,Chapter 1 .Assessment and Clinical Decision-M aking: Overview
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MultipleChoice
Identify thechoicethatbest completesthestatement oranswers thequestion.
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1. Whichtypeofclinicaldecision-making ismost reliable? bn bn
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Whichofthefollowing is false?Toobtainadequatehistory,health-careproviders must be:
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A. Methodicalandsystematic
B. Attentivetothepatient’s verbaland nonverballanguage n
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C. Abletoaccuratelyinterpret thepatient’sresponses
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D. Adept atreading into thepatient’sstatements
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Essentialpartsofahealth historyinclude allofthefollowing except: bn bn bn
3.
A. Chiefcomplaint
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B. Historyofthepresent illness
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C. Current vitalsigns
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D. Alloftheaboveareessential historycomponents
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Whichofthe following is false? Whileperforming the physicalexamination,theexaminer must beable
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4. to:
A. Differentiatebetweennormalandabnormalfindings
B. Recallknowledgeofarangeofconditions andtheir associated signs ands ymptoms n
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b
C. Recognize howcertainconditions affecttheresponsetoother conditions
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D. Foreseeunpredictablefindings n
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Thefollowing istheleast reliables ourceofinformationfordiagnosticstatistics:
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5. A. Evidence-basedinvestigations
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B. Primaryreports ofresearch
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C. Estimationbasedonaprovider’s experience
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D. Publishedmeta-analyses
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Thefollowing canbeused toassist insound clinicaldecision-making:
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6. B. Algorithmpublished
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n inapeer-reviewedjournalarticle
Clinicalpracticeguidelines
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b
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b
C. Evidence-basedresearch
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D. Allofthe above
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Ifa diagnostic studyhas highsensitivity, this indicatesa:
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A. Highpercentage ofpersonswiththegivencondition willhaveanabnormalresult
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7. B. Lowpercentageofpersons withthegivenconditionwillhaveanabnormalresult
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C. Lowlikelihoodofnormalresult inpersons without agivencondition
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D. Noneoftheabove
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, 8. Ifadiagnostic studyhas highspecificity, this indicates a:
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A. Low percentageofhealthyindividuals willshowanormalresult ll n
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B. Highpercentage ofhealthyindividuals willshow anormalresult bn bn bn
C. Highpercentage ofindividuals withadisorder willshowanormalresult
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D. Lowpercentageofindividuals withadisorderwillshow anabnormalresult n
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9. Alikelihoodratio above 1indicatesthat a diagnostic test showinga:
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A. Positiveresult is stronglyassociated withthedisease
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B. Negativeresult isstronglyassociated withabsence ofthedisease
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b
C. Positive result is weaklyassociated withthedisease
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D. Negativeresult isweaklyassociated withabsence ofthedisease
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bn 10. Which of thefollowing clinical reasoning tools is defined as evidence-
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basedresourcebasedon mathematical modeling toexpressthelikelihoodofaconditioninselect situ ations
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,s ettings,and/orpatients?
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A. Clinicalpracticeguideline bn
B. Clinicaldecision rule Clini
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C. cal algorithmC linicalreco
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D. mmendation
, Chapter 1.Assessm ent a nd Clinical Decision-M a king : Overview
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AnswerSection
MULTIPLECHOICE l
1. ANS: B
Croskerry(2009)describes two major typesofclinical diagnosticdecision-
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making: intuitive and analytical. Intuitive decision-making (similar to Augenblink decision-
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making)is based onthe experience andintuition oftheclinician andis less reliable andpaired withfai rl
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y common errors. In contrast, analytical decision-
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making is basedoncarefulconsideration andhas greater reliabilitywithrare errors.
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PTS: 1
2. ANS: D
Toobtainadequatehistory, providersmust bewellorganized, attentiveto thepatient’s verbalandnon bn bn bn l ll bn bn
verbal language, and able toaccurately interpret the patient’s responses to questions. Rather thanr
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eading into the patient’s statements, theyclarifyanyareas ofuncertainty.
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PTS: 1
3. ANS: C
Vitalsigns arepart ofthephysicalexaminationportionofpatient assessment, not partofthe healthhistory.
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PTS: 1
4. ANS: D
Whileperformingthe physicalexamination,theexaminer must beableto differentiate betweennor bn bn ll bn bn
mal and abnormalfindings, recall knowledgeof a range of conditions, including their associated sign s
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and symptoms, recognize howcertain conditions affect theresponse to otherconditions, and disti n
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guishthe relevance ofvaried abnormal findings.
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PTS: 1
5. ANS: C
Sources fordiagnostic statisticsincludetextbooks,primaryreports ofresearch, and published meta
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analyses. Another source of statistics, theonethat has been most widely used and available for appl
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ication tothe reasoning process, is the estimation based on aprovider’s experience, although thes
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e arerarelyaccurate. Over the pastdecade, the availability of evidence onwhich to baseclinicalreas
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o ning is improving, and there isan increasing expectationthat clinicalreasoningbe based on scientif
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ic evidence.Evidence-
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based statistics are also increasingly being used todevelop resources to facilitate clinicaldecision-
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making.
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6. ANS: D
Toassist inclinicaldecision-making,anumberofevidence-
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basedresourceshavebeendevelopedto assisttheclinician. Resources, such as algorithms and clinica bn bn bn bn bn bn bn bn
l practice guidelines, assist in clinicalreasoning whenproperlyapplied.
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