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INTERPRETING FINDINGS AND
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FORMULATING DIFFERENTIAL
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DIAGNOSES 5TH EDITION, MARY JO
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GOOLSBY, LAURIE GRUBBS ISBN-10;
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1719645930 / ISBN-13;978-1719645935
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,Chapter 1. Assessment and Clinical Decision-Making: Overview
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Multiple Choice
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Identify the choice that best completes the statement or answers the question.
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1. Which type of clinical decision-making is most reliable?
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A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
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A. Methodical and systematic YFT L YFT L
B. Attentive to the patient’s verbal and nonverbal language YFT L L
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C. Able to accurately interpret the patient’s responses YFT L YFT L YF
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D. Adept at reading into the patient’s statements YFT L YFT L YFT L YFT L YFT L YFT L
3. Essential parts of a health history include all of the following except: YFT L L
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A. Chief complaint YFT L
B. History of the present illness L
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C. Current vital signs L
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D. All of the above are essential history components
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4. Which of the following is false? While performing the physical examination, the examiner must
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be able to: L
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A. Differentiate between normal and abnormal findings L
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B. Recall knowledge of a range of conditions and their associated signs and symptoms L
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C. Recognize how certain conditions affect the response to other conditions YFT L YFT L YFT L YF T L YFTL L
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D. Foresee unpredictable findings YFT L YFT L
5. The following is the least reliable source of information for diagnostic statistics:
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A. Evidence-based investigations L
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B. Primary reports of research L
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C. Estimation based on a provider’s experience YFT L L
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D. Published meta-analyses L
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6. The following can be used to assist in sound clinical decision-making:
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A. Algorithm published in a peer-reviewed journal article YFTL YFT L L
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B. Clinical practice guidelines YFT L YFT L
C. Evidence-based research L
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D. All of the above YF T L YFT L YFT L
7. If a diagnostic study has high sensitivity, this indicates a:
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A. High percentage of persons with the given condition will have an abnormal result
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B. Low percentage of persons with the given condition will have an abnormal result
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C. Low likelihood of normal result in persons without a given condition
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D. None of the above L
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, 8. If a diagnostic study has high specificity, this indicates a:
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A. Low percentage of healthy individuals will show a normal result
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B. High percentage of healthy individuals will show a normal result
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C. High percentage of individuals with a disorder will show a normal result
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D. Low percentage of individuals with a disorder will show an abnormal result
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9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
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A. Positive result is strongly associated with the disease YFT L YFT L YFT L L
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B. Negative result is strongly associated with absence of the disease L
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C. Positive result is weakly associated with the disease YFT L YFT L YFT L L
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D. Negative result is weakly associated with absence of the disease L
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Y F T L 10. Which of the following clinical reasoning tools is defined as evidence-based resource based
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on mathematical modeling to express the likelihood of a condition in select situations, settings,
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and/or patients?
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A. Clinical practice guideline L
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B. Clinical decision rule L
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C. Clinical algorithm L
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D. Clinical recommendation L
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, Answer Section
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MULTIPLE CHOICE
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1. ANS: B Y F T L Y F T L
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitiveYF T L YF TL Y FT L YFT L YF T L YF T L Y FT L YF T L YF T L YF T L
and analytical. Intuitive decision-making (similar to Augenblink decision-making) is based on
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the experience and intuition of the clinician and is less reliable and paired with fairly common
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errors. In contrast, analytical decision-making is based on careful consideration and has greater
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reliability with rare errors.
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PTS: 1
2. ANS: D Y F T L Y F T L
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and
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nonverbal language, and able to accurately interpret the patient’s responses to questions.
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Rather than reading into the patient’s statements, they clarify any areas of uncertainty.
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3. ANS: C Y F T L Y F T L
Vital signs are part of the physical examination portion of patient assessment, not part of the health
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history.
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4. ANS: D Y F T L Y F T L
While performing the physical examination, the examiner must be able to differentiate between
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normal and abnormal findings, recall knowledge of a range of conditions, including their
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associated signs and symptoms, recognize how certain conditions affect the response to other
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conditions, and distinguish the relevance of varied abnormal findings.
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5. ANS: C Y F T L Y F T L
Sources for diagnostic statistics include textbooks, primary reports of research, and published
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meta-analyses. Another source of statistics, the one that has been most widely used and
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available for application to the reasoning process, is the estimation based on a provider’s
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experience, although these are rarely accurate. Over the past decade, the availability of
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evidence on which to base clinical reasoning is improving, and there is an increasing
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expectation that clinical reasoning be based on scientific evidence. Evidence-based statistics
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are also increasingly being used to develop resources to facilitate clinical decision-making.
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6. ANS: D Y F T L Y F T L
To assist in clinical decision-making, a number of evidence-based resources have been developed
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to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in
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clinical reasoning when properly applied.
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