Test Bank For Harrison’s principles of internal medicine self assessment and board review 19 Edition

Test Bank For Harrison’s principles of internal
medicine self assessment and board review 19

Edition

, SECTION I
General Considerations in Clinical Medicine

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zq zq zq zq QUESTIONS


DIRECTIONS: Choose the one best response to each question.
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I-
1. All of the following statements regarding practice guidelines set forth by governing agencies and p
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rofessional organizations are true EXCEPT: v i v i v i v i




A. Clinical practice guidelines protect caregivers against inappropriate charges of malpractice, y
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etdo not provide protection for patients from receiving substandard care.
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B. Practice guidelines have largely reached a stage of nuance allowing them to address every uniqu
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eillness and patient presented to the modern physician. v i v i v i v i v i v i v i



C. Practice guidelines provide a legal constraint to physicians, and deviation from guideline-
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basedcare invariably leaves physicians vulnerable to legal action. v i v i v i v i v i v i v i



D. Where different organizations disagree regarding practice guidelines, a third-
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party agency has been appointed to mitigate these disagreements such that now all ma
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jor organizations’ guidelines are consistent.
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E. All of the above statements are not true.
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I-2. Regarding molecular medicine, which of the following statements represents an
INACCURATE example of the listed area of study: vi v i v i v i v i v i v i




A. Exposomics: An endocrinologist studies sunlight exposure and population risk of hip fracture. v i v i v i v i v i v i v i v i v i v i v i



B. Metabolomics: A biochemist studies the rate of flux through the creatine kinase pathwa v i v i v i v i v i v i v i v i v i v i v i v i



y during the cardiac cycle.
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C. Metagenomics: A biologist studies the genomic alterations in molds commonly found
in humandwellings. vi



D. Microbiomics: A microbiologist studies the genomic variation in thermophiles, bacteria
that cansurvive extreme heat near deep ocean vents. vi v i v i v i v i v i v i



E. Proteomics: A cardiologist studies desmosomal proteins and their posttranslational modificati v i v i v i v i v i v i v i v i v i



ons in studying arrhythmogenic right ventricular dysplasia.
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I-3. Which of the following is the best definition of evidence-based medicine?
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A. A summary of existing data from existing clinical trials with a critical methodologic
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review andstatistical analysis of summative data
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B. A type of research that compares the results of one approach to
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treating disease wit v i v i



h anotherapproach to treating the same disease
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C. Clinical decision- v i



making support tools developed by professional organizations that includeexpert opinions
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and data from clinical trials v i v i v i v i



D. Clinical decision making supported by data, preferably randomized controlled clinical trials
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E. One physician’s clinical experience in caring for multiple patients with a specific disord
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er over many years
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I-
4. Which of the following is the standard measure for determining the impact of a hea
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lth condition on a population?
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,A. Disability-adjusted life-years
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B. Infant mortality
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C. Life expectancy
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, D. Standardized mortality ratio v i v i



E. Years of life lost v i v i v i




I-5. Which of the following statements regarding disease patterns worldwide is true?
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A. Childhood undernutrition is the leading risk factor for global disease burden. v i v i v i v i v i v i v i v i v i v i



B. In a 2006 publication, the World Health Organization (WHO) estimated that 10% of
the totalglobal burden of disease was due to modifiable environmental risk factors. vi v i v i v i v i v i v i v i v i v i v i



C. In 2010, ischemic heart disease was the leading cause of death among adults.
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D. In the last two decades, mortality attributed to communicable diseases, maternal and perinatalcond
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itions, and nutritional deficiencies has remained fairly stable, with the majority (76%) ofv i v i v i v i v i v i v i v i v i v i v i v i



mortality from these causes occurring in sub-Saharan Africa and southern Asia.
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E. While poverty status has been shown to be linked to health status on the individual
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level, thesame relationship does not hold true when studying the link between national
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health indicators and gross domestic product per capita among nations.
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I-
6. You are appointed to a governmental healthcare advisory subcommittee concerned with addressing
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problems facing the global health community. Your task is to draw general conclusions fro
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m the global fight against tuberculosis (TB) and human immunodeficiency virus (HIV)/acquired i
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mmunodeficiency syndrome (AIDS) that may be applied in combatting other diseases, including noncommunicabl vi vi vi vi vi vi vi vi vi vi vi vi



e diseases. Which of the following conclusions is reasonable when considering HIV/AIDS and
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iTB as chronic diseases? v i v i v i




A. Barriers to adequate healthcare and patient adherence imposed by extreme poverty must beconco v i v i v i v i v i v i v i v i v i v i v i vi



mitantly addressed to adequately treat and prevent chronic disease in developing nations v i v i v i v i v i v i v i v i v i v i vi



.
B. Charging small fees for health services (e.g., AIDS prevention and care) supplies the p v i v i v i v i v i v i v i v i v i v i v i v i v i



atient witha sense of the treatment’s value and increases compliance and overall public vi v i v i v i v i v i v i v i v i v i v i v i v



health. i



C. Despite adequate available tools to practice their trade locally in developing nations, many v i v i v i v i v i v i v i v i v i v i v i vi



physicians and nurses emigrate to developed nations to practice their respective trades, a phenomenon call vi vi vi vi vi vi vi vi vi vi vi vi vi v i



ed “brain drain.” v i v i



D. In developed nations where physicians are abundant, community health worker supervision
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ofthe care of chronically ill patients is not effective.
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E. In the case of chronic infectious diseases, switching from one drug to another through
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aprolonged course of treatment provides the highest cure rate by obviating the infectio v i v i v i v i v i v i v i v i v i v i v i v i



us agent’s ability to develop resistance to any single drug. v i v i v i v i v i v i v i v i v i




I-7. Mrs. Jones, a 22-year-
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old African American woman, presents to Dr. Smith, an internal medicine specialist, with a
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facial rash. Mrs. Jones states that the rash began after spending a day at the beach wi
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th her family. She also notes that her metacarpophalangeal and proximal interphalangeal join
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ts have been painful and swollen for the preceding 2 weeks. On examination, the joints
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are swollen and tender. Laboratory analysis discloses reduced creatinine clearance, proteinuria,
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and hemolytic anemia. Antinuclear antibodies (a test with a high negative predictive value
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for systemic lupus erythematosus) are detected at significant titer, and ultimately, the dia
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gnosis of systemic lupus erythematosus is made. v i v i vi v i v i v i



Two weeks later, Mrs. Johnson, a 24-year- v i v i v i v i v i v i



old African American woman, presents with a facial rash and elbow pain to Dr. Smith. A
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fter a cursory interview and brief physical exam, Dr. Smith sends blood work only testing
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for antinuclear antibodies. When the test returns negative (no antibodies detected), Dr. Smith
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presumes this to be a false-
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negative result and starts Mrs. Johnson on hydroxychloroquine and prednisone for treatment v i v i v i v i v i vi v i v i v i v i v i v i



of systemic lupus erythematosus. Which heuristic(s) did Dr. Smith likely employ in diagnosing
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Mrs. Johnson with systemic lupus erythematosus?
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A. Availability heuristic v i



B. Anchoring heuristic v i