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. 4 — Decision-Making in Clinical Medicine
Question Stem
A 68-year-old man with moderate COPD and early-stage
,prostate cancer asks whether to undergo prostatectomy. He
values independence and fears postoperative respiratory
complications. Which approach best follows shared decision-
making principles to reach a patient-centered
recommendation?
Options
A. Recommend prostatectomy because it offers the best cancer
cure rate.
B. Provide balanced information about options, elicit his values,
and recommend an option concordant with his priorities.
C. Defer entirely to the surgeon since they know the evidence
best.
D. Avoid discussing risks to reduce his anxiety and encourage
surgery.
Correct Answer
B
Rationales
• Correct (B): Shared decision-making requires providing
evidence-based options, eliciting patient values (e.g.,
independence, respiratory risk), and tailoring
recommendations that align with those values. This
balances beneficence and autonomy.
• A: A unilateral recommendation ignores the patient’s
values and risk preferences; not consistent with shared
decision making.
, • C: Deferring to the surgeon without patient involvement
undermines patient autonomy and may ignore comorbid
risk considerations.
• D: Withholding risk information is ethically inappropriate
and impairs informed consent.
Teaching Point
Elicit values, present options/risks, then recommend aligned
choice.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
2)
Reference
Ch. 6 — Screening and Prevention of Disease
Question Stem
A 52-year-old asymptomatic woman with no family history asks
about serum CA-125 testing for ovarian cancer screening. Based
on screening principles, what is the best evidence-based
response?
Options
A. Offer CA-125 annually because early detection improves
survival.
B. Recommend CA-125 plus pelvic ultrasound for all women
, over 50.
C. Advise against routine CA-125 screening due to low
predictive value and potential harms.
D. Only perform CA-125 if patient requests it; patient
preference overrides population evidence.
Correct Answer
C
Rationales
• Correct (C): Effective screening requires a test with
adequate sensitivity/specificity and net benefit; CA-125
lacks sufficient predictive value in average-risk
asymptomatic women and may cause false positives and
harm.
• A: Routine CA-125 is not supported by evidence showing
net benefit in average-risk populations.
• B: Combining tests increases false positives and harms
without proven mortality reduction.
• D: While preferences matter, clinicians should advise
against low-value screening based on evidence and
potential harm.
Teaching Point
Screening must show net benefit; CA-125 is not recommended
for average-risk screening.
& 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. 4 — Decision-Making in Clinical Medicine
Question Stem
A 68-year-old man with moderate COPD and early-stage
,prostate cancer asks whether to undergo prostatectomy. He
values independence and fears postoperative respiratory
complications. Which approach best follows shared decision-
making principles to reach a patient-centered
recommendation?
Options
A. Recommend prostatectomy because it offers the best cancer
cure rate.
B. Provide balanced information about options, elicit his values,
and recommend an option concordant with his priorities.
C. Defer entirely to the surgeon since they know the evidence
best.
D. Avoid discussing risks to reduce his anxiety and encourage
surgery.
Correct Answer
B
Rationales
• Correct (B): Shared decision-making requires providing
evidence-based options, eliciting patient values (e.g.,
independence, respiratory risk), and tailoring
recommendations that align with those values. This
balances beneficence and autonomy.
• A: A unilateral recommendation ignores the patient’s
values and risk preferences; not consistent with shared
decision making.
, • C: Deferring to the surgeon without patient involvement
undermines patient autonomy and may ignore comorbid
risk considerations.
• D: Withholding risk information is ethically inappropriate
and impairs informed consent.
Teaching Point
Elicit values, present options/risks, then recommend aligned
choice.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
2)
Reference
Ch. 6 — Screening and Prevention of Disease
Question Stem
A 52-year-old asymptomatic woman with no family history asks
about serum CA-125 testing for ovarian cancer screening. Based
on screening principles, what is the best evidence-based
response?
Options
A. Offer CA-125 annually because early detection improves
survival.
B. Recommend CA-125 plus pelvic ultrasound for all women
, over 50.
C. Advise against routine CA-125 screening due to low
predictive value and potential harms.
D. Only perform CA-125 if patient requests it; patient
preference overrides population evidence.
Correct Answer
C
Rationales
• Correct (C): Effective screening requires a test with
adequate sensitivity/specificity and net benefit; CA-125
lacks sufficient predictive value in average-risk
asymptomatic women and may cause false positives and
harm.
• A: Routine CA-125 is not supported by evidence showing
net benefit in average-risk populations.
• B: Combining tests increases false positives and harms
without proven mortality reduction.
• D: While preferences matter, clinicians should advise
against low-value screening based on evidence and
potential harm.
Teaching Point
Screening must show net benefit; CA-125 is not recommended
for average-risk screening.
