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LEVEL II > IM 1/2 > Flashcards

IM 1/2 Flashcards

1
Q

Ranking the differential diagnosis is facilitated with the use of hypotheses. In which of the diagnostic hypotheses will test with high sensitivity and very low negative likelihood ratio need to be used?

A. Other hypersensitivity that cannot be excluded
B. Active alternative hypotheses
C. Excluded hypotheses
D. Leading hypothese

A

B. Active alternative hypotheses

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2
Q

When ruling in or ruling out differential diagnosis, which diseases should be tested first?

A. Lead hypotheses
B. Lead hypotheses & active alternatives
C. Lead hypotheses, active alternatives, & other diagnosis
that can’t be ruled out
D. All differentials in the list

A

B. Lead hypotheses & active alternatives

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3
Q

Which of the following statements is true regarding screening of healthy individuals?

A. Pap smear has been proven to decrease the morbidity and mortality among high risk women
B. Cranial CT scan for chronic headache is valid screening test
C. Because breast CA affects both men and women, mammography should be done starting age 40
D. Screening tests are helpful in the early recognition of illnesses with high morbidity and mortality and poses very minimal non-life threatening risks

A

D. Screening tests are helpful in the early recognition of illnesses with high morbidity and mortality and poses very minimal non-life threatening risks

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4
Q

Which of the following should undergo screening?

A. ECG in 30-year-old without comorbidity but with a family history of coronary artery disease
B. Microalbuminuria in a patient who has diabetes for 10 years
C. Abdominal aortic aneurysm in a 65 year-old male who is a heavy smoker
D. Only A and B are correct
E. Only B and C are correct

A

D. Only A and B are correct

A. ECG in 30-year-old without comorbidity but with a family history of coronary artery disease
B. Microalbuminuria in a patient who has diabetes for 10 years

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5
Q

Once you have a leading hypothesis and active alternative hypotheses, the next step to determine is the

A. pretest probability
B. likelihood ratio
C. test threshold
D. treatment threshold

A

A. pretest probability

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6
Q

In the diagnostic approach to abdominal pain, which of the following best facilitates recall? A list of

A. causes of abdominal pain
B. diseases affecting a specific quadrant
C. diseases affecting the hepatobiliary tree
D. diseases in the GI tract

A

C. diseases affecting the hepatobiliary tree (INARA)

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7
Q

Which of the following characterizes availability bias?

A. Seeking data to confirm, rather than refute the initial hypothesis
B. Stopping the diagnostic process too soon
C. Ignoring atypical features that are inconsistent with the favored diagnosis
D. Considering easily remembered diagnosis as more likely, irrespective of prevalence

A

D. Considering easily remembered diagnosis as more likely, irrespective of prevalence

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8
Q

In which approach to ranking the differential diagnosis will all the differential diagnoses to be tested simultaneously?

A. Probabilistic
B. Pragmatic
C. Possibilistic
D. Prognostic

A

C. Possibilistic

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9
Q

In ranking the differential diagnosis, which approach considers the most serious diagnosis first?

A. Probabilistic
B. Pragmatic
C. Possibilistic
D. Prognostic

A

D. Prognostic

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10
Q

In the diagnostic approach to dyspnea, which of the following best facilitates formulation of the differential diagnosis?

A. Making a list of respiratory diseases
B. Contrasting cardiac and respiratory causes of dyspnea
C. Making a list of diseases causing dyspnea
D. Making a list of cardiac diseases

A

B. Contrasting cardiac and respiratory causes of dyspnea

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11
Q

Which is the most important criteria to consider when screening for a particular disease?

A. Evidence of reduction in mortality and morbidity
B. The prevalence of the disease
C. The quality of the screening tests
D. Identifiable high-risk group

A

B. The prevalence of the disease

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12
Q

A certain Problem #1 has a low pretest probability but not enough to exclude it without testing. The ideal test, if the pretest probability is moderate to high, has serious potential side effects. Upon further research, you found a diagnostic test that is non-invasive. Which of the following statements is correct?

A. The pretest probability is based on the subjective decision of the clinician and cannot be validated objectively
B. The sensitivity and specificity of the test are enough to help you decide if you will do the test or not
C. A negative likelihood ratio less than 1 does not push the pretest probability across the test threshold, therefore a false negative result is likely
D. A negative likelihood ratio less than 1 means no further testing is needed, if the result is negative

A

D. A negative likelihood ratio less than 1 means no further testing is needed, if the result is negative

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13
Q

A 22 yo female was brought to the emergency room because of dyspnea. According to the mother she was apparently well until 10 months PTA when she started having dyspnea on exertion which became worse such that she has dyspnea even with doing mundane household chores. You are an intern and this is your first week in the ER. What systems are most likely involved?

A. Cardiac and respiratory
B. Cardiac, respiratory, and renal
C. Cardiac, respiratory, metabolic, and renal
D. Cardiac, respiratory, metabolic, renal, and neurologic

A

A. Cardiac and respiratory

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14
Q

A quick survey revealed BP of 80/60, HR of 112/min, RR of 28/min, bibasal rales, bipedal edema, cold clammy extremities and small pulses. You want to get more data regarding her medical history and ask the resident to help you listen to the chest & lungs, as well as do some lab tests before you can make a more logical impression. What reasoning process are you using?

A. Abductive
B. Deductive
C. Analytical
D. Intuitive

A

C. Analytical

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15
Q

A 56 yo male patient comes in with dyspnea on exertion for a month now. He also complains of occasional palpitation but no chest pain. He used to smoke (6 pack-years) but quit 5 years ago when he was diagnosed to have diabetes 3 years ago. He is only taking metformin 500 mg once a day for sugar control with good compliance. He had history of childhood asthma. His last attack was in high school. Pertinent physical exam include: a BP of 150/90 mmHg, BMI = 22 (normal), pinkish conjunctivae, neck veins not distended, clear breath sounds, irregular cardiac rhythm, mild bipedal edema. Which can be considered acute problem/s of the patient?

A. Dyspnea only
B. Diabetes, hypertension, bronchial asthma, cardiac dysrhythmia
C. Bronchial asthma, cardiac dysrhythmia
D. Dyspnea, cardiac dysrhythmia, elevated blood pressure

A

D. Dyspnea, cardiac dysrhythmia, elevated blood pressure

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16
Q

Which can be considered chronic problem/s?

A. Diabetes only
B. Hypertension & smoking
C. Diabetes & hypertension
D. Smoking & obesity

A

A. Diabetes only

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17
Q

Match the choices with each of the description below.
The percentage of patients who have true positive results

A. Positive likelihood ratio >1
B. Specificity
C. Sensitivity
D. Negative likelihood ratio
E. Pretest probability

A

C. Sensitivity

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18
Q

Match the choices with each of the description below.
This rules out a disease with low or moderate pretest probability

A. Positive likelihood ratio >1
B. Specificity
C. Sensitivity
D. Negative likelihood ratio
E. Pretest probability

A

D. Negative likelihood ratio

19
Q

Match the choices with each of the description below.
This pushes the pretest probability across the treatment threshold

A. Positive likelihood ratio >1
B. Specificity
C. Sensitivity
D. Negative likelihood ratio
E. Pretest probability

A

A. Positive likelihood ratio >1

20
Q

RA is an 18-year old woman was brought to the ER due to a splitting headache which was sudden in onset. The ER doctor cannot interview the patient because she was screaming in pain. Her uncle who accompanied her said that it happened early that morning. The day before she had a fight with his boyfriend, and they broke up. She is an only child and her parents are separated so she was raised by her grandmother. On general survey she seemed fine. The doctor gave IV medications for pain and sent her to psychiatry clinic for consult with the impression of hysteria, but they opted to go home instead. She was later brought again to the ER comatose. The doctor’s reaction is an example of:

A. Base rate neglect
B. Availability bias
C. Representativeness bias
D. Premature closure

A

C. Representativeness bias

21
Q

Your lead hypothesis has a moderate pretest probability, which of the following is correct?

A. If the treatment does not pose a risk to the patient, you may start treatment without further tests
B. If further testing is needed, it must have a high sensitivity
C. If further testing is needed, it needs to move the probability across the test threshold
D. If further testing is needed, it must be able to detect the true negative cases

A

D. If further testing is needed, it must be able to detect the true negative cases

22
Q

A 52-year old male was wheeled into the Emergency Room because of chest pain. He is obese, diaphoretic, doubled over with pain while clutching his chest with his right fist. The senior medical resident’s immediate impression was that the patient is having a heart attack, even before taking the patient’s history. What reasoning process was the resident using?

A. Intuitive
B. Abductive
C. Analytical
D. Deductive

A

A. Intuitive

23
Q

Which of the following is correct regarding the frequency of screening based on guidelines?

A. Bone mineral density every 5 years
B. One-time abdominal aorta ultrasound
C. Bi-annual fecal occult blood test
D. Annual PAPS smear

A

B. One-time abdominal aorta ultrasound

24
Q

Which of the following characterizes availability bias?

A. There is overestimation of the likelihood of the diagnosis
B. Seeking data to confirm, rather than to refute the initial hypothesis
C. Stopping the diagnostic process too soon
D. Ignoring atypical features that are inconsistent with the favored diagnosis

A

A. There is overestimation of the likelihood of the diagnosis

25
Q

Once you have a leading hypothesis and active alternative hypotheses, the next step to determine is the:

A. Likelihood ratio
B. Test threshold
C. Pretest probability
D. Treatment threshold

A

C. Pretest probability

26
Q

Ranking the differential diagnosis is facilitated with the use of hypotheses. In which of the diagnostic hypotheses will tests with high sensitivity and very low negative likelihood ratio need to be used?

A. Active alternative hypotheses
B. Excluded hypotheses
C. Other hypotheses that cannot be excluded
D. Leading hypothesis

A

A. Active alternative hypotheses

27
Q

In ranking the differential diagnosis, which approach considers the most serious diagnosis first?

A. Probabilistic
B. Possibilistic
C. Pragmatic
D. Prognostic

A

D. Prognostic

28
Q

In the diagnostic approach to abdominal pain, which of the following best facilitates recall? A list of:

A. Diseases in the GI tract
B. Causes of abdominal pain
C. Diseases affecting a specific quadrant
D. Diseases in a specific abdominal organ

A

D. Diseases in a specific abdominal organ (HARAYA)

29
Q

Your lead hypothesis has a moderate pretest probability, which of the following is correct?

A. If the treatment does not pose a risk to the patient you may start treatment without further tests.
B. If further testing is needed, it must be able to detect the true negative cases.
C. If further testing is needed, it needs to move the probability across the test threshold.
D. If further testing is needed it must have a high sensitivity.

A

B. If further testing is needed, it must be able to detect the true negative cases.

30
Q

Which of the following screening tests is found to reduce morbidity and mortality?

A. Prostate cancer – Digital rectal exam
B. Breast cancer – Clinical breast examination
C. Lung cancer – Chest X-ray
D. Colon cancer – Fecal occult blood test

A

D. Colon cancer – Fecal occult blood test

31
Q

Problem #1 has a low pretest probability but not enough to exclude it without testing. The ideal test, if the pretest probability is moderate to high, has serious potential side effects. Upon further research, you found a diagnostic test that is non-invasive. Which of the following statements is correct?

A. A positive likelihood ratio greater than 1 means, no further testing is needed, if the result is negative.
B. The sensitivity and specificity of the test are enough to help you decide if you will do the test or not.
C. A negative likelihood ratio less than 1 does not push the pretest probability across the test threshold,
therefore a false negative result is likely.
D. A negative likelihood ratio less than 1 means, no further testing is needed, if the result is negative.

A

D. A negative likelihood ratio less than 1 means, no further testing is needed, if the result is negative.

32
Q

Match the choices with each of the descriptions below.
A high value means that a negative test result is most likely a true negative:

A. Negative likelihood ratio of less than 1
B. Specificity
C. Positive likelihood ratio of greater than 1
D. Pretest probability
E. Sensitivity

A

B. Specificity

33
Q

Match the choices with each of the descriptions below.
The level of certainty that your hypothesis is correct:

A. Negative likelihood ratio of less than 1
B. Specificity
C. Positive likelihood ratio of greater than 1
D. Pretest probability
E. Sensitivity

A

D. Pretest probability

34
Q

Match the choices with each of the descriptions below.
The percentage of patients who have true positive results:

A. Negative likelihood ratio of less than 1
B. Specificity
C. Positive likelihood ratio of greater than 1
D. Pretest probability
E. Sensitivity

A

E. Sensitivity

35
Q

In the diagnostic approach to abdominal pain, which facilitates recall?

A. list of diseases of the GI tract
B. list of diseases that can cause abdominal pain
C. list of diseases that affects organs in specific abdominal quadrant
D. list of diseases that affect the hepatobiliary tree

A

C. list of diseases that affects organs in specific abdominal quadrant (ADAMAS)

36
Q

In ranking the differential diagnoses, which approach will consider first the most serious diagnosis

A. Probabilistic
B. Possibilistic
C. Pragmatic
D. Prognostic

A

D. Prognostic

37
Q

In which approach to ranking the differential diagnoses will all the differential diagnoses be tested simultaneously

A. Probabilistic
B. Possibilistic
C. Pragmatic
D. Prognostic

A

B. Possibilistic

38
Q

Which of the ff is advantage of using immunochemical FOBT over guiac based FOBT?

A. High sensitivity and specificity
B. High accuracy
C. Detects 49% CA
D. Requires fewer samples

A

D. Requires fewer samples

39
Q

Who can benefit most in cholesterol screening?

A. Stroke patients
B. Diabetic
C. Obese patients
D. Elderly

A

C. Obese patients

40
Q

Which of the ff poses the greatest risk to lung cancer?

A. First degree relative with Lung CA
B. Pipe line worker
C. Smoking

A

C. Smoking

41
Q

True regarding screening for abdominal aortic aneurysm?

A. Annual screening needed for high risk individual
B. Screening starts at age 65 for men and 75 for women
C. Smokers who quit smoking for 10 years are no longer at risk
D. Reduction in mortality is evident in male smokers only

A

C. Smokers who quit smoking for 10 years are no longer at risk

42
Q

Mrs. S is a 40 y.o. African female with no medical problem who came in for consult. Several of her friends died recently due to cancer. Her mother’s sister was diagnosed of colon cancer at age 65. She wants to know if she needs to be screened for colon cancer. She used to smoke 2-3 packs for 4 years and drinks occasionally. What is the best thing to do?

A. Screen using FOBT
B. Screen using flexible sigmoidoscopy and FOBT
C. Screen using colonoscopy
D. Assure patient that there is no need to screen at the moment

A

D. Assure patient that there is no need to screen at the moment

43
Q

Mrs. S also wants to know if she needs to have a lipid profile done and you say

A. “You are at risk of CHD because of your age.”
B. “You are at risk of CHD because you used to smoke.”
C. “You are at risk because your father died of stroke.”
D. “No need for screening test.

A

D. “No need for screening test.

LEVEL II (16 decks)

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