Chapter 4 Critical Reasoning Flashcards
Taking the Next Steps: Clinical Reasoning
After the subjective and objective data have been prioritized, the next step is to
a. order laboratory tests.
b. formulate a problem list.
c. initiate appropriate referrals.
d. initiate therapy.
ANS: B
After the data have been prioritized and a presumed diagnosis is made, the next step is to
consider the appropriate laboratory tests, imaging studies, or specialty consultations.
New findings of unknown causes are
a. problems to be noted on the problem list.
b. deferred for subsequent visits.
c. diagnosed before physical examination.
d. reserved for specialists.
ANS: A
New findings of unknown causes are added to the problem list, but do not let them become a
red herring that distracts your attention from the central issues.
Which is an accepted method of making a diagnosis?
a. Relying on intuition
b. Making maximal use of laboratory tests
c. Using first assumptions
d. Using algorithms
ANS: D
Methods to make a diagnosis include recognizing patterns, sampling the universe, and using
algorithms. Do not rely on intuition, extensive use of laboratory findings, or always going
with your first assumptions.
The adage that ―common problems occur commonly‖ advises the practitioner to
a. always diagnose the patient’s problem in terms of what their practice usually sees.
b. refer any uncommon complaints to specialists as soon as possible.
c. not consider more than one diagnosis unless necessary.
d. examine uncommon problems critically before assuming that the issue is an
unusual presentation of a common problem.
ANS: C
This adage is to guide the practitioner to pay attention to unexpected or unusual findings but
not to consider more than one diagnosis unless necessary and to favor the simplest hypothesis
when competing hypotheses exist.
The most important guide to sequencing actions should be
a. probability and utility.
b. assumption and intuition.
c. costs and risks of procedures.
d. reimbursement potential and patient acceptance.
ANS: A
Although all choices are relevant, the prioritized guide is to select actions based on an
estimate of the probability of successfully achieving the patient’s goals and on the utility of
implementation.
Utilitarianism can be described as
a. balancing interests.
b. preventing harm.
c. choosing wisely.
d. doing good.
ANS: C
Utilitarianism occurs when one considers appropriate use of resources with concern for the
greater good of the larger community. It also means to ―choose wisely.‖
Positive outcomes depend on the
a. number of laboratory tests ordered.
b. quality of decisions made.
c. use of pharmacologic modalities.
d. time saved by the use of ancillary personnel.
ANS: B
Positive patient outcomes are dependent on your ability to arrive at accurate hypotheses that
then direct quality patient care decisions.
Self-analysis assists providers in giving proper context to
a. history and physical findings.
b. therapeutic options.
c. attitudes, values, and feelings.
d. differential diagnoses.
ANS: C
Knowing the intensity of your personal attitudes, values, and emotional feelings about patient
care situations helps prevent you from being overtaken by your own impaired or distorted
viewpoints.
Medical decision making requires a balance between
a. trust and suspicion.
b. ethical and unethical behavior.
c. remembering and superstition.
d. mechanism and probabilism.
ANS: D
In making medical decisions, you cannot be too scientific or pursue every possible scenario.
A valid history and physical examination can serve to
a. create higher healthcare costs.
b. limit the indiscriminate use of diagnostics.
c. threaten patient satisfaction.
d. increase the risk of liability.
ANS: B
A comprehensive history with a competent clinical examination can lead you to generate a
more accurate problem list, and therefore increase the proper usage of diagnostic testing while
limiting its indiscriminate use.
A specific test is one that has the ability to
a. correctly identify those who have the disease.
b. correctly identify those who do not have the disease.
c. be exclusively used to make a diagnosis.
d. exclude competing explanations for another test finding.
ANS: B
The specificity of a test is determined by its ability to identify those who do not have the
disease for which the test has been designed. Negative results are more likely to be valid.
Mr. Johnson actually has streptococcal pharyngitis; however, the throat culture is initially read
as negative. This situation describes a test with a
a. low sensitivity.
b. high sensitivity.
c. high specificity.
d. low specificity.
ANS: A
This situation describes a test designed to test those who are positive for the disease. At this
time, the test was not able to detect a true-positive; therefore, the test had a low sensitivity.
Which of the following is not a component of a management plan?
a. Presumptive diagnosis
b. Patient education
c. Diet modification
d. Physical therapy
ANS: A
The management plan details what you are going to do about a patient problem such as education, diet modifications, and physical therapy referrals.
When determining actions for the management plan, the practitioner should first address
a. problems in the order of their chronologic development.
b. the patient’s concern about a particular problem.
c. the patient’s social and economic circumstances.
d. the most urgent problem.
ANS: D
In developing patient care plans, priority should be given to the most life-threatening and
urgent physical needs of the patient. Then focus on addressing the patient’s social and
economic circumstances.
When utilizing a joint approach with the patient, which factors are likely to be considered?
(Select all that apply.)
a. Consultations
b. Laboratory studies
c. Assistive technology
d. Patient education
e. Practitioner background
ANS: A, B, C
A joint approach between the patient and practitioner should include laboratory and imaging
studies, subspecialty consultation, medications, equipment, special care, diet and activity
modification, follow-up visit, and patient education.
