TEST BANK
ADVANCED HEALTH ASSESSMENT & CLINICAL DIAGNOSIS IN
PRIMARY CARE, 6TH EDITION
Joyce E. Dains, Linda Ciofu Baumann & Pamela Scheibel
, lOMoARcPSD|126 567 13
Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom
Analysis
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which type of clinical decision-making is most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient’s verbal and nonverbal language
C. Able to accurately interpret the patient’s responses
D. Adept at reading into the patient’s statements
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. History of the present illness
C. Current vital signs
D. All of the above are essential history
components
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
A. Differentiate between normal and abnormal findings
B. Recall knowledge of a range of conditions and their associated signs and symptoms
C. Recognize how certain conditions affect the response to other conditions
D. Foresee unpredictable findings
5. The following is the least reliable source of information for diagnostic statistics:
A. Evidence-based investigations
B. Primary reports of research
C. Estimation based on a provider’s experience
D. Published meta-analyses
6. The following can be used to assist in sound clinical decision-making:
A. Algorithm published in a peer-reviewed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
7. If a diagnostic study has high sensitivity, this indicates a:
A. High percentage of persons with the given condition will have an
abnormal result
B. Low percentage of persons with the given condition will have an
abnormal result
C. Low likelihood of normal result in persons without a given condition
D. None of the above
8. If a diagnostic study has high specificity, this indicates a:
A. Low percentage of healthy individuals will show a normal result
B. High percentage of healthy individuals will show a normal result
C. High percentage of individuals with a disorder will show a normal
result
D. Low percentage of individuals with a disorder will show an abnormal
result
9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
A. Positive result is strongly associated with the disease
B. Negative result is strongly associated with absence of the disease
C. Positive result is weakly associated with the disease
D. Negative result is weakly associated with absence of the disease
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on
mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?
A. Clinical practice
guideline
B. Clinical decision rule
C. Clinical algorithm
, lOMoARcPSD|126 567 13
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
Answer Section
MULTIPLE CHOICE
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical.
Intuitive decision- making (similar to Augenblink decision-making) is based on the experience and intuition of the
clinician and is less reliable and paired with fairly common errors. In contrast, analytical decision-making is based
on careful consideration and has greater reliability with rare errors.
PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal
language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the
patient’s statements, they clarify any areas of uncertainty.
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and
abnormal findings, recall knowledge of a range of conditions, including their associated signs and symptoms,
recognize how certain conditions affect the response to other conditions, 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.
Another source of statistics, the one that has been most widely used and available for application to the reasoning
process, is the estimation based on a provider’s experience, although these are rarely accurate. Over the past
decade, the availability of evidence on which to base clinical reasoning is improving, and there is an increasing
expectation that clinical reasoning be based on scientific evidence.
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the
clinician. Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly
applied.
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an
abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given
condition will have an abnormal result.
PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result.
The greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if
they do not have the target condition.
PTS: 1
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target
condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a
positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is
associated with an absence of the disease.
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are
evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if
certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use
mathematical models and are specific to certain situations, settings, and/or patient characteristics.
PTS: 1
, lOMoARcPSD|126 567 13
Chapter 2: Evidence-Based Health Screening
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. The first step in the genomic assessment of a patient is obtaining information regarding:
A. Family history
B. Environmental exposures
C. Lifestyle and behaviors
D. Current medications
2. An affected individual who manifests symptoms of a particular condition through whom a family
with a genetic disorder is ascertained is called a(n):
A. Consultand
B. Consulband
C. Index
patient
D. Proband
3. An autosomal dominant disorder involves the:
A. X chromosome
B. Y chromosome
C. Mitochondrial DNA
D. Non-sex
chromosomes
4. To illustrate a union between two second cousin family members in a pedigree, draw:
A. Arrows pointing to the male and female
B. Brackets around the male and female
C. Double horizontal lines between the male and
female
D. Circles around the male and female
5. To illustrate two family members in an adoptive relationship in a pedigree:
A. Arrows are drawn pointing to the male and female
B. Brackets are drawn around the male and female
C. Double horizontal lines are drawn between the male and
female
D. Circles are drawn around the male and female
6. When analyzing the pedigree for autosomal dominant disorders, it is common to see:
A. Several generations of affected members
B. Many consanguineous relationships
C. More members of the maternal lineage affected than
paternal
D. More members of the paternal lineage affected than
maternal
7. In autosomal recessive (AR) disorders, individuals need:
A. Only one mutated gene on the sex chromosomes to acquire the
disease
B. Only one mutated gene to acquire the disease
C. Two mutated genes to acquire the disease
D. Two mutated genes to become carriers
8. In autosomal recessive disorders, carriers have:
A. Two mutated genes; one from each parent that cause
disease
B. A mutation on a sex chromosome that causes a
disease
C. A single gene mutation that causes the disease
D. One copy of a gene mutation but not the disease
9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a
mutation, the following are the risks to each of their offspring (each pregnancy):
A. 50% chance that offspring will carry the
disease
B. 10% chance of offspring affected by disease
ADVANCED HEALTH ASSESSMENT & CLINICAL DIAGNOSIS IN
PRIMARY CARE, 6TH EDITION
Joyce E. Dains, Linda Ciofu Baumann & Pamela Scheibel
, lOMoARcPSD|126 567 13
Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom
Analysis
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which type of clinical decision-making is most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient’s verbal and nonverbal language
C. Able to accurately interpret the patient’s responses
D. Adept at reading into the patient’s statements
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. History of the present illness
C. Current vital signs
D. All of the above are essential history
components
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
A. Differentiate between normal and abnormal findings
B. Recall knowledge of a range of conditions and their associated signs and symptoms
C. Recognize how certain conditions affect the response to other conditions
D. Foresee unpredictable findings
5. The following is the least reliable source of information for diagnostic statistics:
A. Evidence-based investigations
B. Primary reports of research
C. Estimation based on a provider’s experience
D. Published meta-analyses
6. The following can be used to assist in sound clinical decision-making:
A. Algorithm published in a peer-reviewed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
7. If a diagnostic study has high sensitivity, this indicates a:
A. High percentage of persons with the given condition will have an
abnormal result
B. Low percentage of persons with the given condition will have an
abnormal result
C. Low likelihood of normal result in persons without a given condition
D. None of the above
8. If a diagnostic study has high specificity, this indicates a:
A. Low percentage of healthy individuals will show a normal result
B. High percentage of healthy individuals will show a normal result
C. High percentage of individuals with a disorder will show a normal
result
D. Low percentage of individuals with a disorder will show an abnormal
result
9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
A. Positive result is strongly associated with the disease
B. Negative result is strongly associated with absence of the disease
C. Positive result is weakly associated with the disease
D. Negative result is weakly associated with absence of the disease
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on
mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?
A. Clinical practice
guideline
B. Clinical decision rule
C. Clinical algorithm
, lOMoARcPSD|126 567 13
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
Answer Section
MULTIPLE CHOICE
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical.
Intuitive decision- making (similar to Augenblink decision-making) is based on the experience and intuition of the
clinician and is less reliable and paired with fairly common errors. In contrast, analytical decision-making is based
on careful consideration and has greater reliability with rare errors.
PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal
language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the
patient’s statements, they clarify any areas of uncertainty.
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and
abnormal findings, recall knowledge of a range of conditions, including their associated signs and symptoms,
recognize how certain conditions affect the response to other conditions, 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.
Another source of statistics, the one that has been most widely used and available for application to the reasoning
process, is the estimation based on a provider’s experience, although these are rarely accurate. Over the past
decade, the availability of evidence on which to base clinical reasoning is improving, and there is an increasing
expectation that clinical reasoning be based on scientific evidence.
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the
clinician. Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly
applied.
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an
abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given
condition will have an abnormal result.
PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result.
The greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if
they do not have the target condition.
PTS: 1
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target
condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a
positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is
associated with an absence of the disease.
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are
evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if
certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use
mathematical models and are specific to certain situations, settings, and/or patient characteristics.
PTS: 1
, lOMoARcPSD|126 567 13
Chapter 2: Evidence-Based Health Screening
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. The first step in the genomic assessment of a patient is obtaining information regarding:
A. Family history
B. Environmental exposures
C. Lifestyle and behaviors
D. Current medications
2. An affected individual who manifests symptoms of a particular condition through whom a family
with a genetic disorder is ascertained is called a(n):
A. Consultand
B. Consulband
C. Index
patient
D. Proband
3. An autosomal dominant disorder involves the:
A. X chromosome
B. Y chromosome
C. Mitochondrial DNA
D. Non-sex
chromosomes
4. To illustrate a union between two second cousin family members in a pedigree, draw:
A. Arrows pointing to the male and female
B. Brackets around the male and female
C. Double horizontal lines between the male and
female
D. Circles around the male and female
5. To illustrate two family members in an adoptive relationship in a pedigree:
A. Arrows are drawn pointing to the male and female
B. Brackets are drawn around the male and female
C. Double horizontal lines are drawn between the male and
female
D. Circles are drawn around the male and female
6. When analyzing the pedigree for autosomal dominant disorders, it is common to see:
A. Several generations of affected members
B. Many consanguineous relationships
C. More members of the maternal lineage affected than
paternal
D. More members of the paternal lineage affected than
maternal
7. In autosomal recessive (AR) disorders, individuals need:
A. Only one mutated gene on the sex chromosomes to acquire the
disease
B. Only one mutated gene to acquire the disease
C. Two mutated genes to acquire the disease
D. Two mutated genes to become carriers
8. In autosomal recessive disorders, carriers have:
A. Two mutated genes; one from each parent that cause
disease
B. A mutation on a sex chromosome that causes a
disease
C. A single gene mutation that causes the disease
D. One copy of a gene mutation but not the disease
9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a
mutation, the following are the risks to each of their offspring (each pregnancy):
A. 50% chance that offspring will carry the
disease
B. 10% chance of offspring affected by disease
