TEST BANK - Advanced Health Assessment
and Clinical Diagnosis in Primary Care 6th
Edition by Joyce E
Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom
Analysis
Question 1
Which type of clinical decision-making is considered most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
Correct Answer: B. Analytical
Rationale: Croskerry (2009) describes two major types of clinical diagnostic decision-
making: intuitive and analytical. Intuitive decision-making (similar to Augenblick 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 .
Question 2
Which of the following statements is FALSE? To obtain an adequate history, healthcare 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
Correct Answer: D. Adept at reading into the patient's statements
Rationale: To obtain an 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 should clarify
any areas of uncertainty .
Question 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. Past medical history
Correct Answer: C. Current vital signs
Rationale: Vital signs are part of the physical examination portion of patient assessment,
not part of the health history. The health history includes the chief complaint, history of present
illness, past medical history, family history, social history, and review of systems .
Question 4
While performing the physical examination, the examiner must be able to do all of the following
EXCEPT:
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
Correct Answer: D. Foresee unpredictable findings
Rationale: 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.
Foreseeing unpredictable findings is not a realistic expectation .
Question 5
The least reliable source of information for diagnostic statistics is:
,A. Evidence-based investigations
B. Primary reports of research
C. Estimation based on a provider's experience
D. Published meta-analyses
Correct Answer: C. Estimation based on a provider's experience
Rationale: 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 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 has been improving .
Question 6
Which of the following can be used to assist in sound clinical decision-making?
A. Algorithms published in peer-reviewed journal articles
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
Correct Answer: D. All of the above
Rationale: To assist in clinical decision-making, a number of evidence-based resources have
been developed. Resources such as algorithms, clinical practice guidelines, and evidence-based
research all assist in clinical reasoning when properly applied .
Question 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
Correct Answer: A. High percentage of persons with the given condition will have an
abnormal result
Rationale: 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. This
concept is essential for understanding the utility of screening tests .
Question 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
Correct Answer: B. High percentage of healthy individuals will show a normal result
Rationale: 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 .
Question 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
Correct Answer: A. Positive result is strongly associated with the disease
Rationale: 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. Likelihood ratios are powerful tools for interpreting diagnostic test
results in clinical practice .
Question 10
Which of the following clinical reasoning tools is defined as an evidence-based resource based
on mathematical modeling to express the likelihood of a condition in select situations, settings,
and/or patients?
and Clinical Diagnosis in Primary Care 6th
Edition by Joyce E
Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom
Analysis
Question 1
Which type of clinical decision-making is considered most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
Correct Answer: B. Analytical
Rationale: Croskerry (2009) describes two major types of clinical diagnostic decision-
making: intuitive and analytical. Intuitive decision-making (similar to Augenblick 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 .
Question 2
Which of the following statements is FALSE? To obtain an adequate history, healthcare 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
Correct Answer: D. Adept at reading into the patient's statements
Rationale: To obtain an 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 should clarify
any areas of uncertainty .
Question 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. Past medical history
Correct Answer: C. Current vital signs
Rationale: Vital signs are part of the physical examination portion of patient assessment,
not part of the health history. The health history includes the chief complaint, history of present
illness, past medical history, family history, social history, and review of systems .
Question 4
While performing the physical examination, the examiner must be able to do all of the following
EXCEPT:
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
Correct Answer: D. Foresee unpredictable findings
Rationale: 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.
Foreseeing unpredictable findings is not a realistic expectation .
Question 5
The least reliable source of information for diagnostic statistics is:
,A. Evidence-based investigations
B. Primary reports of research
C. Estimation based on a provider's experience
D. Published meta-analyses
Correct Answer: C. Estimation based on a provider's experience
Rationale: 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 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 has been improving .
Question 6
Which of the following can be used to assist in sound clinical decision-making?
A. Algorithms published in peer-reviewed journal articles
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
Correct Answer: D. All of the above
Rationale: To assist in clinical decision-making, a number of evidence-based resources have
been developed. Resources such as algorithms, clinical practice guidelines, and evidence-based
research all assist in clinical reasoning when properly applied .
Question 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
Correct Answer: A. High percentage of persons with the given condition will have an
abnormal result
Rationale: 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. This
concept is essential for understanding the utility of screening tests .
Question 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
Correct Answer: B. High percentage of healthy individuals will show a normal result
Rationale: 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 .
Question 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
Correct Answer: A. Positive result is strongly associated with the disease
Rationale: 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. Likelihood ratios are powerful tools for interpreting diagnostic test
results in clinical practice .
Question 10
Which of the following clinical reasoning tools is defined as an evidence-based resource based
on mathematical modeling to express the likelihood of a condition in select situations, settings,
and/or patients?
