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 56-year-old patient with multiple chronic conditions asks
whether seeing a specialist or coordinating care through their
primary physician would best reduce fragmented care. Which
approach most directly reduces care fragmentation and
improves longitudinal outcomes?
Options
A. Referral to multiple specialty clinics for single-issue expertise
,B. Primary care–led coordination with clear role assignment and
communication
C. Self-directed follow-up by the patient with whichever
clinician is available
D. Ad hoc phone messaging between specialists without a lead
clinician
Correct Answer
B
Rationales
• Correct (B): Primary care–led coordination assigns a
central clinician responsible for longitudinal care, reduces
duplication, and integrates management plans — a core
principle of high-quality practice.
• Incorrect (A): Multiple specialty visits can increase
fragmentation unless there is active coordination.
• Incorrect (C): Patient self-direction without a coordinating
clinician risks missed linkages and inconsistent plans.
• Incorrect (D): Informal messaging among specialists
without a designated lead often fails to create
comprehensive, accountable care plans.
Teaching Point
Primary care coordination reduces fragmentation and improves
continuity of care.
,Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2
Reference — Ch. 2 — Promoting Good Health
Question Stem
A clinic implements a brief counseling intervention to help
smokers quit. The team plans to measure population-level
impact. Which measure best captures both individual behavior
change and public-health impact?
Options
A. Number of cigarettes sold in the community each month
B. Proportion of clinic smokers who quit at 6 months
(biochemically verified)
C. Patient satisfaction scores after counseling sessions
D. Number of counseling pamphlets distributed
Correct Answer
B
Rationales
• Correct (B): Proportion of smokers achieving verified
abstinence at 6 months measures individual behavior
change and allows estimation of population-level benefit
when scaled.
, • Incorrect (A): Cigarette sales are a blunt instrument
influenced by many factors unrelated to the clinic’s
intervention.
• Incorrect (C): Satisfaction measures acceptability but not
effectiveness or sustained cessation.
• Incorrect (D): Pamphlet distribution measures reach but
not behavior or health outcomes.
Teaching Point
Behavioral interventions should be evaluated by sustained,
verified outcome measures.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 2.
3
Reference — Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem
A 28-year-old pregnant patient expresses strong concerns about
a recommended vaccine because of misinformation online.
Which clinician response most likely improves her acceptance
while respecting autonomy?
Options
A. Dismiss her concerns and insist she receive the vaccine
immediately
(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 56-year-old patient with multiple chronic conditions asks
whether seeing a specialist or coordinating care through their
primary physician would best reduce fragmented care. Which
approach most directly reduces care fragmentation and
improves longitudinal outcomes?
Options
A. Referral to multiple specialty clinics for single-issue expertise
,B. Primary care–led coordination with clear role assignment and
communication
C. Self-directed follow-up by the patient with whichever
clinician is available
D. Ad hoc phone messaging between specialists without a lead
clinician
Correct Answer
B
Rationales
• Correct (B): Primary care–led coordination assigns a
central clinician responsible for longitudinal care, reduces
duplication, and integrates management plans — a core
principle of high-quality practice.
• Incorrect (A): Multiple specialty visits can increase
fragmentation unless there is active coordination.
• Incorrect (C): Patient self-direction without a coordinating
clinician risks missed linkages and inconsistent plans.
• Incorrect (D): Informal messaging among specialists
without a designated lead often fails to create
comprehensive, accountable care plans.
Teaching Point
Primary care coordination reduces fragmentation and improves
continuity of care.
,Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2
Reference — Ch. 2 — Promoting Good Health
Question Stem
A clinic implements a brief counseling intervention to help
smokers quit. The team plans to measure population-level
impact. Which measure best captures both individual behavior
change and public-health impact?
Options
A. Number of cigarettes sold in the community each month
B. Proportion of clinic smokers who quit at 6 months
(biochemically verified)
C. Patient satisfaction scores after counseling sessions
D. Number of counseling pamphlets distributed
Correct Answer
B
Rationales
• Correct (B): Proportion of smokers achieving verified
abstinence at 6 months measures individual behavior
change and allows estimation of population-level benefit
when scaled.
, • Incorrect (A): Cigarette sales are a blunt instrument
influenced by many factors unrelated to the clinic’s
intervention.
• Incorrect (C): Satisfaction measures acceptability but not
effectiveness or sustained cessation.
• Incorrect (D): Pamphlet distribution measures reach but
not behavior or health outcomes.
Teaching Point
Behavioral interventions should be evaluated by sustained,
verified outcome measures.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 2.
3
Reference — Ch. 3 — Vaccine Opposition and Hesitancy
Question Stem
A 28-year-old pregnant patient expresses strong concerns about
a recommended vaccine because of misinformation online.
Which clinician response most likely improves her acceptance
while respecting autonomy?
Options
A. Dismiss her concerns and insist she receive the vaccine
immediately
