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.
accessmedicine.mhmedical.com
Stem: A 72-year-old man with newly diagnosed systolic heart
failure asks whether to accept a guideline-recommended ACE
inhibitor. He has mild chronic cough from ACE inhibitor trial
exposure in the past. Which approach best reflects professional
medical practice?
Options:
A. Insist he start the ACE inhibitor because guidelines are
evidence-based.
,B. Start an ARB immediately without discussing tradeoffs
because cough history predicts intolerance.
C. Engage him in shared decision-making: review benefits, risks,
and his preferences before choosing therapy.
D. Delay all therapy until he meets with a cardiologist to avoid
responsibility for adverse effects.
Correct Answer: C
Rationales — Correct: Shared decision-making respects
evidence while incorporating patient values and risks; clinicians
should explain benefit/risk and co-create the plan.
Rationales — Incorrect:
A. Guidelines inform but do not replace individualized
discussion—insistence undermines autonomy.
B. Automatically substituting therapy ignores discussion of prior
cough severity and the patient’s priorities.
D. Unnecessary delay risks harm; referral may be appropriate
but not required before initiating evidence-based care.
Teaching Point: Shared decision-making aligns evidence with
patient values for safe, ethical care.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 1. learn.mheducation.com
2
Reference — Ch. 1 — The Practice of Medicine.
accessmedicine.mhmedical.com
Stem: During a busy shift you realize you documented a
,medication dose incorrectly for a patient. Which action best
reflects professional responsibility?
Options:
A. Leave the note; small documentation errors are expected
during busy shifts.
B. Correct the record promptly with an addendum and notify
the care team of the error.
C. Delete the original note to avoid confusion.
D. Wait until discharge summary to correct the mistake.
Correct Answer: B
Rationales — Correct: Prompt correction and team notification
preserves patient safety, transparency, and legal/ethical
standards.
Rationales — Incorrect:
A. Ignoring errors risks harm; normalization of deviance is
unsafe.
C. Deleting original records is unethical and often prohibited;
addenda preserve audit trail.
D. Waiting delays mitigation and can endanger the patient if
dosing decisions depend on the record.
Teaching Point: Correct documentation promptly and
communicate to reduce safety risk.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 1. learn.mheducation.com
3
, Reference — Ch. 2 — Promoting Good Health.
learn.mheducation.com
Stem: A 50-year-old woman with prediabetes asks how to
reduce her progression risk to diabetes. Which intervention has
the strongest evidence for preventing progression and should
be prioritized?
Options:
A. Starting metformin immediately regardless of lifestyle.
B. Structured lifestyle intervention focusing on weight loss and
physical activity.
C. A short course of high-intensity statin therapy.
D. Annual HbA1c screening only, with no active intervention
until diabetes develops.
Correct Answer: B
Rationales — Correct: Structured lifestyle programs that
promote modest weight loss and increased activity have the
strongest evidence to reduce progression from prediabetes to
diabetes.
Rationales — Incorrect:
A. Metformin can reduce risk in some groups but is adjunctive
and less effective than intensive lifestyle change for many
patients.
C. Statins reduce cardiovascular risk but do not prevent
progression to diabetes.
D. Passive surveillance misses the opportunity to prevent
disease with proven interventions.
Teaching Point: Lifestyle modification is primary for diabetes
(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.
accessmedicine.mhmedical.com
Stem: A 72-year-old man with newly diagnosed systolic heart
failure asks whether to accept a guideline-recommended ACE
inhibitor. He has mild chronic cough from ACE inhibitor trial
exposure in the past. Which approach best reflects professional
medical practice?
Options:
A. Insist he start the ACE inhibitor because guidelines are
evidence-based.
,B. Start an ARB immediately without discussing tradeoffs
because cough history predicts intolerance.
C. Engage him in shared decision-making: review benefits, risks,
and his preferences before choosing therapy.
D. Delay all therapy until he meets with a cardiologist to avoid
responsibility for adverse effects.
Correct Answer: C
Rationales — Correct: Shared decision-making respects
evidence while incorporating patient values and risks; clinicians
should explain benefit/risk and co-create the plan.
Rationales — Incorrect:
A. Guidelines inform but do not replace individualized
discussion—insistence undermines autonomy.
B. Automatically substituting therapy ignores discussion of prior
cough severity and the patient’s priorities.
D. Unnecessary delay risks harm; referral may be appropriate
but not required before initiating evidence-based care.
Teaching Point: Shared decision-making aligns evidence with
patient values for safe, ethical care.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 1. learn.mheducation.com
2
Reference — Ch. 1 — The Practice of Medicine.
accessmedicine.mhmedical.com
Stem: During a busy shift you realize you documented a
,medication dose incorrectly for a patient. Which action best
reflects professional responsibility?
Options:
A. Leave the note; small documentation errors are expected
during busy shifts.
B. Correct the record promptly with an addendum and notify
the care team of the error.
C. Delete the original note to avoid confusion.
D. Wait until discharge summary to correct the mistake.
Correct Answer: B
Rationales — Correct: Prompt correction and team notification
preserves patient safety, transparency, and legal/ethical
standards.
Rationales — Incorrect:
A. Ignoring errors risks harm; normalization of deviance is
unsafe.
C. Deleting original records is unethical and often prohibited;
addenda preserve audit trail.
D. Waiting delays mitigation and can endanger the patient if
dosing decisions depend on the record.
Teaching Point: Correct documentation promptly and
communicate to reduce safety risk.
Citation: Loscalzo et al. (2022). Harrison’s Principles of Internal
Medicine (21st Ed.). Ch. 1. learn.mheducation.com
3
, Reference — Ch. 2 — Promoting Good Health.
learn.mheducation.com
Stem: A 50-year-old woman with prediabetes asks how to
reduce her progression risk to diabetes. Which intervention has
the strongest evidence for preventing progression and should
be prioritized?
Options:
A. Starting metformin immediately regardless of lifestyle.
B. Structured lifestyle intervention focusing on weight loss and
physical activity.
C. A short course of high-intensity statin therapy.
D. Annual HbA1c screening only, with no active intervention
until diabetes develops.
Correct Answer: B
Rationales — Correct: Structured lifestyle programs that
promote modest weight loss and increased activity have the
strongest evidence to reduce progression from prediabetes to
diabetes.
Rationales — Incorrect:
A. Metformin can reduce risk in some groups but is adjunctive
and less effective than intensive lifestyle change for many
patients.
C. Statins reduce cardiovascular risk but do not prevent
progression to diabetes.
D. Passive surveillance misses the opportunity to prevent
disease with proven interventions.
Teaching Point: Lifestyle modification is primary for diabetes
