DOCUMENTS BY TOPTUTOR254
TEST BANK
Harrison's Principles of Internal Medicine Self-Assessment and Board Review
by Wiener, Kasper, Fauci
19th Edition
All Chapters |100% Accurate &Verified Answers |Grade A+
1|Page
, DIRECTIONS:
Choose the one best response to each question.
I-1. All of the following statements regarding practice guidelines set forth by governing agencies and professional
organizations are true EXCEPT:
A. Clinical practice guidelines protect caregivers against inappropriate charges of malpractice, yet do not
provide protection for patients from receiving substandard care.
B. Practice guidelines have largely reached a stage of nuance allowing them to address every unique illness and
patient presented to the modern physician.
C. Practice guidelines provide a legal constraint to physicians, and deviation from guideline-based care
invariably leaves physicians vulnerable to legal action.
D. Where different organizations disagree regarding practice guidelines, a third-party agency has been appointed
to mitigate these disagreements such that now all major organizations’ guidelines are consistent.
E. All of the above statements are not true.
I-2. Regarding molecular medicine, which of the following statements represents an INACCURATE example
of the listed area of study:
A. Exposomics: An endocrinologist studies sunlight exposure and population risk of hip fracture.
B. Metabolomics: A biochemist studies the rate of flux through the creatine kinase pathway during the
cardiac cycle.
C. Metagenomics: A biologist studies the genomic alterations in molds commonly found in human
dwellings.
D. Microbiomics: A microbiologist studies the genomic variation in thermophiles, bacteria that can
survive extreme heat near deep ocean vents.
E. Proteomics: A cardiologist studies desmosomal proteins and their posttranslational modifications in
studying arrhythmogenic right ventricular dysplasia.
I-3. Which of the following is the best definition of evidence-based medicine?
A. A summary of existing data from existing clinical trials with a critical methodologic review and
statistical analysis of summative data
B. A type of research that compares the results of one approach to treating disease with another
approach to treating the same disease
C. Clinical decision-making support tools developed by professional organizations that include
expert opinions and data from clinical trials
D. Clinical decision making supported by data, preferably randomized controlled clinical trials
E. One physician’s clinical experience in caring for multiple patients with a specific disorder over
many years
2|Page
, I-4. Which of the following is the standard measure for determining the impact of a health condition on a population?
A. Disability-adjusted life-years
B. Infant mortality
C. Life expectancy
D. Standardized mortality ratio
E. Years of life lost
I-5. Which of the following statements regarding disease patterns worldwide is true?
A. Childhood undernutrition is the leading risk factor for global disease burden.
B. In a 2006 publication, the World Health Organization (WHO) estimated that 10% of the total
global burden of disease was due to modifiable environmental risk factors.
C. In 2010, ischemic heart disease was the leading cause of death among adults.
D. In the last two decades, mortality attributed to communicable diseases, maternal and perinatal conditions, and
nutritional deficiencies has remained fairly stable, with the majority (76%) of mortality from these causes
occurring in sub-Saharan Africa and southern Asia.
E. While poverty status has been shown to be linked to health status on the individual level, the same
relationship does not hold true when studying the link between national health indicators and gross
domestic product per capita among nations.
I-6. You are appointed to a governmental healthcare advisory subcommittee concerned with addressing problems
facing the global health community. Your task is to draw general conclusions from the global fight against
tuberculosis (TB) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) that
may be applied in combatting other diseases, including noncommunicable diseases. Which of the following
conclusions is reasonable when considering HIV/AIDS and TB as chronic diseases?
A. Barriers to adequate healthcare and patient adherence imposed by extreme poverty must be concomitantly
addressed to adequately treat and prevent chronic disease in developing nations.
B. Charging small fees for health services (e.g., AIDS prevention and care) supplies the patient with a sense
of the treatment’s value and increases compliance and overall public health.
C. Despite adequate available tools to practice their trade locally in developing nations, many physicians and
nurses emigrate to developed nations to practice their respective trades, a phenomenon called “brain drain.”
D. In developed nations where physicians are abundant, community health worker supervision of the care
of chronically ill patients is not effective.
E. In the case of chronic infectious diseases, switching from one drug to another through a prolonged
course of treatment provides the highest cure rate by obviating the infectious agent’s ability to develop
resistance to any single drug.
I-7. Mrs. Jones, a 22-year-old African American woman, presents to Dr. Smith, an internal medicine specialist, with a
facial rash. Mrs. Jones states that the rash began after spending a day at the beach with her family. She also
notes that her metacarpophalangeal and proximal interphalangeal joints have been painful and swollen for the
preceding 2 weeks. On examination, the joints are swollen and tender. Laboratory analysis discloses reduced
creatinine clearance, proteinuria, and hemolytic anemia. Antinuclear antibodies (a test with a high negative
predictive value for systemic lupus erythematosus) are detected at significant titer, and ultimately, the diagnosis of
systemic lupus erythematosus is made.
Two weeks later, Mrs. Johnson, a 24-year-old African American woman, presents with a facial rash and elbow
pain to Dr. Smith. After a cursory interview and brief physical exam, Dr. Smith sends blood work only
testing for antinuclear antibodies. When the test returns negative (no antibodies detected), Dr. Smith presumes this
to be a false-negative result and starts Mrs. Johnson on hydroxychloroquine and prednisone for treatment of
systemic lupus erythematosus. Which heuristic(s) did Dr. Smith likely
3|Page
, employ in diagnosing Mrs. Johnson with systemic lupus erythematosus?
A. Availability heuristic
B. Anchoring heuristic
C. Bayes’ rule
D. Confirmation bias
E. A and B
I-8. You have invented a blood test, which you name “veritangin,” to determine if patients are having a
myocardial infarction. You devise an experiment to determine the performance of your veritangin assay by
testing it versus the troponin assay, the currently accepted gold standard for determining myocardial
infarction, in 100 random emergency department patients with chest pain. You choose a veritangin result >1
ng/dL as positive for myocardial infarction. Your results are listed in the table below.
Which of the following statements regarding the characteristics of the veritangin assay in this trial is true?
A. The posttest probability of the veritangin test does not depend on the population studied.
B. The sensitivity of the veritangin assay depends on the population studied and the disease
prevalence in that population.
C. The sensitivity of the veritangin assay will decrease by 50% if you reduce the threshold for a
positive result to >0.5 ng/dL.
D. The sensitivity of the veritangin test cannot be calculated based on the above data.
E. The specificity of the veritangin assay is 0.93 (70/75).
I-9. You are designing a clinical trial to test the use of a novel anticoagulant, clotbegone, in the treatment of
deep vein thrombosis. Which of the following statements regarding the design of the trial is true?
A. An optimal study design would assign many patients to clotbegone and compare their outcomes to the
outcomes of prior (historical) patients not taking clotbegone. This would allow faster trial completion.
B. If the trial returns a positive result (clotbegone is superior to placebo), that means that any patient with
a clot would benefit from clotbegone therapy.
C. Observing the outcomes of patients already taking clotbegone versus patients who are not is preferable to
assigning patients to clotbegone or placebo in a blinded fashion. The observational strategy is more “real
world,” applicable to the general population, and free of bias.
D. Population selection for the trial enrollment is not important as long as careful attention to randomization and
blinding is observed.
E. The advantage of performing a randomized clinical trial of clotbegone over a prospective observational
study of clotbegone is the avoidance of treatment selection bias.
I-10. A receiver operating characteristic (ROC) curve is constructed for a new test developed to diagnose disease X.
All of the following statements regarding the ROC curve are true EXCEPT:
A. One criticism of the ROC curve is that it is developed for testing only one test or clinical
4|Page
TEST BANK
Harrison's Principles of Internal Medicine Self-Assessment and Board Review
by Wiener, Kasper, Fauci
19th Edition
All Chapters |100% Accurate &Verified Answers |Grade A+
1|Page
, DIRECTIONS:
Choose the one best response to each question.
I-1. All of the following statements regarding practice guidelines set forth by governing agencies and professional
organizations are true EXCEPT:
A. Clinical practice guidelines protect caregivers against inappropriate charges of malpractice, yet do not
provide protection for patients from receiving substandard care.
B. Practice guidelines have largely reached a stage of nuance allowing them to address every unique illness and
patient presented to the modern physician.
C. Practice guidelines provide a legal constraint to physicians, and deviation from guideline-based care
invariably leaves physicians vulnerable to legal action.
D. Where different organizations disagree regarding practice guidelines, a third-party agency has been appointed
to mitigate these disagreements such that now all major organizations’ guidelines are consistent.
E. All of the above statements are not true.
I-2. Regarding molecular medicine, which of the following statements represents an INACCURATE example
of the listed area of study:
A. Exposomics: An endocrinologist studies sunlight exposure and population risk of hip fracture.
B. Metabolomics: A biochemist studies the rate of flux through the creatine kinase pathway during the
cardiac cycle.
C. Metagenomics: A biologist studies the genomic alterations in molds commonly found in human
dwellings.
D. Microbiomics: A microbiologist studies the genomic variation in thermophiles, bacteria that can
survive extreme heat near deep ocean vents.
E. Proteomics: A cardiologist studies desmosomal proteins and their posttranslational modifications in
studying arrhythmogenic right ventricular dysplasia.
I-3. Which of the following is the best definition of evidence-based medicine?
A. A summary of existing data from existing clinical trials with a critical methodologic review and
statistical analysis of summative data
B. A type of research that compares the results of one approach to treating disease with another
approach to treating the same disease
C. Clinical decision-making support tools developed by professional organizations that include
expert opinions and data from clinical trials
D. Clinical decision making supported by data, preferably randomized controlled clinical trials
E. One physician’s clinical experience in caring for multiple patients with a specific disorder over
many years
2|Page
, I-4. Which of the following is the standard measure for determining the impact of a health condition on a population?
A. Disability-adjusted life-years
B. Infant mortality
C. Life expectancy
D. Standardized mortality ratio
E. Years of life lost
I-5. Which of the following statements regarding disease patterns worldwide is true?
A. Childhood undernutrition is the leading risk factor for global disease burden.
B. In a 2006 publication, the World Health Organization (WHO) estimated that 10% of the total
global burden of disease was due to modifiable environmental risk factors.
C. In 2010, ischemic heart disease was the leading cause of death among adults.
D. In the last two decades, mortality attributed to communicable diseases, maternal and perinatal conditions, and
nutritional deficiencies has remained fairly stable, with the majority (76%) of mortality from these causes
occurring in sub-Saharan Africa and southern Asia.
E. While poverty status has been shown to be linked to health status on the individual level, the same
relationship does not hold true when studying the link between national health indicators and gross
domestic product per capita among nations.
I-6. You are appointed to a governmental healthcare advisory subcommittee concerned with addressing problems
facing the global health community. Your task is to draw general conclusions from the global fight against
tuberculosis (TB) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) that
may be applied in combatting other diseases, including noncommunicable diseases. Which of the following
conclusions is reasonable when considering HIV/AIDS and TB as chronic diseases?
A. Barriers to adequate healthcare and patient adherence imposed by extreme poverty must be concomitantly
addressed to adequately treat and prevent chronic disease in developing nations.
B. Charging small fees for health services (e.g., AIDS prevention and care) supplies the patient with a sense
of the treatment’s value and increases compliance and overall public health.
C. Despite adequate available tools to practice their trade locally in developing nations, many physicians and
nurses emigrate to developed nations to practice their respective trades, a phenomenon called “brain drain.”
D. In developed nations where physicians are abundant, community health worker supervision of the care
of chronically ill patients is not effective.
E. In the case of chronic infectious diseases, switching from one drug to another through a prolonged
course of treatment provides the highest cure rate by obviating the infectious agent’s ability to develop
resistance to any single drug.
I-7. Mrs. Jones, a 22-year-old African American woman, presents to Dr. Smith, an internal medicine specialist, with a
facial rash. Mrs. Jones states that the rash began after spending a day at the beach with her family. She also
notes that her metacarpophalangeal and proximal interphalangeal joints have been painful and swollen for the
preceding 2 weeks. On examination, the joints are swollen and tender. Laboratory analysis discloses reduced
creatinine clearance, proteinuria, and hemolytic anemia. Antinuclear antibodies (a test with a high negative
predictive value for systemic lupus erythematosus) are detected at significant titer, and ultimately, the diagnosis of
systemic lupus erythematosus is made.
Two weeks later, Mrs. Johnson, a 24-year-old African American woman, presents with a facial rash and elbow
pain to Dr. Smith. After a cursory interview and brief physical exam, Dr. Smith sends blood work only
testing for antinuclear antibodies. When the test returns negative (no antibodies detected), Dr. Smith presumes this
to be a false-negative result and starts Mrs. Johnson on hydroxychloroquine and prednisone for treatment of
systemic lupus erythematosus. Which heuristic(s) did Dr. Smith likely
3|Page
, employ in diagnosing Mrs. Johnson with systemic lupus erythematosus?
A. Availability heuristic
B. Anchoring heuristic
C. Bayes’ rule
D. Confirmation bias
E. A and B
I-8. You have invented a blood test, which you name “veritangin,” to determine if patients are having a
myocardial infarction. You devise an experiment to determine the performance of your veritangin assay by
testing it versus the troponin assay, the currently accepted gold standard for determining myocardial
infarction, in 100 random emergency department patients with chest pain. You choose a veritangin result >1
ng/dL as positive for myocardial infarction. Your results are listed in the table below.
Which of the following statements regarding the characteristics of the veritangin assay in this trial is true?
A. The posttest probability of the veritangin test does not depend on the population studied.
B. The sensitivity of the veritangin assay depends on the population studied and the disease
prevalence in that population.
C. The sensitivity of the veritangin assay will decrease by 50% if you reduce the threshold for a
positive result to >0.5 ng/dL.
D. The sensitivity of the veritangin test cannot be calculated based on the above data.
E. The specificity of the veritangin assay is 0.93 (70/75).
I-9. You are designing a clinical trial to test the use of a novel anticoagulant, clotbegone, in the treatment of
deep vein thrombosis. Which of the following statements regarding the design of the trial is true?
A. An optimal study design would assign many patients to clotbegone and compare their outcomes to the
outcomes of prior (historical) patients not taking clotbegone. This would allow faster trial completion.
B. If the trial returns a positive result (clotbegone is superior to placebo), that means that any patient with
a clot would benefit from clotbegone therapy.
C. Observing the outcomes of patients already taking clotbegone versus patients who are not is preferable to
assigning patients to clotbegone or placebo in a blinded fashion. The observational strategy is more “real
world,” applicable to the general population, and free of bias.
D. Population selection for the trial enrollment is not important as long as careful attention to randomization and
blinding is observed.
E. The advantage of performing a randomized clinical trial of clotbegone over a prospective observational
study of clotbegone is the avoidance of treatment selection bias.
I-10. A receiver operating characteristic (ROC) curve is constructed for a new test developed to diagnose disease X.
All of the following statements regarding the ROC curve are true EXCEPT:
A. One criticism of the ROC curve is that it is developed for testing only one test or clinical
4|Page
