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 illnesses presents with
nonspecific fatigue and malaise. Lab tests show mildly elevated
creatinine and a new normocytic anemia. As his physician, you
,must determine whether to pursue an extensive diagnostic
workup. Which approach best aligns with high-value practice
and the principles of Harrison’s chapter on the practice of
medicine?
A. Order a full-body CT scan to search for occult malignancy.
B. Begin empiric broad-spectrum antibiotics while arranging
inpatient workup.
C. Review baseline data, perform focused history/physical, then
pursue targeted tests guided by pretest probability.
D. Refer immediately to multiple subspecialists for parallel
evaluation to expedite diagnosis.
Correct Answer
C
Rationales
Correct: Harrison emphasizes patient-centered, high-value
care—start with a focused history/physical and use pretest
probability to guide targeted, not indiscriminate, testing. This
minimizes harm and false positives.
A: Routine full-body CT is low-value and increases radiation and
incidental findings without improving outcomes.
B: Empiric broad antibiotics without an infectious indication
risks harm and resistance.
D: Multiple parallel referrals often produce redundant testing,
fragmented care, and delays in meaningful diagnosis.
,Teaching Point
Use focused evaluation and pretest probability to guide
targeted, high-value testing.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2) Reference
Ch. 1 — The Practice of Medicine
Question Stem
A resident is uncertain whether a patient with atypical chest
pain needs urgent troponin testing and admits they are worried
about missing an MI. Which cognitive strategy taught in the
chapter reduces diagnostic error and supports safer decision-
making?
A. Rely on pattern recognition exclusively because it is fastest.
B. Use reflective reasoning and consider alternative diagnoses
when uncertainty exists.
C. Always escalate to cardiology consultation for any chest pain.
D. Ignore pretest probability if the patient is elderly.
Correct Answer
B
Rationales
Correct: Harrison advises combining intuitive pattern
, recognition with reflective (analytical) reasoning when
uncertainty or atypical presentations occur to reduce error.
A: Pattern recognition alone can lead to heuristics and biases,
especially in atypical cases.
C: Automatic consultation for every chest pain is inefficient and
unnecessary when clinical reasoning suffices.
D: Pretest probability remains essential regardless of age;
ignoring it increases overtesting.
Teaching Point
Combine intuitive pattern recognition with analytic reflection
when diagnostic uncertainty exists.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
3) Reference
Ch. 2 — Promoting Good Health
Question Stem
A 52-year-old woman with hypertension and BMI 34 asks how
to reduce her cardiovascular risk. According to principles in the
chapter on promoting good health, which initial intervention is
most likely to be effective at population and individual levels?
A. Prescribe weight-loss medication immediately.
B. Provide brief counseling using motivational interviewing and
set achievable behavioral goals.
& 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 illnesses presents with
nonspecific fatigue and malaise. Lab tests show mildly elevated
creatinine and a new normocytic anemia. As his physician, you
,must determine whether to pursue an extensive diagnostic
workup. Which approach best aligns with high-value practice
and the principles of Harrison’s chapter on the practice of
medicine?
A. Order a full-body CT scan to search for occult malignancy.
B. Begin empiric broad-spectrum antibiotics while arranging
inpatient workup.
C. Review baseline data, perform focused history/physical, then
pursue targeted tests guided by pretest probability.
D. Refer immediately to multiple subspecialists for parallel
evaluation to expedite diagnosis.
Correct Answer
C
Rationales
Correct: Harrison emphasizes patient-centered, high-value
care—start with a focused history/physical and use pretest
probability to guide targeted, not indiscriminate, testing. This
minimizes harm and false positives.
A: Routine full-body CT is low-value and increases radiation and
incidental findings without improving outcomes.
B: Empiric broad antibiotics without an infectious indication
risks harm and resistance.
D: Multiple parallel referrals often produce redundant testing,
fragmented care, and delays in meaningful diagnosis.
,Teaching Point
Use focused evaluation and pretest probability to guide
targeted, high-value testing.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
2) Reference
Ch. 1 — The Practice of Medicine
Question Stem
A resident is uncertain whether a patient with atypical chest
pain needs urgent troponin testing and admits they are worried
about missing an MI. Which cognitive strategy taught in the
chapter reduces diagnostic error and supports safer decision-
making?
A. Rely on pattern recognition exclusively because it is fastest.
B. Use reflective reasoning and consider alternative diagnoses
when uncertainty exists.
C. Always escalate to cardiology consultation for any chest pain.
D. Ignore pretest probability if the patient is elderly.
Correct Answer
B
Rationales
Correct: Harrison advises combining intuitive pattern
, recognition with reflective (analytical) reasoning when
uncertainty or atypical presentations occur to reduce error.
A: Pattern recognition alone can lead to heuristics and biases,
especially in atypical cases.
C: Automatic consultation for every chest pain is inefficient and
unnecessary when clinical reasoning suffices.
D: Pretest probability remains essential regardless of age;
ignoring it increases overtesting.
Teaching Point
Combine intuitive pattern recognition with analytic reflection
when diagnostic uncertainty exists.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
3) Reference
Ch. 2 — Promoting Good Health
Question Stem
A 52-year-old woman with hypertension and BMI 34 asks how
to reduce her cardiovascular risk. According to principles in the
chapter on promoting good health, which initial intervention is
most likely to be effective at population and individual levels?
A. Prescribe weight-loss medication immediately.
B. Provide brief counseling using motivational interviewing and
set achievable behavioral goals.
