Chapter 4: Taking the Next Steps: Clinical Reasoning

Question 1

A specific test is one that has the ability to:

Select one:
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. suggest the presence of a disease that is not present.
e. exclude competing explanations for another test finding.

Answer 1

b. correctly identify those who do not have the disease

Question 2

Differential diagnoses belong in the:

Select one:

a. history.
b. physical examination.
c. assessment/ plan
d. laboratory data.

Answer 2

c. assessment/ plan

Question 3

After 50 years of age, stature:

Select one:
a. becomes fixed.

b. begins a barely perceptible secondary increase
c. increases at a rate of 0.5 cm/year
d. declines.
e. declines and then begins a barely perceptible increase.

Answer 3

d. declines.

Question 4

A round face, preauricular fat, hyperpigmentation, and a buffalo hump in the posterior cervical area are associated with:

Select one:

a. infantile hydrocephalus.
b. hypopituitary dwarfism.
c. Cushing syndrome.
d. achondroplasia.
e. acromegaly.

Answer 4

c.Cushing syndrome

Question 5

Medical decision making requires a balance between:
Select one:

a. speculation and feelings
b. opinions and beliefs
c. knowledge and superstition
d. Mechanism and probability.
e. trust and suspicion

Answer 5

d. Mechanism and probability

Question 6

Two hypothalamic hormones control growth hormone synthesis and secretion in the anterior pituitary gland. Growth hormone–releasing hormone (GHRH) and:
Select one:
a. IGF-I.

b. thyroid hormone.
c. leptin.
d. somatostatin.
e. thyroid-stimulating hormone.

Answer 6

d. somatostatin.

Somatostatin, or growth hormone–inhibiting hormone (GHIBH), inhibits the secretion of both GHRH and thyroid-stimulating hormone (TSH).

Question 7

Bits of information that are distracting and draw your thinking away from central issues are referred to as:
Select one:
a. Bayes theorem.
b. true negatives.
c. mechanism and probability
d. red herrings.
e. false negatives.

Answer 7

d. red herrings.

Question 8

The proportion of persons with an observation characteristic of a disease that have the disease is known as _____ value.
Select one:
a. sensitivity positive specific

b. negative specific
c. positive predictive
d. negative predictive
e. true negative

Answer 8

c. positive predictive

A positive predictive value is defined as the proportion of persons thought to have a disease who actually have the disease.

Question 9

Which of the following is initially appropriate in the management of a patient’s diagnosed problem?
Select one:
a. Inform the patient of the treatment plan.
b. Give the patient detailed written instructions regarding the treatment plan.
c. the patient that the plan has been tailored to his needs.
d. Inform the patient of treatment options and possible results.
e. Lead the patient to an understanding that you know the best treatment option.

Answer 9

d. Inform the patient of treatment options and possible results

Question 10

Which of the following is an accepted method of making a diagnosis?
Select one:
a. Always unifying your findings into one diagnosis
b. Making maximal use of laboratory tests
c. Using algorithms
d. Using first assumptions
e. Relying on intuition

Answer 10

Using algorithms

Question 11

When evaluating results of laboratory tests, a test that is highly sensitive implies that the test:
Select one:
a. suggests that a disease is present when it actually is not.
b. will not have any false-positive results.
c. suggests that a disease is absent when it is absent.
d. is able to correctly identify for the disease being tested.
e. is able to confirm a diagnosis even when the disease is not present.

Answer 11

d. is able to correctly identify for the disease being tested.

Testing that is sensitive is a test that will be able to correctly identify persons with the disease that the test has been designed to test for. Positive results are more likely to be positive for the disease. High specificity suggests the ability of an observation to identify correctly those who do not have the disease.