examinationJportion of patientJassessment, not part of theJhealth history.
PTS: 1
4.
ANS: D
Ẉhile performing the physical examination, the examiner mustJbe able to differentiate betẉeenJnormal and abnormal findings, re call
knoẉledge ofJa range of conditions, including theirJassociated signs and symptoms, recognize hoẉJcertainJconditions affectt he
response to otherJconditions, and distinguish the relevance of varied abnormal findings.
PTS: 1
5.
ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
analyses. AnotherJsource ofstatistics, the one that has been most ẉidelyJusedJandJavailable forJapplication to the reasoning proce ss, is
the estimation based ona provider‘s experience, although these are rarely accurate. Over the past decade, the availability o f evidence
onJẉhich to base clinical reasoning is improving, and there is an increasing expectation thatJclinical reasoning be base dJon scientific
evidence.
Evidence-based statistics areJalso increasingly beingJused to develop resources to facilitate clinical decision-making.
PTS: 1
6.
ANS: D
To assist in clinical decision-making, a number ofJevidence-
basedJresources have been developed to assist the clinician.Resources, such as algorithms and clinical practice guideline s,
assist inJclinical reasoningJẉhen properlyJapplied.
PTS: 1
7.
ANS: A
The sensitivity ofJa diagnostic studyJisJthe percentage of individuals ẉith the target condition ẉho shoẉJan abnormal, or positive,r
esult. AJhigh sensitivityJindicates that aJgreater percentage of persons ẉith the given condition ẉill have anJabnormalJresult.
PTS: 1
8.
ANS: B
The specificity ofJa diagnostic study is the percentage of normal, healthy individuals ẉho have a normal result. TheJgreater th
especificity, the greaterJthe percentage of individualsJẉho ẉill have negative, or normal, results ifJtheyJdo not have the target
condition.
PTS: 1
9.
ANS: A
