ADVANCED ASSESSMENT: INTERPRETING FINDINGS AND
FORMULATING DIFFERENTIAL DIAGNOSES 5th Ed Goolsby
Chapterf1.fAssessment and Clinical Decision-Making: Overview
MultiplefChoice
Identifyfthef choicef thatf bestfcompletesf thef statementf orfanswersf thef question.
f 1. Whichftypef offclinicalfdecision-makingf isf mostf reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2.
f Whichfofftheffollowingfisffalse?fTofobtainfadequatefhistory,fhealth-
carefprovidersfmustfbe:
A. Methodicalfandfsystematic
B. Attentiveftofthefpatient’sf verbalfand
nonverbalf language
C. Ableftofaccuratelyfinterpretfthefpatient’s
responses
D. Adeptfatfreadingf intofthefpatient’s
statements
f 3. Essentialfpartsf offaf healthfhistoryfincludefallf offthef followingf except:
A. Chieffcomplaint
B. Historyfoffthefpresentf illness
C. Currentfvitalfsigns
D. Allfoffthefabovef arefessentialf history
components
f4.
Whichfofftheffollowingfisffalse?fWhilefperformingfthefphysicalfexaminati
on,fthefexaminerfmustfbefablefto:
A. Differentiatef betweenfnormalfand
abnormalf findings
B. Recallfknowledgef offafrangef offconditions
andftheirfassociatedfsignsf andfsymptoms
C. Recognizef howf certainfconditionsf affect
thefresponseftofotherfconditions
D. Foreseefunpredictablef findings
f5.
Theffollowingfisfthefleastfreliablefsourcefoffinformationfforfdiagnosticfstatistics:
A. Evidence-basedf investigations
B. Primaryfreportsf offresearch
C. Estimationfbasedf onfaf provider’s
experience
D. Publishedfmeta-analyses
, f 6. Thef followingfcanfbefusedf tofassistf infsoundf clinicalfdecision-making:
A. Algorithmfpublishedfinfafpeer-reviewed
journalfarticle
B. Clinicalfpracticefguidelines
C. Evidence-basedfresearch
D. Allfoffthefabove
f 7. Iffafdiagnosticfstudyfhasfhighfsensitivity,fthisf indicatesf a:
A. Highfpercentagef offpersonsf withfthefgiven
conditionfwillf havef anfabnormalfresult
B. Lowf percentagef offpersonsf withfthefgiven
conditionfwillf havef anfabnormalfresult
C. Lowf likelihoodf offnormalfresultfin
personsfwithoutfaf givenfcondition
D. Nonefoffthefabove
f 8. Iffafdiagnosticfstudyfhasfhighfspecificity,fthisf indicatesf a:
A. Lowf percentagef offhealthyf individuals
willfshowf afnormalfresult
B. Highfpercentagef off healthyf individuals
willfshowf afnormalfresult
C. Highfpercentagef offindividualsf withfa
disorderfwillfshowf afnormalfresult
D. Lowfpercentagef off individualsfwithfa
disorderfwillfshowf anfabnormalfresult
f 9. Aflikelihoodfratiofabovef1f indicatesfthatfafdiagnosticftestfshowingfa:
A. Positivefresultfisfstronglyfassociatedfwith
thefdisease
B. Negativefresultfisfstronglyfassociatedfwith
absencefoffthefdisease
C. Positivefresultfisfweaklyfassociatedfwith
thefdisease
D. Negativefresultfisfweaklyfassociatedfwith
absencefoffthefdisease
f 10. Whichfofftheffollowingfclinicalfreasoningftoolsfisfdefinedfasfevidence-
fbasedfresourcefbasedfonfmathematicalfmodelingftofexpressftheflikelihoodfoffafconditionfi
nfselectfsituations,fsettings,fand/orfpatients?
A. Clinicalfpracticefguideline
B. Clinicalfdecisionf rule
C. Clinicalfalgorithm
D. Clinicalf recommendation
Chapterf1.fAssessmentfandfClinicalfDecision-Making:fOverview
,AnswerfSection
MULTIPLEfCHOICE
1. ANS:f B
Croskerryf(2009)fdescribesftwofmajorftypesfoffclinicalfdiagnosticfdecision-
making:fintuitivefandfanalytical.fIntuitivefdecision-
makingf(similarftofAugenblinkfdecision-
fmaking)fisfbasedfonfthefexperiencefandfintuitionfoffthefclinicianfandfisflessfreliablefandf
pairedfwithffairlyfcommonferrors.fInfcontrast,fanalyticalfdecision-
makingfisfbasedfonfcarefulfconsiderationfandfhasfgreaterfreliabilityfwithfrareferrors.
PTS: 1
2. ANS:f D
Tofobtainfadequatefhistory,fprovidersfmustfbefwellforganized,fattentiveftofthefpatient’sfve
rbalfandfnonverbalflanguage,fandfableftofaccuratelyfinterpretfthefpatient’sfresponsesftofqu
estions.fRatherfthanfreadingfintofthefpatient’sfstatements,ftheyfclarifyfanyfareasfoffuncerta
inty.
PTS: 1
3. ANS:f C
Vitalfsignsfarefpartfoffthefphysicalfexaminationfportionfoffpatientfassessment,fnotfpartfofft
hefhealthfhistory.
PTS: 1
4. ANS:f D
Whilefperformingfthefphysicalfexamination,fthefexaminerfmustfbefableftofdifferentiatefb
etweenfnormalfandfabnormalffindings,frecallfknowledgefoffafrangefoffconditions,finclud
ingftheirfassociatedfsignsfandfsymptoms,frecognizefhowfcertainfconditionsfaffectfthefres
ponseftofotherfconditions,fandfdistinguishfthefrelevancefoffvariedfabnormalffindings.
PTS: 1
5. ANS:f C
Sourcesfforfdiagnosticfstatisticsfincludeftextbooks,fprimaryfreportsfoffresearch,fandfpublis
hedfmeta-
analyses.fAnotherfsourcefoffstatistics,fthefonefthatfhasfbeenfmostfwidelyfusedfandfavailabl
efforfapplicationftofthefreasoningfprocess,fisfthefestimationfbasedfonfafprovider’sfexperien
ce,falthoughfthesefarefrarelyfaccurate.fOverfthefpastfdecade,fthefavailabilityfoffevidencefon
fwhichftofbasefclinicalfreasoningfisfimproving,fandftherefisfanfincreasingfexpectationfthatf
clinicalfreasoningfbefbasedfonfscientificfevidence.fEvidence-
fbasedfstatisticsfarefalsofincreasinglyfbeingfusedftofdevelopfresourcesftoffacilitatefclinicalf
decision-making.
PTS: 1
6. ANS:f D
, Tofassistfinfclinicalfdecision-making,fafnumberfoffevidence-
basedfresourcesfhavefbeenfdevelopedftofassistfthefclinician.fResources,fsuchfasfalgorith
msfandfclinicalfpracticefguidelines,fassistfinfclinicalfreasoningfwhenfproperlyfapplied.
PTS: 1
7. ANS:f A
Thefsensitivityfoffafdiagnosticfstudyfisfthefpercentagefoffindividualsfwithftheftargetfcond
itionfwhofshowfanfabnormal,forfpositive,fresult.fAfhighfsensitivityfindicatesfthatfafgreate
rfpercentagefoffpersonsfwithfthefgivenfconditionfwillfhavefanfabnormalfresult.
PTS: 1
8. ANS:f B
Thefspecificityfoffafdiagnosticfstudyfisfthefpercentagefoffnormal,fhealthyfindividualsfwhofh
avefafnormalfresult.fThefgreaterfthefspecificity,fthefgreaterfthefpercentagefoffindividualsfwh
ofwillfhavefnegative,forfnormal,fresultsfifftheyfdofnotfhaveftheftargetfcondition.
PTS: 1
9. ANS:f A
Theflikelihoodfratiofisfthefprobabilityfthatfafpositiveftestfresultfwillfbefassociatedfwithfafpe
rsonfwhofhasftheftargetfconditionfandfafnegativefresultfwillfbefassociatedfwithfafhealthyfpe
rson.fAflikelihoodfratiofabovef1findicatesfthatfafpositivefresultfisfassociatedfwithfthefdiseas
e;faflikelihoodfratioflessfthanf1findicatesfthatfafnegativefresultfisfassociatedfwithfanfabsence
foffthefdisease.
PTS: 1
10. ANS:f B
Clinicalfdecisionf(orfprediction)frulesfprovidefanotherfsupportfforfclinicalfreasoning.fClin
icalfdecisionfrulesfarefevidence-
basedfresourcesfthatfprovidefprobabilisticfstatementsfregardingftheflikelihoodfthatfafcondi
tionfexistsfiffcertainfvariablesfarefmetfwithfregardftofthefprognosisfoffpatientsfwithfspecifi
cffindings.fDecisionfrulesfusefmathematicalfmodelsfandfarefspecificftofcertainfsituations,f
settings,fand/orfpatientfcharacteristics.
PTS: 1
FORMULATING DIFFERENTIAL DIAGNOSES 5th Ed Goolsby
Chapterf1.fAssessment and Clinical Decision-Making: Overview
MultiplefChoice
Identifyfthef choicef thatf bestfcompletesf thef statementf orfanswersf thef question.
f 1. Whichftypef offclinicalfdecision-makingf isf mostf reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2.
f Whichfofftheffollowingfisffalse?fTofobtainfadequatefhistory,fhealth-
carefprovidersfmustfbe:
A. Methodicalfandfsystematic
B. Attentiveftofthefpatient’sf verbalfand
nonverbalf language
C. Ableftofaccuratelyfinterpretfthefpatient’s
responses
D. Adeptfatfreadingf intofthefpatient’s
statements
f 3. Essentialfpartsf offaf healthfhistoryfincludefallf offthef followingf except:
A. Chieffcomplaint
B. Historyfoffthefpresentf illness
C. Currentfvitalfsigns
D. Allfoffthefabovef arefessentialf history
components
f4.
Whichfofftheffollowingfisffalse?fWhilefperformingfthefphysicalfexaminati
on,fthefexaminerfmustfbefablefto:
A. Differentiatef betweenfnormalfand
abnormalf findings
B. Recallfknowledgef offafrangef offconditions
andftheirfassociatedfsignsf andfsymptoms
C. Recognizef howf certainfconditionsf affect
thefresponseftofotherfconditions
D. Foreseefunpredictablef findings
f5.
Theffollowingfisfthefleastfreliablefsourcefoffinformationfforfdiagnosticfstatistics:
A. Evidence-basedf investigations
B. Primaryfreportsf offresearch
C. Estimationfbasedf onfaf provider’s
experience
D. Publishedfmeta-analyses
, f 6. Thef followingfcanfbefusedf tofassistf infsoundf clinicalfdecision-making:
A. Algorithmfpublishedfinfafpeer-reviewed
journalfarticle
B. Clinicalfpracticefguidelines
C. Evidence-basedfresearch
D. Allfoffthefabove
f 7. Iffafdiagnosticfstudyfhasfhighfsensitivity,fthisf indicatesf a:
A. Highfpercentagef offpersonsf withfthefgiven
conditionfwillf havef anfabnormalfresult
B. Lowf percentagef offpersonsf withfthefgiven
conditionfwillf havef anfabnormalfresult
C. Lowf likelihoodf offnormalfresultfin
personsfwithoutfaf givenfcondition
D. Nonefoffthefabove
f 8. Iffafdiagnosticfstudyfhasfhighfspecificity,fthisf indicatesf a:
A. Lowf percentagef offhealthyf individuals
willfshowf afnormalfresult
B. Highfpercentagef off healthyf individuals
willfshowf afnormalfresult
C. Highfpercentagef offindividualsf withfa
disorderfwillfshowf afnormalfresult
D. Lowfpercentagef off individualsfwithfa
disorderfwillfshowf anfabnormalfresult
f 9. Aflikelihoodfratiofabovef1f indicatesfthatfafdiagnosticftestfshowingfa:
A. Positivefresultfisfstronglyfassociatedfwith
thefdisease
B. Negativefresultfisfstronglyfassociatedfwith
absencefoffthefdisease
C. Positivefresultfisfweaklyfassociatedfwith
thefdisease
D. Negativefresultfisfweaklyfassociatedfwith
absencefoffthefdisease
f 10. Whichfofftheffollowingfclinicalfreasoningftoolsfisfdefinedfasfevidence-
fbasedfresourcefbasedfonfmathematicalfmodelingftofexpressftheflikelihoodfoffafconditionfi
nfselectfsituations,fsettings,fand/orfpatients?
A. Clinicalfpracticefguideline
B. Clinicalfdecisionf rule
C. Clinicalfalgorithm
D. Clinicalf recommendation
Chapterf1.fAssessmentfandfClinicalfDecision-Making:fOverview
,AnswerfSection
MULTIPLEfCHOICE
1. ANS:f B
Croskerryf(2009)fdescribesftwofmajorftypesfoffclinicalfdiagnosticfdecision-
making:fintuitivefandfanalytical.fIntuitivefdecision-
makingf(similarftofAugenblinkfdecision-
fmaking)fisfbasedfonfthefexperiencefandfintuitionfoffthefclinicianfandfisflessfreliablefandf
pairedfwithffairlyfcommonferrors.fInfcontrast,fanalyticalfdecision-
makingfisfbasedfonfcarefulfconsiderationfandfhasfgreaterfreliabilityfwithfrareferrors.
PTS: 1
2. ANS:f D
Tofobtainfadequatefhistory,fprovidersfmustfbefwellforganized,fattentiveftofthefpatient’sfve
rbalfandfnonverbalflanguage,fandfableftofaccuratelyfinterpretfthefpatient’sfresponsesftofqu
estions.fRatherfthanfreadingfintofthefpatient’sfstatements,ftheyfclarifyfanyfareasfoffuncerta
inty.
PTS: 1
3. ANS:f C
Vitalfsignsfarefpartfoffthefphysicalfexaminationfportionfoffpatientfassessment,fnotfpartfofft
hefhealthfhistory.
PTS: 1
4. ANS:f D
Whilefperformingfthefphysicalfexamination,fthefexaminerfmustfbefableftofdifferentiatefb
etweenfnormalfandfabnormalffindings,frecallfknowledgefoffafrangefoffconditions,finclud
ingftheirfassociatedfsignsfandfsymptoms,frecognizefhowfcertainfconditionsfaffectfthefres
ponseftofotherfconditions,fandfdistinguishfthefrelevancefoffvariedfabnormalffindings.
PTS: 1
5. ANS:f C
Sourcesfforfdiagnosticfstatisticsfincludeftextbooks,fprimaryfreportsfoffresearch,fandfpublis
hedfmeta-
analyses.fAnotherfsourcefoffstatistics,fthefonefthatfhasfbeenfmostfwidelyfusedfandfavailabl
efforfapplicationftofthefreasoningfprocess,fisfthefestimationfbasedfonfafprovider’sfexperien
ce,falthoughfthesefarefrarelyfaccurate.fOverfthefpastfdecade,fthefavailabilityfoffevidencefon
fwhichftofbasefclinicalfreasoningfisfimproving,fandftherefisfanfincreasingfexpectationfthatf
clinicalfreasoningfbefbasedfonfscientificfevidence.fEvidence-
fbasedfstatisticsfarefalsofincreasinglyfbeingfusedftofdevelopfresourcesftoffacilitatefclinicalf
decision-making.
PTS: 1
6. ANS:f D
, Tofassistfinfclinicalfdecision-making,fafnumberfoffevidence-
basedfresourcesfhavefbeenfdevelopedftofassistfthefclinician.fResources,fsuchfasfalgorith
msfandfclinicalfpracticefguidelines,fassistfinfclinicalfreasoningfwhenfproperlyfapplied.
PTS: 1
7. ANS:f A
Thefsensitivityfoffafdiagnosticfstudyfisfthefpercentagefoffindividualsfwithftheftargetfcond
itionfwhofshowfanfabnormal,forfpositive,fresult.fAfhighfsensitivityfindicatesfthatfafgreate
rfpercentagefoffpersonsfwithfthefgivenfconditionfwillfhavefanfabnormalfresult.
PTS: 1
8. ANS:f B
Thefspecificityfoffafdiagnosticfstudyfisfthefpercentagefoffnormal,fhealthyfindividualsfwhofh
avefafnormalfresult.fThefgreaterfthefspecificity,fthefgreaterfthefpercentagefoffindividualsfwh
ofwillfhavefnegative,forfnormal,fresultsfifftheyfdofnotfhaveftheftargetfcondition.
PTS: 1
9. ANS:f A
Theflikelihoodfratiofisfthefprobabilityfthatfafpositiveftestfresultfwillfbefassociatedfwithfafpe
rsonfwhofhasftheftargetfconditionfandfafnegativefresultfwillfbefassociatedfwithfafhealthyfpe
rson.fAflikelihoodfratiofabovef1findicatesfthatfafpositivefresultfisfassociatedfwithfthefdiseas
e;faflikelihoodfratioflessfthanf1findicatesfthatfafnegativefresultfisfassociatedfwithfanfabsence
foffthefdisease.
PTS: 1
10. ANS:f B
Clinicalfdecisionf(orfprediction)frulesfprovidefanotherfsupportfforfclinicalfreasoning.fClin
icalfdecisionfrulesfarefevidence-
basedfresourcesfthatfprovidefprobabilisticfstatementsfregardingftheflikelihoodfthatfafcondi
tionfexistsfiffcertainfvariablesfarefmetfwithfregardftofthefprognosisfoffpatientsfwithfspecifi
cffindings.fDecisionfrulesfusefmathematicalfmodelsfandfarefspecificftofcertainfsituations,f
settings,fand/orfpatientfcharacteristics.
PTS: 1
