ii
100% ge
2023-2024
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ii ii ii ii ii ii ii ii ii ii
Multiple Choice
ii
Identify the choice that best completes the statement or answers the question.
ii ii ii ii ii ii ii ii ii ii ii
ii 1. Which type of clinical decision-making is most reliable? ii ii ii ii ii ii g e ii
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
ii 2. Which of the following is false? To obtain adequate history, health-care providers must be:
ii ii i ii ii
R
X ii ii ii ii ii
R
X ii ii
R
X ii
A. Methodical and systematic ii ii
B. Attentive to the patient‘s verbal and nonverbal language
ii ii ii ii ii ii ii
C. Able to accurately interpret the patient‘s responses
ii ii ii ii ii ii
D. Adept at reading into the patient‘s statements
ii ii ii ii ii ii
ii 3. Essential parts of a health history include all of the following except: ii ii ii ii ii ii ii ii ii ii ii
A. Chief complaint ii
B. History o f the present illness i ii ii ii
R
X
C. Current vital signs ii geii
D. All of the above are essential history components
ii
X
R ii ii ii ii geii ii
ii 4. Which of the following is false? While performing the physical examination, the examiner must be able to:
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
A. Differentiate between normal and abnormal findings ii ii ii ii ii
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ii eii
g ii ii ii ii ii ii ii geii geii ii
C. Recognize how certain conditions affect the response to other conditions
ii ii iXRi i ii
R
X ii i ii ii
D. Foresee unpredictable findings ii ii
ii 5. The following is the least reliable source o f information for diagnostic statistics:
ii ii ii ii ii ii i ii iXRi ii i
A. Evidence-based investigations ii
B. Primary reports of research ii ii ii
C. Estimation based on a provider‘s experience ii eii
g eii
g ii ii
D. Published meta-analyses ii
ii 6. The following can be used to assist in sound clinical decision-making:
ii ii ii ii g e g e ii ii ii ii ii
X
R ii
A. Algorithmpublished in a peer-reviewed journal article i iXRi ii i ii
R
X ii
B. Clinical practice guidelines ii geii
C. Evidence-based research ii
D. All of the above
ii ii ii
ii 7. If a diagnostic study h as high sensitivity, this indicates a:
ii ii
X
R ii ii gei i ii ii gei i geii
A. High percentage of persons with the given condition will have an abnormal result
ii geii ii geii ii ii ge ii iXRi ii ii ii ii
B. Low percentage of persons with the given condition will have an abnormal result
ii ii ii ii ii ii ii ii ii ii g e ii ii
C. Low likelihood of normal result in persons without a given condition
ii ii ii ii ii ii g e ii ii ii ii
D. None of the aboveii ii ii
ii 8. If a diagnostic study has high specificity, this indicates a:
ii ii
X
R ii ii g e ii ii ii ii g e ii
A. Low percentage of healthy individuals will show a normal result
ii eii
g ii ii eii
g ii ii geii ii
B. High percentage of healthy individuals will show a normal result
ii ii
R
X ii i ii ii ii ii g e ii
C. High percentage of i ndividuals with a d isorder will show a normal result
ii ge ii ii ii
X
R iXRi ii ii ii ii ii g e ii
D. Low percentage of individuals with a disorder will show an abnormal result
ii ii ii ii ii ii ii g e ii ii ii ii
ii 9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
ii iXRi eii
g eii
g ii ii ii ii ii ii ii
A. Positive result is strongly associated with the disease
ii ii ii
R
X ii iXRi ii ii
B. Negative result is strongly associated with absence of the disease
ii ii ii
R
X i ii ii g e ii ii ii
C. Positive result is weakly associated with the disease
ii ii ii ii ii ii ii
D. Negative result is weaklyassociated with absence of the disease
ii ii ii
R
X i ii
X
R ge ii ii ii ii
ii 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling
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, iige
to express thelikelihood ofa condition in select situations, settin gs, and/orpatients?
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e ii
ge gei ii ge ii ge i ge ii i
, ii
A. Clinical practice guideline ii ii
X
R
B. Clinical decision rule ii ii
C. Clinical algorithm ii
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ii ii ii ii ii ii ii ii ii ii
Answer Section
ii
MULTIPLE CHOICE ii
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
ii eii
g ii ii ii ii ii ii
R
X geii ii ii geii ii geii
making (similar to Augenblink decision-
geii ii ii eii
g ii
making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In co
ii
R
X ii ii ii ii
R
X geii ii ii
X
R ii ii
R
X geii ii ii
X
R ii
R
X geii ii ii geii ii iXRi geii geii
ntrast, analytical decision-making is based on careful consideration and has greater reliability with rare errors.
ii ii ii geii geii ii gei i ii iXRi ii
X
R geii ii geii ii
PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient‘s verbal and nonverbal language, and able t
ii
X
R ii iXRi ii geii geii geii eii
g ii
R
X geii ii
X
R ii ii
R
X ii geii ii ii geii ii
o accurately interpret the patient‘s responses to questions. Rather than reading into the patient‘s statements, they clarify any areas
ii ii ii eii
g ii ii ii iXRi ii geii ii iXRi ii ii ii
R
X ii geii ii ii
of uncertainty. ii
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, rec
ii ii ii geii ii ii geii geii geii ii geii ii ii geii geii ii
X
R geii
all knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affec
geii ii ii ii ii ii ii ii gei i iRi
X iRi
X geii ii ii ii geii geii
t the response to other conditions, and distinguish the relevance of varied abnormal findings.
ii ii ii ii ii eii
g ii ii
X
R ii ii ii geii XRi i ge
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
ii geii eii
g eii
g ii eii
g ii ii
R
X ii
R
X ii
R
X ii iXRi
analyses. Another source of statistics, the one that has been most widelyused and available for application to the reasoning process, is the estimation bas
ii ii eii
g geii i ii i ii ii iRi
X ii i ii ii ii
R
X i ii i ii i iXRi ii ii ii
ed ona provider‘s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base clinical reasoni
i i geii ii ii eii
g ii eii
g ii ii ii ii ii iXRi ii ii ii ii geii ii ii geii ii
ng is i mproving, and there i s an increasing expectation that clinical reasoning b e based on scientific evidence.
ii ii ii ii i ii ii ii iXRi ii ii ii ii geii ii ii
Evidence-based statistics are also increasinglybeing used to develop resources to facilitate clinical decision-making. ii ii ii g e g e ii i ii ii ii ii ii ii ii ii
X
R
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-
ii
X
R ii
R
X ii ii ii
X
R ii
X
R geii ii
based resources have been developed to assist the clinician.Resources, such as algorithms and clinical practice guideline
ii
X
R gei i ii ii
X
R geii geii eii
g geii i ii ii
X
R ii ii ii ii iXRi
s, assist in clinical reasoning when properly applied.
geii ii ii ii ii ii geii
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positi
ii ii ii eii
g eii
g ii eii
g eii
g geii ii ii geii gei i ii
R
X iXRi ii ii gei i ii
X
R ge ii
ve,result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
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R
X i ii ii ii ii ii geii ii ii ii ii i ii iXRi ii ii ii ge ii
PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater thes
ii ii ii eii
g eii
g ii eii
g eii
g geii ii ii ii ii ii ii ii geii ii
X
R ii ge ii i
pecificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target conditi
ii
X
R ii ii ii geii ii ii ii
R
X geii ii ii ii ii
R
X geii ii ii geii ii ii geii ii
R
X
on.
PTS: 1
9. ANS: 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 ne
ii geii geii geii geii ii geii geii geii geii geii geii geii geii ge ii geii geii geii ii geii geii geii geii ii
gative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with the
geii geii geii geii geii ii geii geii geii geii geii ii geii geii geii geii geii ii ii geii geii ii i
disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ii
R
X ii ii
X
R ii ii
X
R ii ii ii geii ii ii geii ii
X
R ii ii
R
X iXRi ii ii ii
, ii
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
ii eii
g ii iXRi ii geii ii geii ii ii ii ii ii gei i ii
X
R
gebased resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met
ii eii
g iXRi ii geii ii ii geii iXRi ii ii
R
X iXRi ii
X
R ii geii geii geii geii
with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain
ii geii ii ii
R
X ii ii geii ii ii
R
X gei i ii
R
X ii
X
R geii geii ii ii geii ii geii ii
R
X
situations, settings, and/or patient characteristics.
ii ii ii ii
PTS: 1
100% ge
2023-2024
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ii ii ii ii ii ii ii ii ii ii
Multiple Choice
ii
Identify the choice that best completes the statement or answers the question.
ii ii ii ii ii ii ii ii ii ii ii
ii 1. Which type of clinical decision-making is most reliable? ii ii ii ii ii ii g e ii
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
ii 2. Which of the following is false? To obtain adequate history, health-care providers must be:
ii ii i ii ii
R
X ii ii ii ii ii
R
X ii ii
R
X ii
A. Methodical and systematic ii ii
B. Attentive to the patient‘s verbal and nonverbal language
ii ii ii ii ii ii ii
C. Able to accurately interpret the patient‘s responses
ii ii ii ii ii ii
D. Adept at reading into the patient‘s statements
ii ii ii ii ii ii
ii 3. Essential parts of a health history include all of the following except: ii ii ii ii ii ii ii ii ii ii ii
A. Chief complaint ii
B. History o f the present illness i ii ii ii
R
X
C. Current vital signs ii geii
D. All of the above are essential history components
ii
X
R ii ii ii ii geii ii
ii 4. Which of the following is false? While performing the physical examination, the examiner must be able to:
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
A. Differentiate between normal and abnormal findings ii ii ii ii ii
B. Recall knowledge of a range of conditions and their associated signs and symptoms
ii eii
g ii ii ii ii ii ii ii geii geii ii
C. Recognize how certain conditions affect the response to other conditions
ii ii iXRi i ii
R
X ii i ii ii
D. Foresee unpredictable findings ii ii
ii 5. The following is the least reliable source o f information for diagnostic statistics:
ii ii ii ii ii ii i ii iXRi ii i
A. Evidence-based investigations ii
B. Primary reports of research ii ii ii
C. Estimation based on a provider‘s experience ii eii
g eii
g ii ii
D. Published meta-analyses ii
ii 6. The following can be used to assist in sound clinical decision-making:
ii ii ii ii g e g e ii ii ii ii ii
X
R ii
A. Algorithmpublished in a peer-reviewed journal article i iXRi ii i ii
R
X ii
B. Clinical practice guidelines ii geii
C. Evidence-based research ii
D. All of the above
ii ii ii
ii 7. If a diagnostic study h as high sensitivity, this indicates a:
ii ii
X
R ii ii gei i ii ii gei i geii
A. High percentage of persons with the given condition will have an abnormal result
ii geii ii geii ii ii ge ii iXRi ii ii ii ii
B. Low percentage of persons with the given condition will have an abnormal result
ii ii ii ii ii ii ii ii ii ii g e ii ii
C. Low likelihood of normal result in persons without a given condition
ii ii ii ii ii ii g e ii ii ii ii
D. None of the aboveii ii ii
ii 8. If a diagnostic study has high specificity, this indicates a:
ii ii
X
R ii ii g e ii ii ii ii g e ii
A. Low percentage of healthy individuals will show a normal result
ii eii
g ii ii eii
g ii ii geii ii
B. High percentage of healthy individuals will show a normal result
ii ii
R
X ii i ii ii ii ii g e ii
C. High percentage of i ndividuals with a d isorder will show a normal result
ii ge ii ii ii
X
R iXRi ii ii ii ii ii g e ii
D. Low percentage of individuals with a disorder will show an abnormal result
ii ii ii ii ii ii ii g e ii ii ii ii
ii 9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
ii iXRi eii
g eii
g ii ii ii ii ii ii ii
A. Positive result is strongly associated with the disease
ii ii ii
R
X ii iXRi ii ii
B. Negative result is strongly associated with absence of the disease
ii ii ii
R
X i ii ii g e ii ii ii
C. Positive result is weakly associated with the disease
ii ii ii ii ii ii ii
D. Negative result is weaklyassociated with absence of the disease
ii ii ii
R
X i ii
X
R ge ii ii ii ii
ii 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling
ii ii ii ii ii ii ii ii ii ii ii ii g e ii ii ii
, iige
to express thelikelihood ofa condition in select situations, settin gs, and/orpatients?
gei ge ii ge ii ge i ge iig
e ii
ge gei ii ge ii ge i ge ii i
, ii
A. Clinical practice guideline ii ii
X
R
B. Clinical decision rule ii ii
C. Clinical algorithm ii
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
ii ii ii ii ii ii ii ii ii ii
Answer Section
ii
MULTIPLE CHOICE ii
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive decision-
ii eii
g ii ii ii ii ii ii
R
X geii ii ii geii ii geii
making (similar to Augenblink decision-
geii ii ii eii
g ii
making) is based on the experience and intuition of the clinician and is less reliable and paired with fairly common errors. In co
ii
R
X ii ii ii ii
R
X geii ii ii
X
R ii ii
R
X geii ii ii
X
R ii
R
X geii ii ii geii ii iXRi geii geii
ntrast, analytical decision-making is based on careful consideration and has greater reliability with rare errors.
ii ii ii geii geii ii gei i ii iXRi ii
X
R geii ii geii ii
PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient‘s verbal and nonverbal language, and able t
ii
X
R ii iXRi ii geii geii geii eii
g ii
R
X geii ii
X
R ii ii
R
X ii geii ii ii geii ii
o accurately interpret the patient‘s responses to questions. Rather than reading into the patient‘s statements, they clarify any areas
ii ii ii eii
g ii ii ii iXRi ii geii ii iXRi ii ii ii
R
X ii geii ii ii
of uncertainty. ii
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal findings, rec
ii ii ii geii ii ii geii geii geii ii geii ii ii geii geii ii
X
R geii
all knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain conditions affec
geii ii ii ii ii ii ii ii gei i iRi
X iRi
X geii ii ii ii geii geii
t the response to other conditions, and distinguish the relevance of varied abnormal findings.
ii ii ii ii ii eii
g ii ii
X
R ii ii ii geii XRi i ge
PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-
ii geii eii
g eii
g ii eii
g ii ii
R
X ii
R
X ii
R
X ii iXRi
analyses. Another source of statistics, the one that has been most widelyused and available for application to the reasoning process, is the estimation bas
ii ii eii
g geii i ii i ii ii iRi
X ii i ii ii ii
R
X i ii i ii i iXRi ii ii ii
ed ona provider‘s experience, although these are rarely accurate. Over the past decade, the availability of evidence on which to base clinical reasoni
i i geii ii ii eii
g ii eii
g ii ii ii ii ii iXRi ii ii ii ii geii ii ii geii ii
ng is i mproving, and there i s an increasing expectation that clinical reasoning b e based on scientific evidence.
ii ii ii ii i ii ii ii iXRi ii ii ii ii geii ii ii
Evidence-based statistics are also increasinglybeing used to develop resources to facilitate clinical decision-making. ii ii ii g e g e ii i ii ii ii ii ii ii ii ii
X
R
PTS: 1
6. ANS: D
To assist in clinical decision-making, a number of evidence-
ii
X
R ii
R
X ii ii ii
X
R ii
X
R geii ii
based resources have been developed to assist the clinician.Resources, such as algorithms and clinical practice guideline
ii
X
R gei i ii ii
X
R geii geii eii
g geii i ii ii
X
R ii ii ii ii iXRi
s, assist in clinical reasoning when properly applied.
geii ii ii ii ii ii geii
PTS: 1
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or positi
ii ii ii eii
g eii
g ii eii
g eii
g geii ii ii geii gei i ii
R
X iXRi ii ii gei i ii
X
R ge ii
ve,result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an abnormal result.
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R
X i ii ii ii ii ii geii ii ii ii ii i ii iXRi ii ii ii ge ii
PTS: 1
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The greater thes
ii ii ii eii
g eii
g ii eii
g eii
g geii ii ii ii ii ii ii ii geii ii
X
R ii ge ii i
pecificity, the greater the percentage of individuals who will have negative, or normal, results if they do not have the target conditi
ii
X
R ii ii ii geii ii ii ii
R
X geii ii ii ii ii
R
X geii ii ii geii ii ii geii ii
R
X
on.
PTS: 1
9. ANS: 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 ne
ii geii geii geii geii ii geii geii geii geii geii geii geii geii ge ii geii geii geii ii geii geii geii geii ii
gative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a positive result is associated with the
geii geii geii geii geii ii geii geii geii geii geii ii geii geii geii geii geii ii ii geii geii ii i
disease; a likelihood ratio less than 1 indicates that a negative result is associated with an absence of the disease.
ii
R
X ii ii
X
R ii ii
X
R ii ii ii geii ii ii geii ii
X
R ii ii
R
X iXRi ii ii ii
, ii
PTS: 1
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are evidence-
ii eii
g ii iXRi ii geii ii geii ii ii ii ii ii gei i ii
X
R
gebased resources that provide probabilistic statements regarding the likelihood that a condition exists if certain variables are met
ii eii
g iXRi ii geii ii ii geii iXRi ii ii
R
X iXRi ii
X
R ii geii geii geii geii
with regard to the prognosis of patients with specific findings. Decision rules use mathematical models and are specific to certain
ii geii ii ii
R
X ii ii geii ii ii
R
X gei i ii
R
X ii
X
R geii geii ii ii geii ii geii ii
R
X
situations, settings, and/or patient characteristics.
ii ii ii ii
PTS: 1
