Harrison's Principles of Internal Medicine
(Vol.1 & Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo;
J. Larry Jameson
TEST BANK
1)
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 68-year-old man with multiple chronic conditions is admitted
for heart failure. As the primary nurse, you must develop a care
plan that balances disease-specific guidelines and the patient's
goals. Which approach most closely aligns with the model of
high-value medicine described in Harrison?
,A. Strictly apply all disease-specific guideline recommendations
regardless of patient preferences.
B. Prioritize interventions with the highest expected net benefit
tailored to the patient's life expectancy and goals.
C. Defer all decisions to subspecialists because they have
condition-specific expertise.
D. Focus on maximizing diagnostic testing to exclude every
possible comorbidity.
Correct Answer
B
Rationales
• Correct (B): Harrison emphasizes high-value care: select
interventions offering the greatest expected benefit
weighted by patient preferences, prognosis, and harms;
this tailors care to the individual.
• Incorrect (A): Applying all guidelines rigidly ignores
individual trade-offs and may create harm or low-value
care.
• Incorrect (C): While subspecialty input can help, deferring
all decisions undermines coordinated, patient-centered
care.
• Incorrect (D): Excessive testing can cause harm and low-
value care without improving outcomes when not
targeted.
,Teaching Point
High-value care: choose interventions with greatest expected
benefit aligned to patient goals.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2)
Reference
Ch. 4 — Decision-Making in Clinical Medicine
Question Stem
A 45-year-old woman presents with atypical chest pain. Pretest
probability for coronary artery disease is intermediate. Which
diagnostic strategy best follows Harrison’s recommendations for
rational diagnostic decision-making?
A. Order coronary CT angiography for every patient with chest
pain.
B. Use a stepwise testing strategy informed by pretest
probability and test characteristics.
C. Begin empiric treatment without diagnostic testing to avoid
delays.
D. Perform invasive coronary angiography as the first-line test.
Correct Answer
B
, Rationales
• Correct (B): Harrison recommends matching the diagnostic
test to pretest probability and test accuracy, using stepwise
testing to maximize yield and minimize harm.
• Incorrect (A): Routine CT angiography for all is inefficient
and may expose low-risk patients to unnecessary radiation
and contrast.
• Incorrect (C): Empiric treatment without targeted
diagnosis risks inappropriate therapy and missed
alternative diagnoses.
• Incorrect (D): Invasive angiography is reserved for high-
probability cases or when noninvasive testing is
inconclusive or indicates high risk.
Teaching Point
Choose diagnostics based on pretest probability and test
performance characteristics.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
3)
Reference
Ch. 6 — Screening and Prevention of Disease
(Vol.1 & Vol.2)
21st Edition Newer Edition
Author(s)Joseph Loscalzo; Anthony S. Fauci;
Dennis L. Kasper; Stephen Hauser; Dan Longo;
J. Larry Jameson
TEST BANK
1)
Reference
Ch. 1 — The Practice of Medicine
Question Stem
A 68-year-old man with multiple chronic conditions is admitted
for heart failure. As the primary nurse, you must develop a care
plan that balances disease-specific guidelines and the patient's
goals. Which approach most closely aligns with the model of
high-value medicine described in Harrison?
,A. Strictly apply all disease-specific guideline recommendations
regardless of patient preferences.
B. Prioritize interventions with the highest expected net benefit
tailored to the patient's life expectancy and goals.
C. Defer all decisions to subspecialists because they have
condition-specific expertise.
D. Focus on maximizing diagnostic testing to exclude every
possible comorbidity.
Correct Answer
B
Rationales
• Correct (B): Harrison emphasizes high-value care: select
interventions offering the greatest expected benefit
weighted by patient preferences, prognosis, and harms;
this tailors care to the individual.
• Incorrect (A): Applying all guidelines rigidly ignores
individual trade-offs and may create harm or low-value
care.
• Incorrect (C): While subspecialty input can help, deferring
all decisions undermines coordinated, patient-centered
care.
• Incorrect (D): Excessive testing can cause harm and low-
value care without improving outcomes when not
targeted.
,Teaching Point
High-value care: choose interventions with greatest expected
benefit aligned to patient goals.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2)
Reference
Ch. 4 — Decision-Making in Clinical Medicine
Question Stem
A 45-year-old woman presents with atypical chest pain. Pretest
probability for coronary artery disease is intermediate. Which
diagnostic strategy best follows Harrison’s recommendations for
rational diagnostic decision-making?
A. Order coronary CT angiography for every patient with chest
pain.
B. Use a stepwise testing strategy informed by pretest
probability and test characteristics.
C. Begin empiric treatment without diagnostic testing to avoid
delays.
D. Perform invasive coronary angiography as the first-line test.
Correct Answer
B
, Rationales
• Correct (B): Harrison recommends matching the diagnostic
test to pretest probability and test accuracy, using stepwise
testing to maximize yield and minimize harm.
• Incorrect (A): Routine CT angiography for all is inefficient
and may expose low-risk patients to unnecessary radiation
and contrast.
• Incorrect (C): Empiric treatment without targeted
diagnosis risks inappropriate therapy and missed
alternative diagnoses.
• Incorrect (D): Invasive angiography is reserved for high-
probability cases or when noninvasive testing is
inconclusive or indicates high risk.
Teaching Point
Choose diagnostics based on pretest probability and test
performance characteristics.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
3)
Reference
Ch. 6 — Screening and Prevention of Disease
