FINDINGS AND FORMULATING DIFFERENTIAL DIAGNOSES
5th EDITION GOOLSBY CHAPTERS 1 - 22 | COMPLETE
, ➢ Chapter 1. Assessment and Clinical Decision Making: An Overview
Multiple Choice
Identify the choice that best completes the statement or accurate answer:->s the question.
1. Which type of clinical decision-making is most reliable?
A. Intuitive
B. Analytica
l
C. Experient
ial
D. Augenbli
ck
2. Which of the following is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient’s verbal and
nonverbal language
C. Able to accurately interpret the patient’s
responses
D. Adept at reading into the patient’s
statements
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. History of the present illness
C. Current vital signs
D. All of the above are essential history
components
4. Which of the following is false? While performing the physical examination, the examiner must be able to:
A. Differentiate between normal and abnormal findings
B. Recall knowledge of a range of conditions and their associated
signs and symptoms
C. Recognize how certain conditions affect the response to other
conditions
D. Foresee unpredictable findings
5. The following is the least reliable source of information for diagnostic statistics:
A. Evidence-based investigations
B. Primaryreports of research
C. Estimation based on a provider’s
experience
D. Published meta-analyses
6. The following can be used to assist in sound clinical decision-making:
A. Algorithmpublished in a peer-reviewed
journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
7. If a diagnostic study has high sensitivity, this indicates a:
A. High percentage of persons with the given condition will have an
abnormal result
B. Low percentage of persons with the given condition will have an
abnormal result
C. Low likelihood of normal result in persons without a given
condition
D. None of the above
8. If a diagnostic study has high specificity, this indicates a:
A. Low percentage of healthy individuals will show a normal
result
B. High percentage of healthy individuals will show a normal
result
C. High percentage of individuals with a disorder will show a
normal result
D. Low percentage of individuals with a disorder will show an
abnormal result
9. Alikelihood ratio above 1 indicates that a diagnostic test showing a:
A. Positive result is strongly associated with the sickness
, B. Negative result is strongly associated with absence
of the sickness
C. Positive result is weakly associated with the sickness
D. Negative result is weakly associated with absence
of the sickness
10. Which of the following clinical reasoning tools is defined as evidence-based resource
based on mathematical modeling
A. Clinical practice
guideline
B. Clinical decision rule
C. Clinical algorithm
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
Accurate answer:-> Section
MULTIPLE CHOICE
1. ACCURATE ANSWER:->: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and
analytical. Intuitive decision- making (similar to Augenblink decision-making) is based on the
experience and intuition of the clinician and is less reliable andpaired with fairly common errors. In
contrast, analytical decision-making is based on careful consideration and has greater reliability
with rare errors.
POINTS:1
2. ACCURATE ANSWER:->: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal
and nonverbal language, and ableto accurately interpret the patient’s responses to questions.
Rather than reading into the patient’s statements, they clarify any areas of uncertainty.
POINTS:1
3. ACCURATE ANSWER:->: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
POINTS:1
4. ACCURATE ANSWER:->: D
While performing the physical examination, the examiner must be able to differentiate between
normal and abnormal findings, recall knowledge of a range of conditions, including their
associated signs and symptoms, recognize how certain conditions affectthe response to other
conditions, and distinguish the relevance of varied abnormal findings.
POINTS:1
5. ACCURATE ANSWER:->: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published
meta-analyses. Another source of statistics, the one that has been most widelyused and available
for application to the reasoning process, is the estimation based ona provider’s experience, although
these are rarely accurate. Over the past decade, the availability of evidence on which to base
clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be
based on scientific evidence.
Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
POINTS:1
6. ACCURATE ANSWER:->: D
To assist in clinical decision-making, a number of evidence-based resources have been
developed to assist the clinician. Resources, such as algorithms and clinical practice guidelines,
assist in clinical reasoning when properly applied.
POINTS:1
7. ACCURATE ANSWER:->: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who
show an abnormal, or positive,result. A high sensitivity indicates that a greater percentage of
persons with the given condition will have an abnormal result.
, POINTS:1
8. ACCURATE ANSWER:->: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have
a normal result. The greater the specificity, the greater the percentage of individuals who will
have negative, or normal, results if they do not have the target condition.
POINTS:1
9. ACCURATE ANSWER:->: 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 negative result will be associated with a healthy person. A
likelihood ratio above 1 indicates that a positive result is associated with the sickness; a likelihood
ratio less than 1 indicates that a negative result is associated with an absence of the sickness.
POINTS:1
10. ACCURATE ANSWER:->: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical
decision rules are evidence-based resources that provide probabilistic statements regarding the
likelihood that a condition exists if certain variables are met with regard to the prognosis of
patients with specific findings. Decision rules use mathematical models and are specific to
certain situations, settings, and/or patient characteristics.
POINTS:1