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 72-year-old man with multiple chronic illnesses and limited
functional reserve asks whether to proceed with an elective
colonoscopy. Which approach best embodies patient-centered
decision making in this scenario?
Options
A. Advise the patient that guideline-based screening is always
indicated regardless of comorbidity.
B. Recommend against any testing because of his age alone.
,C. Discuss the balance of benefits, risks, and the patient’s values
to reach a shared decision.
D. Defer to the family to decide because the clinician must
avoid causing distress.
Correct Answer
C
Rationales
Correct — C: Shared decision making integrates clinical
evidence (benefit vs harm) with the patient’s goals and
functional status, producing a decision aligned with Harrison’s
emphasis on individualized care.
Incorrect — A: Guidelines are population-based; they must be
individualized for frail, multimorbid older adults.
Incorrect — B: Age alone is not a sufficient reason to withhold
care; functional status and goals matter.
Incorrect — D: The clinician should engage the patient first;
family input is secondary unless the patient lacks capacity.
Teaching Point
Shared decision making combines evidence, risks, and patient
values for individualized care.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
, 2. Reference
Ch. 4 — Decision-Making in Clinical Medicine
Question Stem
A resident is evaluating a patient with chest pain and low
pretest probability for ACS. Which reasoning strategy best
reduces unnecessary testing while maintaining patient safety?
Options
A. Rely solely on intuition because experience usually suffices.
B. Use explicit probability estimates and a threshold approach
to decide on further testing.
C. Order the maximal battery of tests to avoid missing any
diagnosis.
D. Delay assessment until the patient’s symptoms progress.
Correct Answer
B
Rationales
Correct — B: Applying explicit pretest probability and diagnostic
thresholds (Bayesian reasoning) reduces low-yield testing while
maintaining safety, consistent with Harrison’s recommended
decision frameworks.
Incorrect — A: Pure intuition (heuristics) risks bias and
diagnostic error, particularly in low-probability cases.
Incorrect — C: Over-testing increases harms (false positives,
downstream procedures) without proportional benefit.
Incorrect — D: Delaying assessment can miss early, treatable
pathology and is unsafe.
, Teaching Point
Use pretest probability and diagnostic thresholds to guide safe,
efficient testing.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
3. Reference
Ch. 9 — Diagnosis: Reducing Errors and Improving Quality
Question Stem
During a busy shift a clinician prematurely labels a patient’s
abdominal pain as “functional” without considering red flags.
What single diagnostic strategy would most directly reduce this
kind of premature closure?
Options
A. Increase reliance on a single trusted clinician’s gestalt.
B. Systematically ask “what else could this be?” (differential
diagnosis checklist).
C. Immediately order an abdominal CT for all similar patients.
D. Accept the diagnosis if the first test is normal.
Correct Answer
B
Rationales
Correct — B: Using a structured differential checklist combats
premature closure by forcing consideration of alternative
(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 72-year-old man with multiple chronic illnesses and limited
functional reserve asks whether to proceed with an elective
colonoscopy. Which approach best embodies patient-centered
decision making in this scenario?
Options
A. Advise the patient that guideline-based screening is always
indicated regardless of comorbidity.
B. Recommend against any testing because of his age alone.
,C. Discuss the balance of benefits, risks, and the patient’s values
to reach a shared decision.
D. Defer to the family to decide because the clinician must
avoid causing distress.
Correct Answer
C
Rationales
Correct — C: Shared decision making integrates clinical
evidence (benefit vs harm) with the patient’s goals and
functional status, producing a decision aligned with Harrison’s
emphasis on individualized care.
Incorrect — A: Guidelines are population-based; they must be
individualized for frail, multimorbid older adults.
Incorrect — B: Age alone is not a sufficient reason to withhold
care; functional status and goals matter.
Incorrect — D: The clinician should engage the patient first;
family input is secondary unless the patient lacks capacity.
Teaching Point
Shared decision making combines evidence, risks, and patient
values for individualized care.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 1.
, 2. Reference
Ch. 4 — Decision-Making in Clinical Medicine
Question Stem
A resident is evaluating a patient with chest pain and low
pretest probability for ACS. Which reasoning strategy best
reduces unnecessary testing while maintaining patient safety?
Options
A. Rely solely on intuition because experience usually suffices.
B. Use explicit probability estimates and a threshold approach
to decide on further testing.
C. Order the maximal battery of tests to avoid missing any
diagnosis.
D. Delay assessment until the patient’s symptoms progress.
Correct Answer
B
Rationales
Correct — B: Applying explicit pretest probability and diagnostic
thresholds (Bayesian reasoning) reduces low-yield testing while
maintaining safety, consistent with Harrison’s recommended
decision frameworks.
Incorrect — A: Pure intuition (heuristics) risks bias and
diagnostic error, particularly in low-probability cases.
Incorrect — C: Over-testing increases harms (false positives,
downstream procedures) without proportional benefit.
Incorrect — D: Delaying assessment can miss early, treatable
pathology and is unsafe.
, Teaching Point
Use pretest probability and diagnostic thresholds to guide safe,
efficient testing.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 4.
3. Reference
Ch. 9 — Diagnosis: Reducing Errors and Improving Quality
Question Stem
During a busy shift a clinician prematurely labels a patient’s
abdominal pain as “functional” without considering red flags.
What single diagnostic strategy would most directly reduce this
kind of premature closure?
Options
A. Increase reliance on a single trusted clinician’s gestalt.
B. Systematically ask “what else could this be?” (differential
diagnosis checklist).
C. Immediately order an abdominal CT for all similar patients.
D. Accept the diagnosis if the first test is normal.
Correct Answer
B
Rationales
Correct — B: Using a structured differential checklist combats
premature closure by forcing consideration of alternative
