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
An 82-year-old man with severe COPD and moderate dementia
has a symptomatic carotid stenosis found after a transient
ischemic attack. Surgery reduces stroke risk but carries
perioperative risk and long recovery. The patient’s son insists on
“doing everything.” What is the most appropriate clinician next
step?
,Options
A. Schedule carotid endarterectomy immediately because
surgery reduces stroke risk.
B. Defer any discussion and follow the son’s wishes to avoid
family conflict.
C. Conduct a structured goals-of-care conversation exploring
the patient’s values, functional goals, and acceptable tradeoffs.
D. Refer to palliative care only if the patient deteriorates
postoperatively.
Correct Answer
C
Rationales
• Correct (C): Decision-making principles prioritize eliciting
the patient’s goals and values and integrating them with
evidence about benefits and harms to reach shared
decisions — especially when risks and benefits are closely
balanced.
• Incorrect (A): Offering surgery without exploring patient
values risks interventions inconsistent with goals of care
and may cause harm given frailty and dementia.
• Incorrect (B): Deferring discussion and uncritically
following a surrogate’s request violates shared decision-
making and informed consent principles.
, • Incorrect (D): Waiting to involve palliative care until after
deterioration misses an opportunity for early goals
alignment and symptom planning.
Teaching Point
Elicit patient goals and integrate risks/benefits for shared,
values-based decisions.
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 76-year-old man with well-controlled hypertension asks about
prostate-specific antigen (PSA) screening. He is asymptomatic
and independent. How should you advise him?
Options
A. Strongly recommend PSA screening because early detection
always improves survival.
B. Recommend against PSA screening because all screening
causes net harm in men >70.
C. Offer an informed discussion about potential benefits, harms
(false positives, overdiagnosis), and the patient’s preferences.
D. Order PSA and proceed to biopsy if elevated without further
discussion.
, Correct Answer
C
Rationales
• Correct (C): For older adults with limited life expectancy or
where benefits are uncertain, guidelines support
individualized, informed decision-making about screening
that weighs risks of false positives and overdiagnosis.
• Incorrect (A): Screening does not universally improve
survival and can cause overdiagnosis and harm; blanket
recommendation is inappropriate.
• Incorrect (B): A categorical “no” ignores patient
heterogeneity and the need for individualized counseling.
• Incorrect (D): Proceeding to invasive diagnostics without
shared decision-making violates screening principles and
consent.
Teaching Point
Screening decisions require individualized discussion of
benefits, harms, and patient values.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 6.
3
Reference — Ch. 3 — Vaccine Opposition and Hesitancy
(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
An 82-year-old man with severe COPD and moderate dementia
has a symptomatic carotid stenosis found after a transient
ischemic attack. Surgery reduces stroke risk but carries
perioperative risk and long recovery. The patient’s son insists on
“doing everything.” What is the most appropriate clinician next
step?
,Options
A. Schedule carotid endarterectomy immediately because
surgery reduces stroke risk.
B. Defer any discussion and follow the son’s wishes to avoid
family conflict.
C. Conduct a structured goals-of-care conversation exploring
the patient’s values, functional goals, and acceptable tradeoffs.
D. Refer to palliative care only if the patient deteriorates
postoperatively.
Correct Answer
C
Rationales
• Correct (C): Decision-making principles prioritize eliciting
the patient’s goals and values and integrating them with
evidence about benefits and harms to reach shared
decisions — especially when risks and benefits are closely
balanced.
• Incorrect (A): Offering surgery without exploring patient
values risks interventions inconsistent with goals of care
and may cause harm given frailty and dementia.
• Incorrect (B): Deferring discussion and uncritically
following a surrogate’s request violates shared decision-
making and informed consent principles.
, • Incorrect (D): Waiting to involve palliative care until after
deterioration misses an opportunity for early goals
alignment and symptom planning.
Teaching Point
Elicit patient goals and integrate risks/benefits for shared,
values-based decisions.
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 76-year-old man with well-controlled hypertension asks about
prostate-specific antigen (PSA) screening. He is asymptomatic
and independent. How should you advise him?
Options
A. Strongly recommend PSA screening because early detection
always improves survival.
B. Recommend against PSA screening because all screening
causes net harm in men >70.
C. Offer an informed discussion about potential benefits, harms
(false positives, overdiagnosis), and the patient’s preferences.
D. Order PSA and proceed to biopsy if elevated without further
discussion.
, Correct Answer
C
Rationales
• Correct (C): For older adults with limited life expectancy or
where benefits are uncertain, guidelines support
individualized, informed decision-making about screening
that weighs risks of false positives and overdiagnosis.
• Incorrect (A): Screening does not universally improve
survival and can cause overdiagnosis and harm; blanket
recommendation is inappropriate.
• Incorrect (B): A categorical “no” ignores patient
heterogeneity and the need for individualized counseling.
• Incorrect (D): Proceeding to invasive diagnostics without
shared decision-making violates screening principles and
consent.
Teaching Point
Screening decisions require individualized discussion of
benefits, harms, and patient values.
Citation
Loscalzo et al. (2022). Harrison’s Principles of Internal Medicine
(21st Ed.). Ch. 6.
3
Reference — Ch. 3 — Vaccine Opposition and Hesitancy
