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 sees you for a
new-onset cough and confusion. As his clinician, you must
integrate patient goals into management. Which approach best
aligns with patient-centered care and shared decision-making
for this patient?
,Options
A. Recommend guideline-directed therapy without discussing
goals, since comorbidities increase mortality.
B. Elicit the patient’s values and priorities, then present
treatment options and probable outcomes.
C. Defer decisions to the healthcare proxy immediately because
the patient is confused.
D. Start broad-spectrum therapy and discuss goals later when
the patient is stable.
Correct Answer
B
Rationales
• Correct (B): Shared decision-making requires eliciting
patient values and presenting realistic options and
outcomes; this aligns with the practice of medicine’s
patient-centered framework.
• A: Ignores individual goals and may lead to treatments the
patient would decline; patient-centered care requires
discussion.
• C: A proxy may be needed if decisional capacity is absent,
but initial effort should assess capacity and elicit the
patient’s known values first.
• D: Immediate treatment without discussing goals can
violate patient autonomy and lead to unwanted
interventions.
,Teaching Point
Elicit patient values first; then present options and likely
outcomes for shared decisions.
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 hospitalist evaluates an elderly patient for polypharmacy.
Which strategy best reduces medication-related harm while
preserving therapeutic benefit?
Options
A. Discontinue all nonprescription supplements immediately.
B. Apply an individualized medication review considering
benefits, risks, and patient goals.
C. Substitute every high-risk drug with newer agents regardless
of cost.
D. Continue current regimen if there are no recent adverse
events.
Correct Answer
B
, Rationales
• Correct (B): A careful, individualized medication review
weighing benefits, risks, and patient goals reduces harm
and aligns with best practice.
• A: Blanket discontinuation may remove beneficial
therapies and miss dependence/withdrawal issues.
• C: Newer agents are not always safer; substitutions require
evidence and alignment with patient context.
• D: Absence of recent adverse events does not preclude
future harm; proactive review is indicated.
Teaching Point
Individualized medication reviews balance benefit and harm
while aligning with patient goals.
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 community clinic plans an intervention to reduce type 2
diabetes incidence. Which population-level strategy best
follows evidence-based prevention principles?
(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 sees you for a
new-onset cough and confusion. As his clinician, you must
integrate patient goals into management. Which approach best
aligns with patient-centered care and shared decision-making
for this patient?
,Options
A. Recommend guideline-directed therapy without discussing
goals, since comorbidities increase mortality.
B. Elicit the patient’s values and priorities, then present
treatment options and probable outcomes.
C. Defer decisions to the healthcare proxy immediately because
the patient is confused.
D. Start broad-spectrum therapy and discuss goals later when
the patient is stable.
Correct Answer
B
Rationales
• Correct (B): Shared decision-making requires eliciting
patient values and presenting realistic options and
outcomes; this aligns with the practice of medicine’s
patient-centered framework.
• A: Ignores individual goals and may lead to treatments the
patient would decline; patient-centered care requires
discussion.
• C: A proxy may be needed if decisional capacity is absent,
but initial effort should assess capacity and elicit the
patient’s known values first.
• D: Immediate treatment without discussing goals can
violate patient autonomy and lead to unwanted
interventions.
,Teaching Point
Elicit patient values first; then present options and likely
outcomes for shared decisions.
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 hospitalist evaluates an elderly patient for polypharmacy.
Which strategy best reduces medication-related harm while
preserving therapeutic benefit?
Options
A. Discontinue all nonprescription supplements immediately.
B. Apply an individualized medication review considering
benefits, risks, and patient goals.
C. Substitute every high-risk drug with newer agents regardless
of cost.
D. Continue current regimen if there are no recent adverse
events.
Correct Answer
B
, Rationales
• Correct (B): A careful, individualized medication review
weighing benefits, risks, and patient goals reduces harm
and aligns with best practice.
• A: Blanket discontinuation may remove beneficial
therapies and miss dependence/withdrawal issues.
• C: Newer agents are not always safer; substitutions require
evidence and alignment with patient context.
• D: Absence of recent adverse events does not preclude
future harm; proactive review is indicated.
Teaching Point
Individualized medication reviews balance benefit and harm
while aligning with patient goals.
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 community clinic plans an intervention to reduce type 2
diabetes incidence. Which population-level strategy best
follows evidence-based prevention principles?
