TESTBANK l
ADVANCEDlHEALTHlASSESSMENTl&lCLINICALlDIAGNOSISlINl
PRIMARYlCARE,l6THlEDITION
JoycelE.lDains,lLindalCiofulBaumannl&lPamelalScheibel
, l
lOMoARcPSD|126 567
l 13
TestlBanklforlAdvancedlHealthlAssessmentl&lClinicallDiagnosislinlPrimarylCarel6th
lEditionlDains
Chapterl1:lClinicallReasoning,lDifferentiallDiagnosis,lEvidence-BasedlPractice,landlSymptomlAnalysis
MultiplelChoice
Identifylthelchoicelthatlbestlcompleteslthelstatementlorlanswerslthelquestion.
1. Whichltypeloflclinicalldecision-makinglislmostlreliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Whichloflthelfollowinglislfalse?lTolobtainladequatelhistory,lhealth-carelproviderslmustlbe:
A. Methodicallandlsystematic
B. Attentiveltolthelpatient’slverballandlnonverballlanguage
C. Ableltolaccuratelylinterpretlthelpatient’slresponses
D. Adeptlatlreadinglintolthelpatient’slstatements
3. Essentiallpartsloflalhealthlhistorylincludelallloflthelfollowinglexcept:
A. Chieflcomplaint
B. Historyloflthelpresentlillness
C. Currentlvitallsigns
D. Allloflthelabovelarelessentiallhistorylcomponents
4. Whichloflthelfollowinglislfalse?lWhilelperforminglthelphysicallexamination,lthelexaminerlmustlbelablelto:
A. Differentiatelbetweenlnormallandlabnormallfindings
B. Recalllknowledgeloflalrangeloflconditionslandltheirlassociatedlsignslandlsymptoms
C. Recognizelhowlcertainlconditionslaffectlthelresponseltolotherlconditions
D. Foreseelunpredictablel findings
5. Thelfollowinglislthelleastlreliablelsourceloflinformationlforldiagnosticlstatistics:
A. Evidence-basedlinvestigations
B. Primarylreportsloflresearch
C. Estimationlbasedlonlalprovider’slexperience
D. Publishedlmeta-analyses
6. Thelfollowinglcanlbelusedltolassistlinlsoundlclinicalldecision-making:
A. Algorithmlpublishedlinlalpeer-reviewedljournallarticle
B. Clinicallpracticelguidelines
C. Evidence-basedlresearch
D. Allloflthelabove
7. Iflaldiagnosticlstudylhaslhighlsensitivity,l thislindicatesla:
A. Highlpercentageloflpersonslwithlthelgivenlconditionlwilllhavelanlabnormallresult
B. Lowlpercentageloflpersonslwithlthelgivenlconditionlwilllhavelanlabnormallresult
C. Lowllikelihoodloflnormallresultlinlpersonslwithoutlalgivenlcondition
D. Noneloflthelabove
8. Iflaldiagnosticlstudylhaslhighlspecificity,lthislindicatesla:
A. Lowlpercentageloflhealthylindividualslwilllshowlalnormallresult
B. Highlpercentageloflhealthylindividualslwilllshowlalnormallresult
C. Highlpercentageloflindividualslwithlaldisorderlwilllshowlalnormallresult
D. Lowlpercentageloflindividualslwithlaldisorderlwilllshowlanlabnormallresult
9. Allikelihoodlratiolabovel1lindicateslthatlaldiagnosticltestlshowingla:
A. Positivelresultlislstronglylassociatedlwithltheldisease
B. Negativelresultlislstronglylassociatedlwithlabsencelofltheldisease
C. Positivelresultlislweaklylassociatedlwithltheldisease
D. Negativelresultlislweaklylassociatedlwithlabsencelofltheldisease
10. Whichloflthelfollowinglclinicallreasoningltoolslisldefinedlaslevidence-
basedlresourcelbasedlonlmathematicallmodelingltolexpresslthellikelihoodloflalconditionlinlselectlsituations,lsettings,land/orlpatie
nts?
, l
lOMoARcPSD|126 567
l 13
A. Clinicallpracticelguideline
B. Clinicalldecisionlrule
C. Clinicallalgorithm
Chapterl1:lClinicallreasoning,ldifferentialldiagnosis,levidence-basedlpractice,landlsymptomlana
AnswerlSection
MULTIPLElCHOICE
1. ANS: B
Croskerryl(2009)ldescribesltwolmajorltypesloflclinicalldiagnosticldecision-making:lintuitivelandlanalytical.lIntuitiveldecision-
lmakingl(similarltolAugenblinkldecision-
making)lislbasedlonlthelexperiencelandlintuitionloflthelclinicianlandlisllesslreliablelandlpairedlwithlfairlylcommonlerrors.lInlcontr
ast,lanalyticalldecision-makinglislbasedlonlcarefullconsiderationlandlhaslgreaterlreliabilitylwithlrarelerrors.
PTS: 1
2. ANS: D
Tolobtainladequatelhistory,lproviderslmustlbelwelllorganized,lattentiveltolthelpatient’slverballandlnonverballlanguage,landlableltol
accuratelylinterpretlthelpatient’slresponsesltolquestions.lRatherlthanlreadinglintolthelpatient’slstatements,ltheylclarifylanylareasl
ofluncertainty.
PTS: 1
3. ANS: C
Vitallsignslarelpartloflthelphysicallexaminationlportionloflpatientlassessment,lnotlpartloflthelhealthlhistory.
PTS: 1
4. ANS: D
Whilelperforminglthelphysicallexamination,lthelexaminerlmustlbelableltoldifferentiatelbetweenlnormallandlabnormallfindings,lrec
alllknowledgeloflalrangeloflconditions,lincludingltheirlassociatedlsignslandlsymptoms,lrecognizelhowlcertainlconditionslaffectlthelr
esponseltolotherlconditions,landldistinguishlthelrelevanceloflvariedlabnormallfindings.
PTS: 1
5. ANS: C
Sourceslforldiagnosticlstatisticslincludeltextbooks,lprimarylreportsloflresearch,landlpublishedlmeta-
analyses.lAnotherlsourceloflstatistics,lthelonelthatlhaslbeenlmostlwidelylusedlandlavailablelforlapplicationltolthelreasoninglprocess
,lislthelestimationlbasedlonlalprovider’slexperience,lalthoughltheselarelrarelylaccurate.lOverlthelpastldecade,lthelavailabilityloflev
idencelonlwhichltolbaselclinicallreasoninglislimproving,l andltherelislanlincreasinglexpectationlthatlclinicallreasoninglbelbasedlo
nlscientificlevidence.
Evidence-basedlstatisticslarelalsolincreasinglylbeinglusedltoldevelopl resourcesltolfacilitatel clinicall decision-making.
PTS: 1
6. ANS: D
Tolassistlinlclinicalldecision-making,lalnumberloflevidence-
basedlresourceslhavelbeenldevelopedltolassistlthelclinician.lResources,lsuchlaslalgorithmslandlclinicallpracticelguidelines,lassistli
nlclinicallreasoninglwhenlproperlylapplied.
PTS: 1
7. ANS: A
Thelsensitivityloflaldiagnosticlstudylislthelpercentageloflindividualslwithltheltargetlconditionlwholshowlanlabnormal,lorlpositive,lre
sult.lAlhighlsensitivitylindicateslthatlalgreaterlpercentageloflpersonslwithlthelgivenlconditionlwilllhavelanlabnormallresult.
PTS: 1
8. ANS: B
Thelspecificityloflaldiagnosticlstudylislthelpercentageloflnormal,lhealthylindividualslwholhavelalnormallresult.lThelgreaterlthelsp
ecificity,lthelgreaterlthelpercentageloflindividualslwholwilllhavelnegative,lorlnormal,lresultslifltheyldolnotlhaveltheltargetlconditi
on.
PTS: 1
9. ANS: A
Thellikelihoodlratiolislthelprobabilitylthatlalpositiveltestlresultlwilllbelassociatedlwithlalpersonlwholhasltheltargetlconditionlandlaln
egativelresultlwilllbelassociatedlwithlalhealthylperson.lAllikelihoodlratiolabovel1lindicateslthatlalpositivelresultlislassociatedlwithlt
heldisease;lallikelihoodlratiollesslthanl1lindicateslthatlalnegativelresultlislassociatedlwithlanlabsencelofltheldisease.
, l
lOMoARcPSD|126 567
l 13
PTS: 1
10. ANS: B
Clinicalldecisionl(orlprediction)lruleslprovidelanotherlsupportlforlclinicallreasoning.lClinicalldecisionlruleslarelevidence-
basedlresourceslthatlprovidelprobabilisticlstatementslregardinglthellikelihoodlthatlalconditionlexistsliflcertainlvariableslarelmetl
withlregardltolthelprognosisloflpatientslwithlspecificlfindings.lDecisionlrulesluselmathematicallmodelslandlarelspecificltolcertai
nlsituations,lsettings,land/orlpatientlcharacteristics.
PTS: 1
ADVANCEDlHEALTHlASSESSMENTl&lCLINICALlDIAGNOSISlINl
PRIMARYlCARE,l6THlEDITION
JoycelE.lDains,lLindalCiofulBaumannl&lPamelalScheibel
, l
lOMoARcPSD|126 567
l 13
TestlBanklforlAdvancedlHealthlAssessmentl&lClinicallDiagnosislinlPrimarylCarel6th
lEditionlDains
Chapterl1:lClinicallReasoning,lDifferentiallDiagnosis,lEvidence-BasedlPractice,landlSymptomlAnalysis
MultiplelChoice
Identifylthelchoicelthatlbestlcompleteslthelstatementlorlanswerslthelquestion.
1. Whichltypeloflclinicalldecision-makinglislmostlreliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Whichloflthelfollowinglislfalse?lTolobtainladequatelhistory,lhealth-carelproviderslmustlbe:
A. Methodicallandlsystematic
B. Attentiveltolthelpatient’slverballandlnonverballlanguage
C. Ableltolaccuratelylinterpretlthelpatient’slresponses
D. Adeptlatlreadinglintolthelpatient’slstatements
3. Essentiallpartsloflalhealthlhistorylincludelallloflthelfollowinglexcept:
A. Chieflcomplaint
B. Historyloflthelpresentlillness
C. Currentlvitallsigns
D. Allloflthelabovelarelessentiallhistorylcomponents
4. Whichloflthelfollowinglislfalse?lWhilelperforminglthelphysicallexamination,lthelexaminerlmustlbelablelto:
A. Differentiatelbetweenlnormallandlabnormallfindings
B. Recalllknowledgeloflalrangeloflconditionslandltheirlassociatedlsignslandlsymptoms
C. Recognizelhowlcertainlconditionslaffectlthelresponseltolotherlconditions
D. Foreseelunpredictablel findings
5. Thelfollowinglislthelleastlreliablelsourceloflinformationlforldiagnosticlstatistics:
A. Evidence-basedlinvestigations
B. Primarylreportsloflresearch
C. Estimationlbasedlonlalprovider’slexperience
D. Publishedlmeta-analyses
6. Thelfollowinglcanlbelusedltolassistlinlsoundlclinicalldecision-making:
A. Algorithmlpublishedlinlalpeer-reviewedljournallarticle
B. Clinicallpracticelguidelines
C. Evidence-basedlresearch
D. Allloflthelabove
7. Iflaldiagnosticlstudylhaslhighlsensitivity,l thislindicatesla:
A. Highlpercentageloflpersonslwithlthelgivenlconditionlwilllhavelanlabnormallresult
B. Lowlpercentageloflpersonslwithlthelgivenlconditionlwilllhavelanlabnormallresult
C. Lowllikelihoodloflnormallresultlinlpersonslwithoutlalgivenlcondition
D. Noneloflthelabove
8. Iflaldiagnosticlstudylhaslhighlspecificity,lthislindicatesla:
A. Lowlpercentageloflhealthylindividualslwilllshowlalnormallresult
B. Highlpercentageloflhealthylindividualslwilllshowlalnormallresult
C. Highlpercentageloflindividualslwithlaldisorderlwilllshowlalnormallresult
D. Lowlpercentageloflindividualslwithlaldisorderlwilllshowlanlabnormallresult
9. Allikelihoodlratiolabovel1lindicateslthatlaldiagnosticltestlshowingla:
A. Positivelresultlislstronglylassociatedlwithltheldisease
B. Negativelresultlislstronglylassociatedlwithlabsencelofltheldisease
C. Positivelresultlislweaklylassociatedlwithltheldisease
D. Negativelresultlislweaklylassociatedlwithlabsencelofltheldisease
10. Whichloflthelfollowinglclinicallreasoningltoolslisldefinedlaslevidence-
basedlresourcelbasedlonlmathematicallmodelingltolexpresslthellikelihoodloflalconditionlinlselectlsituations,lsettings,land/orlpatie
nts?
, l
lOMoARcPSD|126 567
l 13
A. Clinicallpracticelguideline
B. Clinicalldecisionlrule
C. Clinicallalgorithm
Chapterl1:lClinicallreasoning,ldifferentialldiagnosis,levidence-basedlpractice,landlsymptomlana
AnswerlSection
MULTIPLElCHOICE
1. ANS: B
Croskerryl(2009)ldescribesltwolmajorltypesloflclinicalldiagnosticldecision-making:lintuitivelandlanalytical.lIntuitiveldecision-
lmakingl(similarltolAugenblinkldecision-
making)lislbasedlonlthelexperiencelandlintuitionloflthelclinicianlandlisllesslreliablelandlpairedlwithlfairlylcommonlerrors.lInlcontr
ast,lanalyticalldecision-makinglislbasedlonlcarefullconsiderationlandlhaslgreaterlreliabilitylwithlrarelerrors.
PTS: 1
2. ANS: D
Tolobtainladequatelhistory,lproviderslmustlbelwelllorganized,lattentiveltolthelpatient’slverballandlnonverballlanguage,landlableltol
accuratelylinterpretlthelpatient’slresponsesltolquestions.lRatherlthanlreadinglintolthelpatient’slstatements,ltheylclarifylanylareasl
ofluncertainty.
PTS: 1
3. ANS: C
Vitallsignslarelpartloflthelphysicallexaminationlportionloflpatientlassessment,lnotlpartloflthelhealthlhistory.
PTS: 1
4. ANS: D
Whilelperforminglthelphysicallexamination,lthelexaminerlmustlbelableltoldifferentiatelbetweenlnormallandlabnormallfindings,lrec
alllknowledgeloflalrangeloflconditions,lincludingltheirlassociatedlsignslandlsymptoms,lrecognizelhowlcertainlconditionslaffectlthelr
esponseltolotherlconditions,landldistinguishlthelrelevanceloflvariedlabnormallfindings.
PTS: 1
5. ANS: C
Sourceslforldiagnosticlstatisticslincludeltextbooks,lprimarylreportsloflresearch,landlpublishedlmeta-
analyses.lAnotherlsourceloflstatistics,lthelonelthatlhaslbeenlmostlwidelylusedlandlavailablelforlapplicationltolthelreasoninglprocess
,lislthelestimationlbasedlonlalprovider’slexperience,lalthoughltheselarelrarelylaccurate.lOverlthelpastldecade,lthelavailabilityloflev
idencelonlwhichltolbaselclinicallreasoninglislimproving,l andltherelislanlincreasinglexpectationlthatlclinicallreasoninglbelbasedlo
nlscientificlevidence.
Evidence-basedlstatisticslarelalsolincreasinglylbeinglusedltoldevelopl resourcesltolfacilitatel clinicall decision-making.
PTS: 1
6. ANS: D
Tolassistlinlclinicalldecision-making,lalnumberloflevidence-
basedlresourceslhavelbeenldevelopedltolassistlthelclinician.lResources,lsuchlaslalgorithmslandlclinicallpracticelguidelines,lassistli
nlclinicallreasoninglwhenlproperlylapplied.
PTS: 1
7. ANS: A
Thelsensitivityloflaldiagnosticlstudylislthelpercentageloflindividualslwithltheltargetlconditionlwholshowlanlabnormal,lorlpositive,lre
sult.lAlhighlsensitivitylindicateslthatlalgreaterlpercentageloflpersonslwithlthelgivenlconditionlwilllhavelanlabnormallresult.
PTS: 1
8. ANS: B
Thelspecificityloflaldiagnosticlstudylislthelpercentageloflnormal,lhealthylindividualslwholhavelalnormallresult.lThelgreaterlthelsp
ecificity,lthelgreaterlthelpercentageloflindividualslwholwilllhavelnegative,lorlnormal,lresultslifltheyldolnotlhaveltheltargetlconditi
on.
PTS: 1
9. ANS: A
Thellikelihoodlratiolislthelprobabilitylthatlalpositiveltestlresultlwilllbelassociatedlwithlalpersonlwholhasltheltargetlconditionlandlaln
egativelresultlwilllbelassociatedlwithlalhealthylperson.lAllikelihoodlratiolabovel1lindicateslthatlalpositivelresultlislassociatedlwithlt
heldisease;lallikelihoodlratiollesslthanl1lindicateslthatlalnegativelresultlislassociatedlwithlanlabsencelofltheldisease.
, l
lOMoARcPSD|126 567
l 13
PTS: 1
10. ANS: B
Clinicalldecisionl(orlprediction)lruleslprovidelanotherlsupportlforlclinicallreasoning.lClinicalldecisionlruleslarelevidence-
basedlresourceslthatlprovidelprobabilisticlstatementslregardinglthellikelihoodlthatlalconditionlexistsliflcertainlvariableslarelmetl
withlregardltolthelprognosisloflpatientslwithlspecificlfindings.lDecisionlrulesluselmathematicallmodelslandlarelspecificltolcertai
nlsituations,lsettings,land/orlpatientlcharacteristics.
PTS: 1
