,Chapter 1. Assessment and Clinical Decision-Making: Overview
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which type of clinical decision-making is most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient’s verbal and nonverbal language
C. Able to accurately interpret the patient’s responses
D. Adept at reading into the patient’s statements
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. History of the present illness
C. Current vital signs
D. All of the above are essential history components
4. Which of the following is false? While performing the physical examination, the examiner must be
able to:
A. Differentiate between normal and abnormal findings
B. Recall knowledge of a range of conditions and their associated signs and symptoms
C. Recognize how certain conditions affect the response to other conditions
D. Foresee unpredictable findings
5. 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
6. The following can be used to assist in sound clinical decision-making:
A. Algorithm published in a peer-reviewed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
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. Low percentage of persons with the given condition will have an abnormal result
C. Low likelihood of normal result in persons without a given condition
D. None of the above
, 8. If a diagnostic study has high specificity, this indicates a:
A. Low percentage of healthy individuals will show a normal result
B. High percentage of healthy individuals will show a normal result
C. High percentage of individuals with a disorder will show a normal result
D. Low percentage of individuals with a disorder will show an abnormal result
9. A likelihood ratio above 1 indicates that a diagnostic test showing 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
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on
mathematical modeling to express the likelihood of a condition in select situations, settings, and/or
patients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
D. Clinical recommendation
, Answer Section
MULTIPLE CHOICE
1. ANS: B
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. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and
nonverbal language, and able to accurately interpret the patient’s responses to questions. Rather
than reading into the patient’s statements, they clarify any areas of uncertainty.
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health
history.
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between
normal and abnormal findings, recall knowledge of a range of conditions, including their
associated signs and symptoms, recognize how certain conditions affect the response to other
conditions, and distinguish the relevance of varied abnormal findings.
PTS: 1
5. 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. ANS: D
To assist in clinical decision-making, a number of 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.
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which type of clinical decision-making is most reliable?
A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
2. Which of the following is false? To obtain adequate history, health-care providers must be:
A. Methodical and systematic
B. Attentive to the patient’s verbal and nonverbal language
C. Able to accurately interpret the patient’s responses
D. Adept at reading into the patient’s statements
3. Essential parts of a health history include all of the following except:
A. Chief complaint
B. History of the present illness
C. Current vital signs
D. All of the above are essential history components
4. Which of the following is false? While performing the physical examination, the examiner must be
able to:
A. Differentiate between normal and abnormal findings
B. Recall knowledge of a range of conditions and their associated signs and symptoms
C. Recognize how certain conditions affect the response to other conditions
D. Foresee unpredictable findings
5. 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
6. The following can be used to assist in sound clinical decision-making:
A. Algorithm published in a peer-reviewed journal article
B. Clinical practice guidelines
C. Evidence-based research
D. All of the above
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. Low percentage of persons with the given condition will have an abnormal result
C. Low likelihood of normal result in persons without a given condition
D. None of the above
, 8. If a diagnostic study has high specificity, this indicates a:
A. Low percentage of healthy individuals will show a normal result
B. High percentage of healthy individuals will show a normal result
C. High percentage of individuals with a disorder will show a normal result
D. Low percentage of individuals with a disorder will show an abnormal result
9. A likelihood ratio above 1 indicates that a diagnostic test showing 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
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on
mathematical modeling to express the likelihood of a condition in select situations, settings, and/or
patients?
A. Clinical practice guideline
B. Clinical decision rule
C. Clinical algorithm
D. Clinical recommendation
, Answer Section
MULTIPLE CHOICE
1. ANS: B
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. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and
nonverbal language, and able to accurately interpret the patient’s responses to questions. Rather
than reading into the patient’s statements, they clarify any areas of uncertainty.
PTS: 1
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health
history.
PTS: 1
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between
normal and abnormal findings, recall knowledge of a range of conditions, including their
associated signs and symptoms, recognize how certain conditions affect the response to other
conditions, and distinguish the relevance of varied abnormal findings.
PTS: 1
5. 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. ANS: D
To assist in clinical decision-making, a number of 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.
