Chapter 1. Clinical Decision Making

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____	1.	What is the MOST appropriate classification of patient impairments that are the result of inactivity and expanding multisystem dysfunction following a stroke?
a.	Direct impairments	
b.	Indirect impairments	
c.	Composite impairments	
d.	Comprehensive impairments	

____	2.	Which one of the following statements BEST describes the difference between measurement and diagnosis?
a.	Measurement describes phenomena in terms that can be analyzed numerically, whereas diagnosis is the process that labels patients and classifies their illnesses, leading to the determination of prognoses.	
b.	Diagnosis describes phenomena in terms that can be analyzed numerically, whereas measurement is the process that labels patients and classifies their illnesses, leading to the determination of prognoses.	
c.	Diagnosis and measurement are part of the same process, and the terms can be used interchangeably.	
d.	Measurement requires the use of SOAP notes, whereas diagnosis is facilitated exclusively through the physical therapy guide.	

____	3.	Which one of the following BEST describes the FIRST step that a physical therapist should take when integrating best evidence into clinical practice?
a.	Identify current best evidence on the most successful interventions for the patient’s diagnosis.	
b.	Mine the available data and critically appraise the evidence for its validity, level of evidence, and applicability.	
c.	Integrate the best evidence into clinical decision making after discussing it with the patient.	
d.	Identify a clinically relevant question that is important for the patient.	

____	4.	Which of the following questions is designed to assess capacity for functional activities and participation when interviewing a patient who suffered a stroke?
a.	How much of a problem do you have in walking long distances?	
b.	Is the problem of walking made worse or better by use of an assistive device?	
c.	How much difficulty do you have walking a quarter of a mile?	
d.	How much of a problem do you have going up and down stairs?	

____	5.	Which one of the following disability standardized instruments is MOST specific for a patient recovering from a stroke?
a.	Functional Independence Measure	
b.	Fugl-Meyer Assessment of Physical Performance	
c.	Short Form-36	
d.	Berg Balance Scale	

____	6.	If a clinical diagnostic test for patients with cervical radiculopathy is positive in 95% of patients who truly have the disease, but it is also positive in a large number of healthy individuals, what is this test most useful for?
a.	Ruling out cervical radiculopathy	
b.	Ruling in cervical radiculopathy	
c.	Neither ruling in nor ruling out cervical radiculopathy	
d.	Both ruling in and ruling out cervical radiculopathy	

Chapter 1. Clinical Decision Making
Answer Section

MULTIPLE CHOICE

	1.	ANS:	B
Explanation: These impairments are best classified as indirect impairments because they result from inactivity and expanding multisystem dysfunction.

PTS:	1	REF:	From: Chapter 1		TOP:	Content: Examination

	2.	ANS:	A
Explanation: Measurement describes phenomena in terms that can be analyzed numerically, whereas diagnosis is the process that labels patients and classifies their illnesses, leading to the determination of prognoses. The test-taker will need to know and understand the differences between the two concepts.

PTS:	1	REF:	From: Chapter 1		TOP:	Content: Examination

	3.	ANS:	D
Explanation: The importance of starting with a clinically relevant question that integrates patient values is commonly overlooked, even though it is necessary for integrating best evidence into clinical practice.

PTS:	1	REF:	From: Chapter 1		TOP:	Content: Examination

	4.	ANS:	C
Explanation: Asking whether the individual has difficulty walking a quarter of a mile is both specific to capacity and quantifiable.

PTS:	1	REF:	From: Chapter 1		TOP:	Content: Examination

	5.	ANS:	B
Explanation: The test-taker needs to know that the Fugl-Meyer scale is specific to stroke, whereas the other instruments are used in a variety of diagnoses.

PTS:	1	REF:	From: Chapter 1		TOP:	Content: Examination

	6.	ANS:	A
Explanation: The test-taker will need to understand the concepts of sensitivity and specificity and understand their clinical utility in this example. This test is highly sensitive but has low specificity; thus, it is more useful for ruling out the disease.

PTS:	1	REF:	From: Chapter 1		TOP:	Content: Examination