TEST BANK FOR
ADVANCED ASSESSMENT INTERPRETING FINDINGS AND FORMULATING
DIFFERENTIAL DIAGNOSES 4TH EDITION GOOLSBY COMPLETE CHAPTERS 18-
42||WITH ANSWER SECTION
,TABLE OF CONTENTS
CHAPTER 1. ASSESSMENT AND CLINICAL DECISION MAKING: AN OVERVIEW ..................... 4
CHAPTER 2. EVIDENCE-BASED HEALTH SCREENING ............................................................... 8
CHAPTER 3. ABDOMEN ...........................................................................................................18
CHAPTER 4: AFFECTIVE CHANGES .........................................................................................40
CHAPTER 5: AMENORRHEA ....................................................................................................50
CHAPTER 6. BREASTS LUMPS AND NIPPLE DISCHARGE .........................................................53
CHAPTER 7. BREAST PAIN ........................................................................................................58
CHAPTER 8: CHEST PAIN..........................................................................................................61
CHAPTER 9. CONFUSION IN OLDER ADULTS ..........................................................................65
CHAPTER 10: CONSTIPATION ..................................................................................................70
CHAPTER 11: COUGH .............................................................................................................73
CHAPTER 12: DIARRHEA ..........................................................................................................73
CHAPTER 13: DIZZINESS ...........................................................................................................83
CHAPTER 14. DYSPNEA ...........................................................................................................86
CHAPTER 15. EARACHE ...........................................................................................................98
CHAPTER 16: FATIGUE ...........................................................................................................103
CHAPTER 17. FEVER ...............................................................................................................106
CHAPTER 18: MALE GENITOURINARY PROBLEMS ................................................................ 110
CHAPTER 19. HEADACHE ......................................................................................................127
CHAPTER 20: HEARTBURN AND INDIGESTION ......................................................................136
CHAPTER 21. HOARSENESS ...................................................................................................137
CHAPTER 22: LOWER EXTREMITY LIMB PAIN .........................................................................140
CHAPTER 23: UPPER EXTREMITY LIMB PAIN ...........................................................................143
CHAPTER 24: LOW BACK PAIN (ACUTE)...............................................................................144
CHAPTER 25.: NASAL SYMPTOMS AND SINUS CONGESTION ..............................................147
CHAPTER 26: PALPITATIONS ..................................................................................................152
CHAPTER 27 PENILE DISCHARGE .......................................................................................... 155
CHAPTER 28 RASHES AND SKIN LESIONS ..............................................................................166
CHAPTER 29: RECTAL PAIN, ITCHING, AND BLEEDING ........................................................ 177
CHAPTER 30. RED EYE............................................................................................................179
CHAPER 31: SLEEP PROBLEMS............................................................................................... 189
CHAPTER 32. SORE THROAT ..................................................................................................197
,CHAPTER 33: SYNCOPE .........................................................................................................200
CHAPTER 34 URINARY INCONTINENCE ................................................................................203
CHAPTER 35 URINARY PROBLEMS IN FEMALES AND CHILDREN ..........................................210
CHAPTER 36. VAGINAL BLEEDING ........................................................................................ 214
CHAPTER 37. VAGINAL DISCHARGE AND ITCHING ............................................................ 217
CHAPTER 38: VISION LOSS ....................................................................................................235
CHAPTER 39: WEIGHT LOSS/GAIN(UNINTENTIONAL) ........................................................... 250
CHAPTER 40: THE ABDOMINAL X-RAY ..................................................................................256
CHAPTER 41: THE CHEST X-RAY ............................................................................................. 265
CHAPTER 42. THE TRANSGENDER PATIENT............................................................................269
,CHAPTER 1. ASSESSMENT AND CLINICAL DECISION MAKING:
AN OVERVIEW
MULTIPLE CHOICE
IDENTIFY THE CHOICE THAT BEST COMPLETES THE STATEMENT OR ANSWERS THE QUESTION.
1. WHICH TYPE OF CLINICAL DECISION-MAKING IS MOST RELIABLE?
A. INTUITIVE
B. ANALYTICAL
C. EXPERIENTIAL
D. AUGENBLICK
2. WHICH OF THE FOLLOWING IS FALSE? TO OBTAIN ADEQUATE HISTORY, HEALTH-CARE
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
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. ALL OF THE ABOVE ARE ESSENTIAL HISTORY COMPONENTS
4. WHICH OF THE FOLLOWING IS FALSE? WHILE PERFORMING THE PHYSICAL
EXAMINATION, THE EXAMINER MUST BE ABLE TO:
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
5. THE FOLLOWING IS THE LEAST RELIABLE SOURCE OF INFORMATION FOR DIAGNOSTIC
STATISTICS:
A. EVIDENCE-BASED INVESTIGATIONS
B. PRIMARY REPORTS OF RESEARCH
C. ESTIMATION BASED ON A PROVIDER’S EXPERIENCE
D. PUBLISHED META-ANALYSES
6. THE FOLLOWING CAN BE USED TO ASSIST IN SOUND CLINICAL DECISION-MAKING:
A. ALGORITHM PUBLISHED IN A PEER-REVIEWED JOURNAL ARTICLE
B. CLINICAL PRACTICE GUIDELINES
C. EVIDENCE-BASED RESEARCH
D. ALL OF THE ABOVE
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
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
,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
10. WHICH OF THE FOLLOWING CLINICAL REASONING TOOLS IS DEFINED AS EVIDENCE-
BASED RESOURCE BASED ON MATHEMATICAL MODELING TO EXPRESS THE LIKELIHOOD OF
A CONDITION IN SELECT SITUATIONS, SETTINGS, AND/OR PATIENTS?
A. CLINICAL PRACTICE GUIDELINE
B. CLINICAL DECISION RULE
C. CLINICAL ALGORITHM
CHAPTER 1: CLINICAL REASONING, DIFFERENTIAL DIAGNOSIS, EVIDENCE-BASED
PRACTICE, AND SYMPTOM ANA
ANSWER SECTION
1. ANSWER: B
CROSKERRY (2009) DESCRIBES TWO MAJOR TYPES OF CLINICAL DIAGNOSTIC DECISION-
MAKING: INTUITIVE AND ANALYTICAL. INTUITIVE DECISION- MAKING (SIMILAR TO
AUGENBLINK DECISION-MAKING) IS BASED ON THE EXPERIENCE AND INTUITION OF THE
CLINICIAN AND IS LESS RELIABLE ANDPAIRED WITH FAIRLY COMMON ERRORS. IN
CONTRAST, ANALYTICAL DECISION-MAKING IS BASED ON CAREFUL CONSIDERATION
AND HAS GREATER RELIABILITY WITH RARE ERRORS.
PTS: 1
2. ANSWER: D
TO OBTAIN ADEQUATE HISTORY, PROVIDERS MUST BE WELL ORGANIZED, ATTENTIVE TO THE
PATIENT’S VERBAL AND NONVERBAL LANGUAGE, AND ABLETO ACCURATELY INTERPRET
THE PATIENT’S RESPONSES TO QUESTIONS. RATHER THAN READING INTO THE PATIENT’S
STATEMENTS, THEY CLARIFY ANY AREAS OF UNCERTAINTY.
,PTS: 1
3. ANSWER: C
VITAL SIGNS ARE PART OF THE PHYSICAL EXAMINATION PORTION OF PATIENT
ASSESSMENT, NOT PART OF THE HEALTH HISTORY.
PTS: 1
4. ANSWER: D
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 AFFECTTHE RESPONSE TO OTHER CONDITIONS,
AND DISTINGUISH THE RELEVANCE OF VARIED ABNORMAL FINDINGS.
PTS: 1
5. ANSWER: C
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 THE ESTIMATION BASED ONA PROVIDER’S EXPERIENCE,
ALTHOUGH THESE ARE RARELY ACCURATE. OVER THE PAST DECADE, THE AVAILABILITY OF
EVIDENCE ON WHICH TO BASE CLINICAL REASONING IS IMPROVING, AND THERE IS AN
INCREASING EXPECTATION THAT CLINICAL REASONING BE BASED ON SCIENTIFIC
EVIDENCE.
EVIDENCE-BASED STATISTICS ARE ALSO INCREASINGLY BEING USED TO DEVELOP
RESOURCES TO FACILITATE CLINICAL DECISION-MAKING.
PTS: 1
6. ANSWER: D
TO ASSIST IN CLINICAL DECISION-MAKING, A NUMBER OF EVIDENCE-BASED RESOURCES
HAVE BEEN DEVELOPED TO ASSIST THE CLINICIAN. RESOURCES, SUCH AS ALGORITHMS
AND CLINICAL PRACTICE GUIDELINES, ASSIST IN CLINICAL REASONING WHEN PROPERLY
APPLIED.
PTS: 1
7. ANSWER: A
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.
,PTS: 1
8. ANSWER: B
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.
PTS: 1
9. ANSWER: A
THE LIKELIHOOD RATIO IS THE PROBABILITY THAT A POSITIVE TEST RESULT WILL BE
ASSOCIATED WITH A PERSON WHO HAS THE TARGET CONDITION AND A NEGATIVE
RESULT WILL BE ASSOCIATED WITH A HEALTHY PERSON. 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.
PTS: 1
10. ANSWER: B
CLINICAL DECISION (OR PREDICTION) RULES PROVIDE ANOTHER SUPPORT FOR CLINICAL
REASONING. CLINICAL DECISION RULES ARE EVIDENCE-BASED RESOURCES THAT PROVIDE
PROBABILISTIC STATEMENTS REGARDING THE LIKELIHOOD THAT A CONDITION EXISTS IF
CERTAIN VARIABLES ARE MET WITH REGARD TO THE PROGNOSIS OF PATIENTS WITH
SPECIFIC FINDINGS. DECISION RULES USE MATHEMATICAL MODELS AND ARE SPECIFIC TO
CERTAIN SITUATIONS, SETTINGS, AND/OR PATIENT CHARACTERISTICS.
PTS: 1
CHAPTER 2. EVIDENCE-BASED HEALTH SCREENING
MULTIPLE CHOICE
IDENTIFY THE CHOICE THAT BEST COMPLETES THE STATEMENT OR ANSWERS THE QUESTION.
,1. THE FIRST STEP IN THE GENOMIC ASSESSMENT OF A PATIENT IS OBTAINING
INFORMATION REGARDING:
A. FAMILY HISTORY
B. ENVIRONMENTAL EXPOSURES
C. LIFESTYLE AND BEHAVIORS
D. CURRENT MEDICATIONS
2. AN AFFECTED INDIVIDUAL WHO MANIFESTS SYMPTOMS OF A PARTICULAR
CONDITION THROUGH WHOM A FAMILY WITH A GENETIC DISORDER IS ASCERTAINED IS
CALLED A(N):
A. CONSULTAND
B. CONSULBAND
C. INDEX PATIENT
D. PROBAND
3. AN AUTOSOMAL DOMINANT DISORDER INVOLVES THE:
A. X CHROMOSOME
B. Y CHROMOSOME
C. MITOCHONDRIAL DNA
D. NON-SEX CHROMOSOMES
4. TO ILLUSTRATE A UNION BETWEEN TWO SECOND COUSIN FAMILY MEMBERS IN A
PEDIGREE, DRAW:
A. ARROWS POINTING TO THE MALE AND FEMALE
B. BRACKETS AROUND THE MALE AND FEMALE
C. DOUBLE HORIZONTAL LINES BETWEEN THE MALE AND FEMALE
D. CIRCLES AROUND THE MALE AND FEMALE
5. TO ILLUSTRATE TWO FAMILY MEMBERS IN AN ADOPTIVE RELATIONSHIP IN A
PEDIGREE:
A. ARROWS ARE DRAWN POINTING TO THE MALE AND FEMALE
B. BRACKETS ARE DRAWN AROUND THE MALE AND FEMALE
C. DOUBLE HORIZONTAL LINES ARE DRAWN BETWEEN THE MALE AND FEMALE
D. CIRCLES ARE DRAWN AROUND THE MALE AND FEMALE
, 6. WHEN ANALYZING THE PEDIGREE FOR AUTOSOMAL DOMINANT DISORDERS, IT IS
COMMON TO SEE:
A. SEVERAL GENERATIONS OF AFFECTED MEMBERS
B. MANY CONSANGUINEOUS RELATIONSHIPS
C. MORE MEMBERS OF THE MATERNAL LINEAGE AFFECTED THAN PATERNAL
D. MORE MEMBERS OF THE PATERNAL LINEAGE AFFECTED THAN MATERNAL
7. IN AUTOSOMAL RECESSIVE (AR) DISORDERS, INDIVIDUALS NEED:
A. ONLY ONE MUTATED GENE ON THE SEX CHROMOSOMES TO ACQUIRE THE DISEASE
B. ONLY ONE MUTATED GENE TO ACQUIRE THE DISEASE
C. TWO MUTATED GENES TO ACQUIRE THE DISEASE
D. TWO MUTATED GENES TO BECOME CARRIERS
8. IN AUTOSOMAL RECESSIVE DISORDERS, CARRIERS HAVE:
A. TWO MUTATED GENES; ONE FROM EACH PARENT THAT CAUSE DISEASE
B. A MUTATION ON A SEX CHROMOSOME THAT CAUSES A DISEASE
C. A SINGLE GENE MUTATION THAT CAUSES THE DISEASE
D. ONE COPY OF A GENE MUTATION BUT NOT THE DISEASE
9. WITH AN AUTOSOMAL RECESSIVE DISORDER, IT IS IMPORTANT THAT PARENTS
UNDERSTAND THAT IF THEY BOTH CARRY A MUTATION, THE FOLLOWING ARE THE RISKS TO
EACH OF THEIR OFFSPRING (EACH PREGNANCY):
A. 50% CHANCE THAT OFFSPRING WILL CARRY THE DISEASE
B. 10% CHANCE OF OFFSPRING AFFECTED BY DISEASE
C. 25% CHANCE CHILDREN WILL CARRY THE DISEASE
D. 10% CHANCE CHILDREN WILL BE DISEASE FREE
10. A WOMAN WITH AN X-LINKED DOMINANT DISORDER WILL:
A. NOT BE AFFECTED BY THE DISORDER HERSELF
B. TRANSMIT THE DISORDER TO 50 % OF HER OFFSPRING (MALE OR FEMALE)
C. NOT TRANSMIT THE DISORDER TO HER DAUGHTERS
D. TRANSMIT THE DISORDER TO ONLY HER DAUGHTERS
ADVANCED ASSESSMENT INTERPRETING FINDINGS AND FORMULATING
DIFFERENTIAL DIAGNOSES 4TH EDITION GOOLSBY COMPLETE CHAPTERS 18-
42||WITH ANSWER SECTION
,TABLE OF CONTENTS
CHAPTER 1. ASSESSMENT AND CLINICAL DECISION MAKING: AN OVERVIEW ..................... 4
CHAPTER 2. EVIDENCE-BASED HEALTH SCREENING ............................................................... 8
CHAPTER 3. ABDOMEN ...........................................................................................................18
CHAPTER 4: AFFECTIVE CHANGES .........................................................................................40
CHAPTER 5: AMENORRHEA ....................................................................................................50
CHAPTER 6. BREASTS LUMPS AND NIPPLE DISCHARGE .........................................................53
CHAPTER 7. BREAST PAIN ........................................................................................................58
CHAPTER 8: CHEST PAIN..........................................................................................................61
CHAPTER 9. CONFUSION IN OLDER ADULTS ..........................................................................65
CHAPTER 10: CONSTIPATION ..................................................................................................70
CHAPTER 11: COUGH .............................................................................................................73
CHAPTER 12: DIARRHEA ..........................................................................................................73
CHAPTER 13: DIZZINESS ...........................................................................................................83
CHAPTER 14. DYSPNEA ...........................................................................................................86
CHAPTER 15. EARACHE ...........................................................................................................98
CHAPTER 16: FATIGUE ...........................................................................................................103
CHAPTER 17. FEVER ...............................................................................................................106
CHAPTER 18: MALE GENITOURINARY PROBLEMS ................................................................ 110
CHAPTER 19. HEADACHE ......................................................................................................127
CHAPTER 20: HEARTBURN AND INDIGESTION ......................................................................136
CHAPTER 21. HOARSENESS ...................................................................................................137
CHAPTER 22: LOWER EXTREMITY LIMB PAIN .........................................................................140
CHAPTER 23: UPPER EXTREMITY LIMB PAIN ...........................................................................143
CHAPTER 24: LOW BACK PAIN (ACUTE)...............................................................................144
CHAPTER 25.: NASAL SYMPTOMS AND SINUS CONGESTION ..............................................147
CHAPTER 26: PALPITATIONS ..................................................................................................152
CHAPTER 27 PENILE DISCHARGE .......................................................................................... 155
CHAPTER 28 RASHES AND SKIN LESIONS ..............................................................................166
CHAPTER 29: RECTAL PAIN, ITCHING, AND BLEEDING ........................................................ 177
CHAPTER 30. RED EYE............................................................................................................179
CHAPER 31: SLEEP PROBLEMS............................................................................................... 189
CHAPTER 32. SORE THROAT ..................................................................................................197
,CHAPTER 33: SYNCOPE .........................................................................................................200
CHAPTER 34 URINARY INCONTINENCE ................................................................................203
CHAPTER 35 URINARY PROBLEMS IN FEMALES AND CHILDREN ..........................................210
CHAPTER 36. VAGINAL BLEEDING ........................................................................................ 214
CHAPTER 37. VAGINAL DISCHARGE AND ITCHING ............................................................ 217
CHAPTER 38: VISION LOSS ....................................................................................................235
CHAPTER 39: WEIGHT LOSS/GAIN(UNINTENTIONAL) ........................................................... 250
CHAPTER 40: THE ABDOMINAL X-RAY ..................................................................................256
CHAPTER 41: THE CHEST X-RAY ............................................................................................. 265
CHAPTER 42. THE TRANSGENDER PATIENT............................................................................269
,CHAPTER 1. ASSESSMENT AND CLINICAL DECISION MAKING:
AN OVERVIEW
MULTIPLE CHOICE
IDENTIFY THE CHOICE THAT BEST COMPLETES THE STATEMENT OR ANSWERS THE QUESTION.
1. WHICH TYPE OF CLINICAL DECISION-MAKING IS MOST RELIABLE?
A. INTUITIVE
B. ANALYTICAL
C. EXPERIENTIAL
D. AUGENBLICK
2. WHICH OF THE FOLLOWING IS FALSE? TO OBTAIN ADEQUATE HISTORY, HEALTH-CARE
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
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. ALL OF THE ABOVE ARE ESSENTIAL HISTORY COMPONENTS
4. WHICH OF THE FOLLOWING IS FALSE? WHILE PERFORMING THE PHYSICAL
EXAMINATION, THE EXAMINER MUST BE ABLE TO:
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
5. THE FOLLOWING IS THE LEAST RELIABLE SOURCE OF INFORMATION FOR DIAGNOSTIC
STATISTICS:
A. EVIDENCE-BASED INVESTIGATIONS
B. PRIMARY REPORTS OF RESEARCH
C. ESTIMATION BASED ON A PROVIDER’S EXPERIENCE
D. PUBLISHED META-ANALYSES
6. THE FOLLOWING CAN BE USED TO ASSIST IN SOUND CLINICAL DECISION-MAKING:
A. ALGORITHM PUBLISHED IN A PEER-REVIEWED JOURNAL ARTICLE
B. CLINICAL PRACTICE GUIDELINES
C. EVIDENCE-BASED RESEARCH
D. ALL OF THE ABOVE
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
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
,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
10. WHICH OF THE FOLLOWING CLINICAL REASONING TOOLS IS DEFINED AS EVIDENCE-
BASED RESOURCE BASED ON MATHEMATICAL MODELING TO EXPRESS THE LIKELIHOOD OF
A CONDITION IN SELECT SITUATIONS, SETTINGS, AND/OR PATIENTS?
A. CLINICAL PRACTICE GUIDELINE
B. CLINICAL DECISION RULE
C. CLINICAL ALGORITHM
CHAPTER 1: CLINICAL REASONING, DIFFERENTIAL DIAGNOSIS, EVIDENCE-BASED
PRACTICE, AND SYMPTOM ANA
ANSWER SECTION
1. ANSWER: B
CROSKERRY (2009) DESCRIBES TWO MAJOR TYPES OF CLINICAL DIAGNOSTIC DECISION-
MAKING: INTUITIVE AND ANALYTICAL. INTUITIVE DECISION- MAKING (SIMILAR TO
AUGENBLINK DECISION-MAKING) IS BASED ON THE EXPERIENCE AND INTUITION OF THE
CLINICIAN AND IS LESS RELIABLE ANDPAIRED WITH FAIRLY COMMON ERRORS. IN
CONTRAST, ANALYTICAL DECISION-MAKING IS BASED ON CAREFUL CONSIDERATION
AND HAS GREATER RELIABILITY WITH RARE ERRORS.
PTS: 1
2. ANSWER: D
TO OBTAIN ADEQUATE HISTORY, PROVIDERS MUST BE WELL ORGANIZED, ATTENTIVE TO THE
PATIENT’S VERBAL AND NONVERBAL LANGUAGE, AND ABLETO ACCURATELY INTERPRET
THE PATIENT’S RESPONSES TO QUESTIONS. RATHER THAN READING INTO THE PATIENT’S
STATEMENTS, THEY CLARIFY ANY AREAS OF UNCERTAINTY.
,PTS: 1
3. ANSWER: C
VITAL SIGNS ARE PART OF THE PHYSICAL EXAMINATION PORTION OF PATIENT
ASSESSMENT, NOT PART OF THE HEALTH HISTORY.
PTS: 1
4. ANSWER: D
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 AFFECTTHE RESPONSE TO OTHER CONDITIONS,
AND DISTINGUISH THE RELEVANCE OF VARIED ABNORMAL FINDINGS.
PTS: 1
5. ANSWER: C
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 THE ESTIMATION BASED ONA PROVIDER’S EXPERIENCE,
ALTHOUGH THESE ARE RARELY ACCURATE. OVER THE PAST DECADE, THE AVAILABILITY OF
EVIDENCE ON WHICH TO BASE CLINICAL REASONING IS IMPROVING, AND THERE IS AN
INCREASING EXPECTATION THAT CLINICAL REASONING BE BASED ON SCIENTIFIC
EVIDENCE.
EVIDENCE-BASED STATISTICS ARE ALSO INCREASINGLY BEING USED TO DEVELOP
RESOURCES TO FACILITATE CLINICAL DECISION-MAKING.
PTS: 1
6. ANSWER: D
TO ASSIST IN CLINICAL DECISION-MAKING, A NUMBER OF EVIDENCE-BASED RESOURCES
HAVE BEEN DEVELOPED TO ASSIST THE CLINICIAN. RESOURCES, SUCH AS ALGORITHMS
AND CLINICAL PRACTICE GUIDELINES, ASSIST IN CLINICAL REASONING WHEN PROPERLY
APPLIED.
PTS: 1
7. ANSWER: A
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.
,PTS: 1
8. ANSWER: B
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.
PTS: 1
9. ANSWER: A
THE LIKELIHOOD RATIO IS THE PROBABILITY THAT A POSITIVE TEST RESULT WILL BE
ASSOCIATED WITH A PERSON WHO HAS THE TARGET CONDITION AND A NEGATIVE
RESULT WILL BE ASSOCIATED WITH A HEALTHY PERSON. 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.
PTS: 1
10. ANSWER: B
CLINICAL DECISION (OR PREDICTION) RULES PROVIDE ANOTHER SUPPORT FOR CLINICAL
REASONING. CLINICAL DECISION RULES ARE EVIDENCE-BASED RESOURCES THAT PROVIDE
PROBABILISTIC STATEMENTS REGARDING THE LIKELIHOOD THAT A CONDITION EXISTS IF
CERTAIN VARIABLES ARE MET WITH REGARD TO THE PROGNOSIS OF PATIENTS WITH
SPECIFIC FINDINGS. DECISION RULES USE MATHEMATICAL MODELS AND ARE SPECIFIC TO
CERTAIN SITUATIONS, SETTINGS, AND/OR PATIENT CHARACTERISTICS.
PTS: 1
CHAPTER 2. EVIDENCE-BASED HEALTH SCREENING
MULTIPLE CHOICE
IDENTIFY THE CHOICE THAT BEST COMPLETES THE STATEMENT OR ANSWERS THE QUESTION.
,1. THE FIRST STEP IN THE GENOMIC ASSESSMENT OF A PATIENT IS OBTAINING
INFORMATION REGARDING:
A. FAMILY HISTORY
B. ENVIRONMENTAL EXPOSURES
C. LIFESTYLE AND BEHAVIORS
D. CURRENT MEDICATIONS
2. AN AFFECTED INDIVIDUAL WHO MANIFESTS SYMPTOMS OF A PARTICULAR
CONDITION THROUGH WHOM A FAMILY WITH A GENETIC DISORDER IS ASCERTAINED IS
CALLED A(N):
A. CONSULTAND
B. CONSULBAND
C. INDEX PATIENT
D. PROBAND
3. AN AUTOSOMAL DOMINANT DISORDER INVOLVES THE:
A. X CHROMOSOME
B. Y CHROMOSOME
C. MITOCHONDRIAL DNA
D. NON-SEX CHROMOSOMES
4. TO ILLUSTRATE A UNION BETWEEN TWO SECOND COUSIN FAMILY MEMBERS IN A
PEDIGREE, DRAW:
A. ARROWS POINTING TO THE MALE AND FEMALE
B. BRACKETS AROUND THE MALE AND FEMALE
C. DOUBLE HORIZONTAL LINES BETWEEN THE MALE AND FEMALE
D. CIRCLES AROUND THE MALE AND FEMALE
5. TO ILLUSTRATE TWO FAMILY MEMBERS IN AN ADOPTIVE RELATIONSHIP IN A
PEDIGREE:
A. ARROWS ARE DRAWN POINTING TO THE MALE AND FEMALE
B. BRACKETS ARE DRAWN AROUND THE MALE AND FEMALE
C. DOUBLE HORIZONTAL LINES ARE DRAWN BETWEEN THE MALE AND FEMALE
D. CIRCLES ARE DRAWN AROUND THE MALE AND FEMALE
, 6. WHEN ANALYZING THE PEDIGREE FOR AUTOSOMAL DOMINANT DISORDERS, IT IS
COMMON TO SEE:
A. SEVERAL GENERATIONS OF AFFECTED MEMBERS
B. MANY CONSANGUINEOUS RELATIONSHIPS
C. MORE MEMBERS OF THE MATERNAL LINEAGE AFFECTED THAN PATERNAL
D. MORE MEMBERS OF THE PATERNAL LINEAGE AFFECTED THAN MATERNAL
7. IN AUTOSOMAL RECESSIVE (AR) DISORDERS, INDIVIDUALS NEED:
A. ONLY ONE MUTATED GENE ON THE SEX CHROMOSOMES TO ACQUIRE THE DISEASE
B. ONLY ONE MUTATED GENE TO ACQUIRE THE DISEASE
C. TWO MUTATED GENES TO ACQUIRE THE DISEASE
D. TWO MUTATED GENES TO BECOME CARRIERS
8. IN AUTOSOMAL RECESSIVE DISORDERS, CARRIERS HAVE:
A. TWO MUTATED GENES; ONE FROM EACH PARENT THAT CAUSE DISEASE
B. A MUTATION ON A SEX CHROMOSOME THAT CAUSES A DISEASE
C. A SINGLE GENE MUTATION THAT CAUSES THE DISEASE
D. ONE COPY OF A GENE MUTATION BUT NOT THE DISEASE
9. WITH AN AUTOSOMAL RECESSIVE DISORDER, IT IS IMPORTANT THAT PARENTS
UNDERSTAND THAT IF THEY BOTH CARRY A MUTATION, THE FOLLOWING ARE THE RISKS TO
EACH OF THEIR OFFSPRING (EACH PREGNANCY):
A. 50% CHANCE THAT OFFSPRING WILL CARRY THE DISEASE
B. 10% CHANCE OF OFFSPRING AFFECTED BY DISEASE
C. 25% CHANCE CHILDREN WILL CARRY THE DISEASE
D. 10% CHANCE CHILDREN WILL BE DISEASE FREE
10. A WOMAN WITH AN X-LINKED DOMINANT DISORDER WILL:
A. NOT BE AFFECTED BY THE DISORDER HERSELF
B. TRANSMIT THE DISORDER TO 50 % OF HER OFFSPRING (MALE OR FEMALE)
C. NOT TRANSMIT THE DISORDER TO HER DAUGHTERS
D. TRANSMIT THE DISORDER TO ONLY HER DAUGHTERS
