TEST BANK
Advanced Assessment: Interpreting Findings and Formulating
Differential Diagnoses
Laurie Goolsby, and Mary Jo Grubbs
5th Edition
,Table of Contents
Chapter 01 Assessment and Clinical Decision Making-An Overview 1
Chapter 02 Diagnostic Studies 4
Chapter 03 Genomic Assessment-Interpreting Findings and Formulating Differential
Diagnosis 6
Chapter 04 Skin 12
Chapter 05 Head, Face, and Neck 20
Chapter 06 The Eye 27
Chapter 07 Ear, Nose, Mouth, and Throat 35
Chapter 08 Cardiac and Peripheral Vascular Systems 45
Chapter 09 Respiratory System 64
Chapter 10 Breasts 73
Chapter 11 Abdomen 79
Chapter 12 Genitourinary System 94
Chapter 13 Male Reproductive System 102
Chapter 14 Female Reproductive System 111
Chapter 15 Musculoskeletal System 128
Chapter 16 Neurological System 141
Chapter 17 Nonspecific Complaints 153
Chapter 18 Psychiatric Mental Health 166
Chapter 19 Pediatric Patients 176
Chapter 20 Pregnant Patients 188
Chapter 21 Assessment of the Transgender or Gender Diverse Adult 202
Chapter 22 Older Patients 207
Chapter 23 Persons With Disabilities 215
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
Chapter 1. Assessment and Clinical Decision Making: An Overview
MULTIPLE CHOICE
1. Which type of clinical decision making is most reliable?
A. Analytical I
B. Augenblink
C. Experiential
D. Intuitive
ANS: A
Croskerry (2009) describes two major types of clinical diagnostic decision making: intuitive
and analytical. Intuitive decision making (similar to Augenblink decision making) is based
on the experience and intuition of the clinician and is less reliable and paired with fairly
common errors. In contrast, analytical decision making is based on careful consideration and
has greater reliability with rare errors.
PTS: 1
2. You are using the PQRST approach while completing the history of present illness for a
patient complaining of pain. Which of the following questions is relevant to the “P” portion
of this approach?
A. How would you describe your pain?
B. Can you point to the area of most severe pain?
C. How has your pain changed since you first noticed it?
D. What makes the pain worse or better?
ANS: D
In the PQRST model, “P” refers to exploring precipitating and palliative factors. Identify
factors that make the symptom worse or better, any previous self-treatment or prescribed
treatment, and response.
PTS: 1
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. Current vital signs
C. History of the present illness
D. Review of systems
ANS: B
Vital signs are part of the physical examination portion of patient assessment, not part of the
health history.
PTS: 1
4. While reading an article on hypothyroidism, you find a helpful graphic depiction of the
decision-making process recommended by the authors to find a definitive diagnosis. This
graphic is an example of:
______________________________________________________________________________________________
1|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
A. A clinical prediction tool
B. Clinical guidelines
C. A decision tree
D. A diagnostic-finding guide
ANS: C
Clinical decision trees provide a graphic depiction of the decision-making process, showing
the pathway based on findings at various steps in the process.
PTS: 1
5. Which of the following is the least reliable source of information for diagnostic statistics?
A. Evidence-based investigations
B. Primary reports of research
C. Estimation based on a provider’s experience
D. Published meta-analyses
ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and
published meta-analyses. Another source of statistics, the one that has been most widely
used and available for application to the reasoning process, is the estimation based on a
provider’s experience, although these are rarely accurate. Over the past decade, the
availability of evidence on which to base clinical reasoning is improving, and there is an
increasing expectation that clinical reasoning be based on scientific evidence.
Evidence-based statistics are also increasingly being used to develop resources to facilitate
clinical decision making.
PTS: 1
6. Which of the following can be used to assist in sound clinical decision making?
A. An algorithm published in a peer-reviewed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
ANS: D
To assist in clinical decision making, several evidence-based resources have been developed
to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist
in clinical reasoning when properly applied.
PTS: 1
7. If a diagnostic study has high sensitivity, this indicates:
A. A high percentage of persons with the given condition will have an abnormal result
B. A high percentage of persons without the condition will have inconclusive results
C. A low likelihood of normal results in persons without a given condition
D. A low percentage of persons with the given condition will have an abnormal result
ANS: A
______________________________________________________________________________________________
2|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
The sensitivity of a diagnostic study is the percentage of individuals with the target
condition who show an abnormal, or positive, result. A high sensitivity indicates that a
greater percentage of persons with the given condition will have an abnormal result.
PTS: 1
8. If a diagnostic study has high specificity, this indicates:
A. A low percentage of healthy individuals will show a normal result
B. A high percentage of healthy individuals will show a normal result
C. A high percentage of individuals with a disorder will show a normal result
D. A low percentage of individuals with a disorder will show an abnormal result
ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who
have a normal result. The greater the specificity, the greater the percentage of individuals
who will have negative, or normal, results if they do not have the target condition.
PTS: 1
9. A likelihood ratio above 1 indicates that a diagnostic test showing that a:
A. Positive result is strongly associated with the disease
B. Negative result is strongly associated with absence of the disease
C. Positive result is weakly associated with the disease
D. Negative result is weakly associated with absence of the disease
ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a
person who has the target condition, and a negative result will be associated with a healthy
person. A likelihood ratio above 1 indicates that a positive result is associated with the
disease; a likelihood ratio less than 1 indicates that a negative result is associated with an
absence of the disease.
PTS: 1
10. Which of the following clinical reasoning tools is defined as an evidence-based resource
based on mathematical modeling to express the likelihood of a condition in select situations,
settings, and patients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
D. Clinical recommendation
ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning.
Clinical decision rules are evidence-based resources that provide probabilistic statements
regarding the likelihood that a condition exists if certain variables are met regarding the
prognosis of patients with specific findings. Decision rules use mathematical models and are
specific to certain situations, settings, and patient characteristics.
PTS: 1
______________________________________________________________________________________________
3|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
Chapter 2. Diagnostic Studies
MULTIPLE CHOICE
1. If a diagnostic study has high sensitivity, this indicates:
A. A high percentage of persons with the given condition will have a positive result
B. A high percentage of persons without the condition will have inconclusive results
C. A high likelihood of normal results in persons without a given condition
D. A low percentage of persons with the given condition will have an abnormal result
ANS: A
Sensitivity refers to the percentage of patients who have the disease or condition who will
test positive with the test. The more sensitive a test, the greater the probability that a patient
with the disease will test positive and the better the test is at identifying persons with the
disease, i.e., true positives. The higher the sensitivity, the less likely the test will have false
negatives for the condition.
PTS: 1
2. If a diagnostic study has high specificity, this indicates:
A. A low percentage of healthy individuals will show a normal result.
B. A high percentage of healthy individuals will show a normal result.
C. A high percentage of individuals without the disorder have a false positive result.
D. A low percentage of individuals with a disorder will show an abnormal result.
ANS: B
Specificity refers to the percentage of patients without the disease or condition who will test
negative. The more specific a test, the greater the probability that a patient without the
disease or condition will test negative; thus it better detects those without the disease, i.e., a
true negative. A high specificity test is helpful in confirming a diagnosis because false
positives are less likely.
PTS: 1
3. Positive predictive values are based on:
A. Statistics of patients who tested positive on a specific test
B. Statistics of patients who tested negative on a specific test
C. Patients with a confirmed diagnosis of a target condition
D. Statistics from one laboratory setting
ANS: A
Positive predictive values (PPV) and negative predictive values (NPV) are based
exclusively on populations who either tested positive (PPV) or tested negative (NPV). They
often better reflect the value of a positive or negative finding in a general population.
PTS: 1
4. Choosing Wisely is:
A. A mnemonic to guide selection of imaging studies
______________________________________________________________________________________________
4|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
B. An initiative to minimize overutilization of tests and treatments
C. A standard reference range published annually
D. A summary of descriptions of key diagnostic tests
ANS: B
The Choosing Wisely initiative is designed to minimize resource utilization, specifically for
costly and overused tests and treatments. This program provides dozens of evidence-based
laboratory recommendations submitted by numerous specialty organizations.
PTS: 1
5. The Appropriateness Criteria is
A. A mnemonic to guide selection of CT scans
B. Provides resources to optimize selection of appropriate laboratory studies
C. Provides resources to optimize selection of appropriate imaging studies
D. Describes the risks and values associated with varied diagnostic tools
ANS: C
The ACR-AC provides evidence-based guidance to optimize selection of the most
appropriate imaging for specific presentations.
PTS: 1
6. Important consideration in ordering laboratory studies include:
A. Will this contribute to the diagnosis, prognosis, or treatment of considered
condition
B. Is the study consistent with evidence-based recommendations
C. Are there existing results available that would be sufficient to consider
D. All of the above
ANS: D
Box 2.3 lists the following considerations before ordering laboratory studies:
Contribution to diagnosis, prognosis, treatment
Impact on patient care
Absence of other sufficient results in current or previous order
Appropriate given any retesting intervals
Test acknowledged by clinicians as significant
Tests consistent with guidelines and recommendations
PTS: 1
______________________________________________________________________________________________
5|Page
, ______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
Chapter 3. Genomic Assessment: Interpreting Findings and Formulating Differential
Diagnosis
MULTIPLE CHOICE
1. The first step in the genomic assessment of a patient is obtaining information regarding:
A. Family history
B. Environmental exposures
C. Lifestyle and behaviors
D. Current medications
ANS: A
A critical first step in any health assessment is collecting and interpreting the family health
history.
PTS: 1
2. An affected individual who manifests symptoms of a particular condition and through whom
a family with a genetic disorder is ascertained is called a(n):
A. Consultand
B. Consulband
C. Index patient
D. Proband
ANS: D
A proband is a family member who manifests symptoms of a particular condition and/or
brings the family to medical attention (Bennett, 2010).
PTS: 1
3. An autosomal dominant (AD) disorder involves the:
A. X chromosome
B. Y chromosome
C. Mitochondrial DNA
D. Non-sex chromosomes
ANS: D
AD inheritance is a result of a gene mutation in one of the 22 autosomes.
PTS: 1
4. To illustrate a union between two second cousin family members in a pedigree:
A. Arrows are drawn pointing to the male and female.
B. Brackets are drawn around the male and female.
C. Double horizontal lines are drawn between the male and female.
D. Circles are drawn around the male and female.
ANS: C
______________________________________________________________________________________________
6|Page
Advanced Assessment: Interpreting Findings and Formulating
Differential Diagnoses
Laurie Goolsby, and Mary Jo Grubbs
5th Edition
,Table of Contents
Chapter 01 Assessment and Clinical Decision Making-An Overview 1
Chapter 02 Diagnostic Studies 4
Chapter 03 Genomic Assessment-Interpreting Findings and Formulating Differential
Diagnosis 6
Chapter 04 Skin 12
Chapter 05 Head, Face, and Neck 20
Chapter 06 The Eye 27
Chapter 07 Ear, Nose, Mouth, and Throat 35
Chapter 08 Cardiac and Peripheral Vascular Systems 45
Chapter 09 Respiratory System 64
Chapter 10 Breasts 73
Chapter 11 Abdomen 79
Chapter 12 Genitourinary System 94
Chapter 13 Male Reproductive System 102
Chapter 14 Female Reproductive System 111
Chapter 15 Musculoskeletal System 128
Chapter 16 Neurological System 141
Chapter 17 Nonspecific Complaints 153
Chapter 18 Psychiatric Mental Health 166
Chapter 19 Pediatric Patients 176
Chapter 20 Pregnant Patients 188
Chapter 21 Assessment of the Transgender or Gender Diverse Adult 202
Chapter 22 Older Patients 207
Chapter 23 Persons With Disabilities 215
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
Chapter 1. Assessment and Clinical Decision Making: An Overview
MULTIPLE CHOICE
1. Which type of clinical decision making is most reliable?
A. Analytical I
B. Augenblink
C. Experiential
D. Intuitive
ANS: A
Croskerry (2009) describes two major types of clinical diagnostic decision making: intuitive
and analytical. Intuitive decision making (similar to Augenblink decision making) is based
on the experience and intuition of the clinician and is less reliable and paired with fairly
common errors. In contrast, analytical decision making is based on careful consideration and
has greater reliability with rare errors.
PTS: 1
2. You are using the PQRST approach while completing the history of present illness for a
patient complaining of pain. Which of the following questions is relevant to the “P” portion
of this approach?
A. How would you describe your pain?
B. Can you point to the area of most severe pain?
C. How has your pain changed since you first noticed it?
D. What makes the pain worse or better?
ANS: D
In the PQRST model, “P” refers to exploring precipitating and palliative factors. Identify
factors that make the symptom worse or better, any previous self-treatment or prescribed
treatment, and response.
PTS: 1
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. Current vital signs
C. History of the present illness
D. Review of systems
ANS: B
Vital signs are part of the physical examination portion of patient assessment, not part of the
health history.
PTS: 1
4. While reading an article on hypothyroidism, you find a helpful graphic depiction of the
decision-making process recommended by the authors to find a definitive diagnosis. This
graphic is an example of:
______________________________________________________________________________________________
1|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
A. A clinical prediction tool
B. Clinical guidelines
C. A decision tree
D. A diagnostic-finding guide
ANS: C
Clinical decision trees provide a graphic depiction of the decision-making process, showing
the pathway based on findings at various steps in the process.
PTS: 1
5. Which of the following is the least reliable source of information for diagnostic statistics?
A. Evidence-based investigations
B. Primary reports of research
C. Estimation based on a provider’s experience
D. Published meta-analyses
ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and
published meta-analyses. Another source of statistics, the one that has been most widely
used and available for application to the reasoning process, is the estimation based on a
provider’s experience, although these are rarely accurate. Over the past decade, the
availability of evidence on which to base clinical reasoning is improving, and there is an
increasing expectation that clinical reasoning be based on scientific evidence.
Evidence-based statistics are also increasingly being used to develop resources to facilitate
clinical decision making.
PTS: 1
6. Which of the following can be used to assist in sound clinical decision making?
A. An algorithm published in a peer-reviewed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
ANS: D
To assist in clinical decision making, several evidence-based resources have been developed
to assist the clinician. Resources, such as algorithms and clinical practice guidelines, assist
in clinical reasoning when properly applied.
PTS: 1
7. If a diagnostic study has high sensitivity, this indicates:
A. A high percentage of persons with the given condition will have an abnormal result
B. A high percentage of persons without the condition will have inconclusive results
C. A low likelihood of normal results in persons without a given condition
D. A low percentage of persons with the given condition will have an abnormal result
ANS: A
______________________________________________________________________________________________
2|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
The sensitivity of a diagnostic study is the percentage of individuals with the target
condition who show an abnormal, or positive, result. A high sensitivity indicates that a
greater percentage of persons with the given condition will have an abnormal result.
PTS: 1
8. If a diagnostic study has high specificity, this indicates:
A. A low percentage of healthy individuals will show a normal result
B. A high percentage of healthy individuals will show a normal result
C. A high percentage of individuals with a disorder will show a normal result
D. A low percentage of individuals with a disorder will show an abnormal result
ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who
have a normal result. The greater the specificity, the greater the percentage of individuals
who will have negative, or normal, results if they do not have the target condition.
PTS: 1
9. A likelihood ratio above 1 indicates that a diagnostic test showing that a:
A. Positive result is strongly associated with the disease
B. Negative result is strongly associated with absence of the disease
C. Positive result is weakly associated with the disease
D. Negative result is weakly associated with absence of the disease
ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a
person who has the target condition, and a negative result will be associated with a healthy
person. A likelihood ratio above 1 indicates that a positive result is associated with the
disease; a likelihood ratio less than 1 indicates that a negative result is associated with an
absence of the disease.
PTS: 1
10. Which of the following clinical reasoning tools is defined as an evidence-based resource
based on mathematical modeling to express the likelihood of a condition in select situations,
settings, and patients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
D. Clinical recommendation
ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning.
Clinical decision rules are evidence-based resources that provide probabilistic statements
regarding the likelihood that a condition exists if certain variables are met regarding the
prognosis of patients with specific findings. Decision rules use mathematical models and are
specific to certain situations, settings, and patient characteristics.
PTS: 1
______________________________________________________________________________________________
3|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
Chapter 2. Diagnostic Studies
MULTIPLE CHOICE
1. If a diagnostic study has high sensitivity, this indicates:
A. A high percentage of persons with the given condition will have a positive result
B. A high percentage of persons without the condition will have inconclusive results
C. A high likelihood of normal results in persons without a given condition
D. A low percentage of persons with the given condition will have an abnormal result
ANS: A
Sensitivity refers to the percentage of patients who have the disease or condition who will
test positive with the test. The more sensitive a test, the greater the probability that a patient
with the disease will test positive and the better the test is at identifying persons with the
disease, i.e., true positives. The higher the sensitivity, the less likely the test will have false
negatives for the condition.
PTS: 1
2. If a diagnostic study has high specificity, this indicates:
A. A low percentage of healthy individuals will show a normal result.
B. A high percentage of healthy individuals will show a normal result.
C. A high percentage of individuals without the disorder have a false positive result.
D. A low percentage of individuals with a disorder will show an abnormal result.
ANS: B
Specificity refers to the percentage of patients without the disease or condition who will test
negative. The more specific a test, the greater the probability that a patient without the
disease or condition will test negative; thus it better detects those without the disease, i.e., a
true negative. A high specificity test is helpful in confirming a diagnosis because false
positives are less likely.
PTS: 1
3. Positive predictive values are based on:
A. Statistics of patients who tested positive on a specific test
B. Statistics of patients who tested negative on a specific test
C. Patients with a confirmed diagnosis of a target condition
D. Statistics from one laboratory setting
ANS: A
Positive predictive values (PPV) and negative predictive values (NPV) are based
exclusively on populations who either tested positive (PPV) or tested negative (NPV). They
often better reflect the value of a positive or negative finding in a general population.
PTS: 1
4. Choosing Wisely is:
A. A mnemonic to guide selection of imaging studies
______________________________________________________________________________________________
4|Page
,______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
B. An initiative to minimize overutilization of tests and treatments
C. A standard reference range published annually
D. A summary of descriptions of key diagnostic tests
ANS: B
The Choosing Wisely initiative is designed to minimize resource utilization, specifically for
costly and overused tests and treatments. This program provides dozens of evidence-based
laboratory recommendations submitted by numerous specialty organizations.
PTS: 1
5. The Appropriateness Criteria is
A. A mnemonic to guide selection of CT scans
B. Provides resources to optimize selection of appropriate laboratory studies
C. Provides resources to optimize selection of appropriate imaging studies
D. Describes the risks and values associated with varied diagnostic tools
ANS: C
The ACR-AC provides evidence-based guidance to optimize selection of the most
appropriate imaging for specific presentations.
PTS: 1
6. Important consideration in ordering laboratory studies include:
A. Will this contribute to the diagnosis, prognosis, or treatment of considered
condition
B. Is the study consistent with evidence-based recommendations
C. Are there existing results available that would be sufficient to consider
D. All of the above
ANS: D
Box 2.3 lists the following considerations before ordering laboratory studies:
Contribution to diagnosis, prognosis, treatment
Impact on patient care
Absence of other sufficient results in current or previous order
Appropriate given any retesting intervals
Test acknowledged by clinicians as significant
Tests consistent with guidelines and recommendations
PTS: 1
______________________________________________________________________________________________
5|Page
, ______________________________________________________________________________________________
Test Bank - Advanced Assessment, 5th Edition (Goolsby, 2023)
Chapter 3. Genomic Assessment: Interpreting Findings and Formulating Differential
Diagnosis
MULTIPLE CHOICE
1. The first step in the genomic assessment of a patient is obtaining information regarding:
A. Family history
B. Environmental exposures
C. Lifestyle and behaviors
D. Current medications
ANS: A
A critical first step in any health assessment is collecting and interpreting the family health
history.
PTS: 1
2. An affected individual who manifests symptoms of a particular condition and through whom
a family with a genetic disorder is ascertained is called a(n):
A. Consultand
B. Consulband
C. Index patient
D. Proband
ANS: D
A proband is a family member who manifests symptoms of a particular condition and/or
brings the family to medical attention (Bennett, 2010).
PTS: 1
3. An autosomal dominant (AD) disorder involves the:
A. X chromosome
B. Y chromosome
C. Mitochondrial DNA
D. Non-sex chromosomes
ANS: D
AD inheritance is a result of a gene mutation in one of the 22 autosomes.
PTS: 1
4. To illustrate a union between two second cousin family members in a pedigree:
A. Arrows are drawn pointing to the male and female.
B. Brackets are drawn around the male and female.
C. Double horizontal lines are drawn between the male and female.
D. Circles are drawn around the male and female.
ANS: C
______________________________________________________________________________________________
6|Page
