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

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SECTION I d




General Considerations in Clinical Medicine d d d d




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
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dandprofessional organizations are true EXCEPT: d d d d



A. d Clinical practice guidelines protect caregivers against inappropriate charges of malpractice,
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d yet
do 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
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C.
uniquePractice guidelines provide a legal constraint to physicians, and deviation from guideline-
d
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based
illness and patient presented to the modern physician.
d d d d d d d

D. careWhere different
invariablyd
leavesorganizations disagree to
physicians vulnerable
d
regarding practice guidelines, a third-party agency
legal action. d
d
d
d d
d d
d d d
d d d d d



dhas
been appointed to mitigate these disagreements such that now all major organizations’ guidelines
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E. areAllconsistent.
of the above statements are not true.
d
d
d d d d d d d




I-2. Regarding molecular medicine, which of the following statements represents an
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d
example of the listed area of study:
INACCURATE d d d d d d



A. Exposomics: An endocrinologist studies sunlight exposure and population risk of hip fracture.
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B. Metabolomics: A biochemist studies the rate of flux through the creatine kinase pathway
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during
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C. theMetagenomics:
cardiac cycle. A biologist studies the genomic alterations in molds commonly found in
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dhuman
D. dwellings.
Microbiomics: A microbiologist studies the genomic variation in thermophiles, bacteria that
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can
d

E. survive
Proteomics:
extreme
d A heat
cardiologist studies
near deep oceandesmosomal
vents. proteins and their posttranslational
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d
d
d
d d
d
d
d
d
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modifications
d


in studying arrhythmogenic right ventricular dysplasia.
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 review
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and
d
statistical analysis of summative data d d d d


B. A type of research that compares the results of one approach to treating disease with
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danother
C. approach
Clinical todecision-making
treating the samesupport
disease tools developed by professional organizations that
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d
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d
d
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include d

D. expert
Clinical decision
opinions
d
andmaking supported
data from clinicalbytrials
data, preferably randomized controlled clinical trials
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d
d
d d
d
d
d
d
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E. One physician’s clinical experience in caring for multiple patients with a specific disorder
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dover
many years d

,d




I-4. Which of the following is the standard measure for determining the impact of a health condition
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don a population?
d



A. d Disability-adjusted life-years d


B. d Infant mortality d


C. d Life expectancy d


D. d Standardized mortality ratio d d


E. d Years of life lost d d d




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.
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B. In a 2006 publication, the World Health Organization (WHO) estimated that 10% of the
d d d d d d d d d d d d d d


dtotal
C. global
In 2010,
d ischemic
burden heartwas
of disease disease
ddue was the leading
to modifiable dcause of death
environmental among
risk adults.
factors.
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D. In the last two decades, mortality attributed to communicable diseases, maternal and
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dperinatal
conditions, and nutritional deficiencies has remained fairly stable, with the majority (76%)
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E. of While poverty status has been shown to be linked to health status on the individual
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d
mortality
level, the from these causes occurring in sub-Saharan Africa and southern Asia.
d
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same relationship does not hold true when studying the link between national health
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indicators
I-6. You are appointed to a governmental healthcare advisory subcommittee concerned with addressing
d


and gross domestic product per capita among nations.
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problems facing the global health community. Your task is to draw general conclusions from
d d d d d d d
d d d d d d d d d d d d d


dthe
global fight against tuberculosis
d (TB) and human immunodeficiency virus
d d d d d d d


d (HIV)/acquired
immunodeficiency syndrome (AIDS) that may be applied in combatting other diseases, d d d d d d d d d d


dincluding
A. Barriers to adequate healthcare and patient adherence imposed by extreme poverty
d d d d d d d d d d d

noncommunicable diseases. Which of the following conclusions is reasonable when d d d d d d d d d

d
d
must be
considering d


concomitantly
HIV/AIDS addressed
and TB as chronic to adequately treat and prevent chronic disease in developing nations.
diseases? d d d
d
d
d
d
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B. Charging small fees for health services (e.g., AIDS prevention and care) supplies the patient
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C. Despite adequate available tools to practice their trade locally in developing nations,
with
d d d d d d d d d d d
d


manyof the treatment’s value and increases compliance and overall public health.
a sense dd d d d d d d d d d d d


physicians and nurses emigrate to developed nations to practice their respective d d d d d d d d d d

D. trades,
In developed
d ad nations where physicians are abundant, community health worker supervision
d
d
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dof the care of chronically
phenomenon ill patients
called “brain drain.” is not effective.
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E. In the case of chronic infectious diseases, switching from one drug to another
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through a d d


prolonged course of treatment provides the highest cure rate by obviating the infectious
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agent’s
I-7. Mrs. Jones, a 22-year-old African American woman, presents to Dr. Smith, an internal
d


ability to develop resistance to any single drug.
d d d d d d d d d d d d d
d d d d d d d

dmedicine
specialist, with a facial rash. Mrs. Jones states that the rash began after spending a day at the
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dbeach
with her family. She also notes that her metacarpophalangeal and proximal interphalangeal
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djoints
Two
have weeks
been later,and
painful d
Mrs. Johnson,
swollen
d
for athe
24-year-old
preceding African
2 weeks.
d
American woman, presents
On examination,
d with
the joints are aswollen
facial rash
andd
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d
d
d
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d
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d

and elbow pain to Dr. Smith. After
d
a cursory interview and brief physical
tender. Laboratory analysis discloses reduced creatinine clearance, proteinuria, and
d d exam, Dr. Smith
d d
d
d
d
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d
d
d
d
d
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d


d
d
sends
hemolytic
blood
anemia.work only testing
Antinuclear for antinuclear
antibodies
d
d
antibodies.
(a test with a high When the test
negative
d returns value
predictive negative
for (no
systemic d
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d
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d
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d

d
d
antibodies
lupus
detected), Dr. are
erythematosus) Smith presumes
detected this to be
at significant titer,a and
d false-negative
ultimately, result and starts
the diagnosis d
d Mrs.
of systemic d
d
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d
d
d
d
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d
d d
d d
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d


d
d
Johnson
lupus on d


hydroxychloroquine
erythematosus is made.and prednisone for treatment of systemic lupus erythematosus. d d
d d d d d d d d


d Which
heuristic(s) did Dr. Smith likely employ in diagnosing Mrs. Johnson withd d d d d d d d d d


d systemic lupus d


erythematosus?

,d




A. d Availability heuristic d


B. d Anchoring heuristic d


C. d Bayes’ rule d


D. d Confirmation bias d


E. d A and B d d




I-8. You have invented a blood test, which you name “veritangin,” to determine if patients are having
d d d d d d d d d d d d d d d d



d a
myocardial infarction. You devise an experiment to determine the performance of your
d d d d d d d d d d d


dveritangin
assay by testing it versus the troponin assay, the currently accepted gold standard for
d d d d d d d d d d d d d


ddetermining
myocardial infarction, in 100 random emergency department patients with chest pain. You choose
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da
veritangin result >1 ng/dL as positive for myocardial infarction. Your results are listed in the
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dtable
below.




Which of the following statements regarding the characteristics of the veritangin assay in this trial is
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true?
A. d The posttest probability of the veritangin test does not depend on the population studied.
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B. The sensitivity of the veritangin assay depends on the population studied and the
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disease d

C. prevalence
The sensitivity of the veritangin assay will decrease by 50% if you reduce the threshold
in that population.
d d
d d d
d d d d d d d d d d d d d



dfor a d

D. positive
The sensitivity
result to of
d the veritangin
>0.5 ng/dL. test cannot be calculated based on the above data.
d
d d
d
d
d d
d
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E. The specificity of the veritangin assay is 0.93 (70/75).
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I-9. You are designing a clinical trial to test the use of a novel anticoagulant, clotbegone,
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d in the d


treatment of deep vein thrombosis. Which of the following statements regarding the design of
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A.
the An optimal study design would assign many patients to clotbegone and compare their
d d d d d d d d d d d d d d


trial
d
is true?
outcomes d d



to the outcomes of prior (historical) patients not taking clotbegone. This would allow faster
d d d d d d d d d d d d d

B.
trialIf the trial returns a positive result (clotbegone is superior to placebo), that means
d
d d d d d d d d d d d d d d



thatcompletion.
d any d

C. patientObserving the would
with a clot outcomes
d
benefitof from
patients alreadytherapy.
clotbegone d
taking clotbegone versus patients who are
d
d
d
d
d d
d d
d d
d
d
d d d d d d



not is
d d


preferable to assigning patients to clotbegone or placebo in a blinded fashion. The
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observational d


strategy is more “real world,” applicable to the general population, and free of bias.
d d d d d d d d d d d d d

E.
D. The advantage
Population of performing
selection
d
a randomized
for the trial enrollment clinical
d trial of clotbegone
is not important as long as over a
careful d
d d
d d d
d d
d
d
d d d
d d d
d d d
d
d
d



d prospective
attention to d d


observational
randomization study of clotbegone
and blinding is the avoidance of treatment selection bias.
is observed.
I-10. A receiver operating characteristic (ROC) curve is constructed for a new test developed to diagnose
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d d d d d d d d d d d d d d d


disease X. All of the following statements regarding the ROC curve are true EXCEPT:
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A. One criticism of the ROC curve is that it is developed for testing only one test or
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parameter
clinical with exclusion of other potentially relevant data.
d
d d d d d d d


B. ROC curve allows the selection of a threshold value for a test that yields the best sensitivity
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d with
the fewest false-positive tests. d d d