INTERPRETINGFINDINGSAND
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FORMULATINGDIFFERENTIAL
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DIAGNOSES5THEDITION,MARYJO
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GOOLSBY, LAURIEGRUBBSISBN-10;
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1719645930/ISBN-13;978-1719645935
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,Chapter 1.Assessment and Clinical Decision-Making: Overview
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Multiple Choice
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Identify the choice that best completes the statement or answers the question.
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1. Which type of clinical decision-making is most reliable?
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A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Whichof the following is false? To obtain adequate history, health-care providers must be:
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A. Methodical and systematic i i
B. Attentive to the patient’s verbal and nonverbal language i i i i i i i
C. Able to accuratelyinterpret the patient’s responses
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D. Adept at reading into the patient’s statements i i i i i i
3. Essential parts of a health historyinclude all of the following except:
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A. Chief complaint i
B. Historyof the present illness i i i i
C. Current vital signs i i
D. All of the above are essential history components
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4. Which of the following is false? While performing the physical examination, the examiner must be able
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to: i
A. Differentiate between normal and abnormal findings i i i i i
B. Recall knowledge of a range of conditions and their associated signs and symptoms
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C. Recognizehow certain conditions affect the response to other conditions i i i i i i i i i
D. Foresee unpredictable findings i i
5. The following is the least reliable source of information for diagnostic statistics:
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A. Evidence-based investigations i
B. Primary reports of research i i i
C. Estimation based on a provider’s experience i i i i i
D. Published meta-analyses i
6. Thefollowing can be used to assist in sound clinical decision-making:
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A. Algorithm published in a peer-reviewed journal article i i i i i i
B. Clinical practice guidelines i i
C. Evidence-based research i
D. All of the above i i i
7. If a diagnostic studyhas high sensitivity, this indicates a:
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A. High percentage of persons with the given condition will have an abnormal result
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B. Lowpercentage of persons with the given condition will have an abnormal result
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C. Low likelihood of normal result in persons without a given condition
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D. None of the above i i i
, 8. If a diagnostic studyhas high specificity, this indicates a:
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A. Low percentage of healthy individuals will show a normal result
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B. High percentage of healthy individuals will show a normal result
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C. High percentage of individuals with a disorder will show a normal result
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D. Low percentage of individuals with a disorder will show an abnormal result
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9. Alikelihood ratio above 1 indicates that a diagnostic test showing a:
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A. Positive result is strongly associated with the disease
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B. Negative result is strongly associated with absence of the disease
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C. Positive result is weakly associated with the disease
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D. Negative result is weakly associated with absence of the disease
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i 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on
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mathematical modeling to express the likelihood of a condition in select situations, settings, and/or
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patients?
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A. Clinical practice guideline
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B. Clinical decision rule i i
C. Clinical algorithm i
D. Clinical recommendation i
, Answer Section
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MULTIPLE CHOICEi
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and
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analytical. Intuitive decision-making (similar to Augenblink decision-making) is based on the
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experience and intuition of the clinician and is less reliable and paired with fairly common errors. In
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contrast, analytical decision-making is based on careful consideration and has greater reliability with
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rare errors.
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PTS: 1
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and
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nonverbal language, and able to accurately interpret the patient’s responses to questions. Rather
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than reading into the patient’s statements, they clarify any areas of uncertainty.
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PTS: 1
3. ANS: C
Vital signs arepart of the physical examination portion of patient assessment, not part of the health
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history.
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PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal
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and abnormal findings, recall knowledge of a range of conditions, including their associated signs
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and symptoms, recognize how certain conditions affect the response to other conditions, and
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distinguish the relevance of varied abnormal findings.
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PTS: 1
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published
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meta-analyses. Another source of statistics, the one that has been most widely used and available for
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application to the reasoning process, is the estimation based on a provider’s experience, although
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these are rarely accurate. Over the past decade, the availability of evidence on which to base
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clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be
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based on scientific evidence. Evidence-based statistics are also increasingly being used to develop
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resources to facilitate clinical decision-making.
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PTS: 1
6. ANS: D
To assist in clinical decision-making, a numberof evidence-based resources havebeen developed to
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assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist in clinical
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reasoning when properly applied.
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