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Chapter 1: Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom
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AnalysisMultiple Choice
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Identify the choice that best completes the statement or answers the question.
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ki 1. Which type of clinical decision-making is most reliable?
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A. Intuitive
B. Analytical
C. Experiential
D. Augenblick
ki 2. Which of the following is false? To obtain adequate history, health-care providers must be:
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A. Methodical and systematic ki ki
B. Attentive to the patient‘s verbal and nonverbal ki ki ki ki ki ki
language
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C. Able to accurately interpret the patient‘s responses
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D. Adept at reading into the patient‘s statements
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ki 3. Essential parts of a health history include all of the following except:
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A. Chief complaint ki
B. History of the present illness
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C. Current vital signs ki ki
D. All of the above are essential history
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components
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ki 4. Which of the following is false? While performing the physical examination, the examiner must be able to:
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A. Differentiate between normal and abnormal findings ki ki ki ki ki
B. Recall knowledge of a range of conditions and their associated signs and
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symptoms
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C. Recognize how certain conditions affect the response to other conditions
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D. Foresee unpredictable findings ki ki
ki 5. The following is the least reliable source of information for diagnostic statistics:
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A. Evidence-based investigations ki
B. Primary reports of research ki ki ki
C. Estimation based on a provider‘s ki ki ki ki
experience
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D. Published meta-analyses ki
ki 6. The following can be used to assist in sound clinical decision-making:
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A. Algorithm published in a peer-reviewed journal ki ki ki ki ki
article
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B. Clinical practice guidelines ki ki
C. Evidence-based research ki
D. All of the above
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ki 7. If a diagnostic study has high sensitivity, this indicates a:
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A. High percentage of persons with the given condition will have an abnormal
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result
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B. Low percentage of persons with the given condition will have an abnormal
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result
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C. Low likelihood of normal result in persons without a given condition
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D. None of the above ki ki ki
ki 8. If a diagnostic study has high specificity, this indicates a:
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A. Low percentage of healthy individuals will show a normal result
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B. High percentage of healthy individuals will show a normal result
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C. High percentage of individuals with a disorder will show a normal result
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D. Low percentage of individuals with a disorder will show an abnormal
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result
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ki 9. A likelihood ratio above 1 indicates that a diagnostic test showing a:
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A. Positive result is strongly associated with the disease
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B. Negative result is strongly associated with absence of the
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disease
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C. Positive result is weakly associated with the disease
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D. Negative result is weakly associated with absence of the
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disease
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ki 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling
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to express the likelihood of a condition in select situations, settings, and/or patients?
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A. Clinical practice guideline ki ki
B. Clinical decision rule ki ki
C. Clinical algorithm ki
Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana
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Answer Section
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MULTIPLE CHOICE ki
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive
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decision- making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and
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is less reliable andpaired with fairly common errors. In contrast, analytical decision-making is based on careful
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consideration and has greater reliability with rare errors.
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2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient‘s verbal and nonverbal language, and
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ableto accurately interpret the patient‘s responses to questions. Rather than reading into the patient‘s statements, they
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clarify any areas of uncertainty.
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3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
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4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal
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findings, recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain
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conditions affectthe response to other conditions, and distinguish the relevance of varied abnormal findings.
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5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another
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source of statistics, the one that has been most widely used and available for application to the reasoning process, is the
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estimation based on a provider‘s experience, although these are rarely accurate. Over the past decade, the availability of
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evidence on which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be
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based on scientific evidence.
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Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical decision-making.
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6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician.
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Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
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7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an abnormal, or
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positive,result. A high sensitivity indicates that a greater percentage of persons with the given condition will have an
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abnormal result.
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8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The
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greater thespecificity, the greater the percentage of individuals who will have negative, or normal, results if they do
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not have the target condition.
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9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target
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condition and anegative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a
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positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is associated with
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an absence of the disease.
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10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are
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evidence-basedresources that provide probabilistic statements regarding the likelihood that a condition exists if certain
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variables are met with regard to the prognosis of patients with specific findings. Decision rules use mathematical
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models and are specific to certain situations, settings, and/or patient characteristics.
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