AND FORMULATING DIFFERENTIAL DIAGNOSES 5th EDITION
GOOLSBY CHAPTERS 1 - 22 | COMPLETE
, Chapter1.AssessmentandClinicalDecisionMaking:AnOverview
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Multiple Choice
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Identify the choice that best completes the statement or accurate answer:->s the question.
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1. Whichtype ofclinical decision-makingis mostreliable? 7
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A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Whichofthefollowingis false?Toobtainadequatehistory, health-careproviders mustbe: 7
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A. Methodical andsystematic 7y 7y
B. Attentivetothepatient’sverbal andnonverballanguage 7
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C. Able toaccuratelyinterpret the patient’s responses
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D. Adept atreadingintothepatient’sstatements 7y 7
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3. Essentialpartsofahealthhistoryincludeall ofthe followingexcept: 7
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A. Chiefcomplaint 7
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B. Historyofthepresentillness 7
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C. Currentvital signs 7
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D. Alloftheabove areessentialhistorycomponents
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4. Whichofthe followingis false?Whileperformingthe physical examination, theexaminer must beableto:
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A. Differentiate between normal and abnormal findings 7y 7y 7 y 7y 7 y
B. Recall knowledge of arangeof conditions andtheir associatedsigns and symptoms
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C. Recognizehowcertainconditionsaffect theresponseto other conditions 7y 7
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D. Foresee unpredictable findings 7y 7 y
5. Thefollowingistheleastreliablesourceofinformation for diagnosticstatistics:
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A. Evidence-based investigations 7 y
B. Primaryreports ofresearch 7y 7
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C. Estimationbasedonaprovider’s experience 7
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D. Published meta-analyses 7 y
6. Thefollowingcanbeusedtoassistinsoundclinicaldecision-making:
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A. Algorithmpublished in apeer-reviewed journal article 7y 7 y 7y 7y 7 y
B. Clinical practice guidelines 7 y 7 y
C. Evidence-based research 7y
D. Alloftheabove
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7. Ifa diagnosticstudyhas highsensitivity, thisindicates a:
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A. Highpercentage ofpersons withthegivenconditionwill haveanabnormal result
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B. Lowpercentage ofpersons withthegivencondition willhaveanabnormal result
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C. Lowlikelihoodofnormal resultinpersons withoutagivencondition
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D. None of theabove 7y 7y 7
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8. Ifa diagnosticstudyhas highspecificity, this indicates a:
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A. Lowpercentage ofhealthyindividuals will showa normalresult
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B. Highpercentage ofhealthyindividuals will showanormalresult
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C. Highpercentageofindividuals withadisorderwillshowanormalresult
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D. Lowpercentageofindividualswithadisorderwillshowanabnormal result
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9. Alikelihoodratioabove 1indicates thatadiagnostictestshowinga: 7
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A. Positive resultis stronglyassociated withthe sickness 7y 7y 7y 7
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B. Negativeresult is stronglyassociated with absence of the sickness 7
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C. Positiveresultis weaklyassociated withthesickness 7
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D. Negativeresultis weaklyassociated with absence ofthesickness 7
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, 10. Whichofthefollowingclinicalreasoningtoolsisdefinedasevidence-
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basedresource basedonmathematical modeling 7
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A. Clinical practice guideline 7y 7y
B. Clinical decision rule 7y 7y
C. Clinical algorithm 7 y
Chapter1:Clinicalreasoning,differentialdiagnosis,evidence-basedpractice,andsymptomana
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Accurateanswer:->Section
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MULTIPLECHOICE 7y
1. ACCURATE ANSWER:->: B 7y
Croskerry(2009)describes twomajortypes ofclinical diagnosticdecision-making:intuitive andanalytical. Intuitive decision-
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making(similar toAugenblinkdecision-
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making) is basedon the experience andintuition ofthe clinician andis lessreliable andpaired with fairlycommon errors. In contrast
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, analytical decision-makingis basedon careful consideration and has greater reliabilitywithrare errors.
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POINTS: 1
2. ACCURATE ANSWER:->: D 7y
To obtain adequate history, providers must be well organized, attentive tothe patient’s verbal and nonverbal language, and a
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bleto accuratelyinterpretthepatient’sresponsestoquestions.Ratherthanreadingintothepatient’sstatements, theyclarifya
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ny areasof uncertainty.
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3. ACCURATE ANSWER:->: C 7y
Vitalsigns arepart ofthephysical examinationportionofpatientassessment, notpart ofthe healthhistory.
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POINTS: 1
4. ACCURATE ANSWER:->: D 7y
Whileperformingthephysicalexamination,theexaminermustbeabletodifferentiatebetweennormalandabnormalfindings,reca
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ll knowledge of a range ofconditions, includingtheir associatedsigns andsymptoms, recognize how certain conditionsaffectt
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he response to other conditions, and distinguish the relevance of varied abnormal findings.
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POINTS: 1
5. ACCURATE ANSWER:->: C 7y
Sourcesfordiagnosticstatisticsincludetextbooks,primaryreportsofresearch,andpublishedmeta-
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analyses.Anothersourceof statistics,the onethathasbeen most widelyused andavailable for applicationtothereasoningproces
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s,istheestimationbased ona provider’s experience, althoughthesearerarelyaccurate. Overthepastdecade, the availabilityofevide
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nceonwhichtobaseclinical reasoningisimproving,andthereisanincreasingexpectationthatclinicalreasoningbebasedonscien
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tificevidence. 7
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Evidence-basedstatistics arealsoincreasinglybeingused todevelopresourcesto facilitate clinical decision-making. 7
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POINTS: 1
6. ACCURATE ANSWER:->: D 7y
Toassistinclinicaldecision-making, anumberofevidence-
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basedresources have beendevelopedtoassisttheclinician. Resources,such asalgorithmsandclinicalpracticeguidelines,assi
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stinclinical reasoningwhenproperlyapplied.
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POINTS: 1
7. ACCURATE ANSWER:->: 7y A
The sensitivityofa diagnosticstudyis the percentage ofindividuals withthe targetconditionwhoshowan abnormal, orpositive,result.
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Ahighsensitivityindicatesthatagreaterpercentageofpersonswiththegivenconditionwillhaveanabnormalresult.
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8. ACCURATE ANSWER:->: B 7y
Thespecificityofadiagnosticstudyisthepercentageofnormal,healthyindividualswhohaveanormalresult.Thegreaterthe
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specificity,thegreaterthepercentageofindividualswhowillhavenegative,ornormal,resultsiftheydonot havethetarget
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condition.
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9. ACCURATE ANSWER:->: A 7y
Thelikelihood ratiois the probability that apositive test result will beassociated with aperson whohas the targetcondition anda
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negativeresultwillbeassociatedwithahealthyperson. Alikelihoodratioabove1indicatesthatapositiveresultisassociatedwiththe s
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ickness;alikelihoodratiolessthan1indicatesthatanegativeresultisassociatedwithanabsence ofthesickness.
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