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Advanced Health Assessment & Clinical Diagnosis in Primary Care
6th
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Chapter 1 Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis

Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which type of clinical decision-making is most reliable?

A Intuitive
B Analytical
C Experiential
D Augenblick

2. Which of the following is false? To obtain adequate history, health-care providers must be:

A Methodical and systematic

B Attentive to the patient’s verbal and nonverbal lang uage Able to
C accurately interpret the patient’s responses Adept at reading into the
D patient’s statements
3. Essential parts of a health history include all of the following except:

A Chief complaint
B History of the present illness
C. Current vital signs
D All of the above are essential history compon ents

4.Which of the following is false?While performing the physical examination, the examiner must be able to:
A Differentiate between normal and abnormal findings
B Recall knowledge of a range of conditions and their associated signs and sy mptoms Recognize how
C certain conditions affect the response to other conditions
D Foresee unpredictable findings
5. The following is the least reliable source of information for diagnostic statistics:

A Evidence-based investigations
B Primary reports of research
C Estimation based on a provider’s experie nce
D Published meta-analyses
6. The following can be used to assist in sound clinical decision-making: Algorithm

A published in a peer-reviewed journal article

B Clinical practice guidelines
C Evidence-based research
D All of the above

7. If a diagnostic study has high sensitivity, this indicates a:

A High percentage of persons with the given condition will have an abnorma l result
B Low percentage of persons with the given condition will have an abnorma
C of normal result in persons without a given condition
l result Low likelihood

8. If a diagnostic study has high specificity, this indicates a:

A Low percentage of healthy individuals will show a normal result
 B High percentage of healthy individuals will show a normal result
C High percentage of individuals with a disorder will show a normal re sult
D Low percentage of individuals with a disorder will show an abnorma l result
9. A likelihood ratio above 1 indicates that a diagnostic test showing a: Positive result is strongly associated with the
A disease
B Negative result is strongly associated with absence of the di sease Positive result is weakly associated with the disease
Negative result is weakly associated with absence of the dis ease
C
D
10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical

modeling to express the likelihood of a condition in select situations, settings, and/or patients?
A Clinical practice guideli ne
B Clinical decision rule
C Clinical algorithm

Answer Section

MULTIPLE CHOICE

1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive
decision-making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is
less reliable and paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration
and has greater reliability with rare errors.
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal

language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the patient’s
statements, they clarify any areas of uncertainty.
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.

4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal
findings, recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain
conditions affect the response to other conditions, and distinguish the relevance of varied abnormal findings.
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source
of statistics, the one that has been most widely used and available for application to the reasoning process, is the estimation
based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on
which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on
scientific evidence. Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical
decision-making.
6. ANS: D

To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician.
Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
7. ANS: A
The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an
abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given
condition will have an abnormal result.
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The
greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if they do
not have the target condition.
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target
condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a
positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is
associated with an absence of the disease.
10. ANS: B

Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are
evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if
certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use
mathematical models and are specific to certain situations, settings, and/or patient characteristics.
Exploring the Variety of Random
Documents with Different Content
 Croquet de Luxe JAQUES LONDON
Jaques’ Croquet de Luxe.
The materials contained in this set are all of the finest make,
newest designs and of the most approved patterns. It includes
Composition Balls, Malacca Mallets, Roehampton Hoops and
Sockets, etc., etc., and is without doubt the finest set of
Croquet ever produced. Price £4 15s.
Jaques’ New Model Tournament Croquet Set.
No Lawn too small. With a few modifications the Laws and
Tactics observed in the Tournament Game are observed. The
size of a court used with this set is 17½ yards × 14 yards, just
half the full size, and these dimensions may be still further
reduced if want of space demands it. Each set contains 4
Model Association Croquet Mallets, 6 × 2½, 4 Model Boxwood
Balls, set of 6 Model Hoops, pair of Model Turning and Winning
Pegs, all made in correct proportions, set of Clips, 126 yards
Boundary Cord with holding down pins, Rules, etc., in wood
box. Price 30/0
Small stand to carry Mallets, Balls, etc., for above ... Price 9/0
 THE ASSOCIATION SET JAQUES’ LONDON
Jaques’ Croquet.
No. 13 X. The Association. Containing 4 superior Association
Mallets (heads 9 in. × 3 in.), bound Octagon Handles, each
stamped to weight, four 3⅝ in. selected Glisglos Boxwood
Balls, Association Hoops, Pegs, Hoop Gauge, Marking Flags,
and every article requisite for the setting out of Match Croquet
Lawns. Complete in Stout Case. Price 60/0
Jaques’ 13-Tournament Set.
Containing 4 9 in. × 3 in. All-England Mallets, 4 Boxwood Balls,
3⅝ in., Tournament Hoops, Association Clips, Association Pegs,
Marking Pegs, Rules, etc. Complete in Box. Price 46/0
Juvenile Croquet.
Painted Regulation Colours.
No. 0x. Containing 4 2 ft. 3 in. Ash Mallets, Heads 4½ in. ×
1¾ in.; 4 Balls, 3 in. diameter; Hoop Clips; starting Post;
Rules. In Box complete, ... ... Price 6/11
No 2x. Ditto, but with 2 ft. 8 in. Mallets; Heads 4½ in. ×
2½ in., and 3¼ in. Balls ... Price 10/ 6
No. 5x. Ditto, but with 3 ft. 2 in. Mallets; Head, 5¼ × 2½ in.
Balls 3⅝ in. diameter ... Price 16/ 6
 F.H.AYRES THE WIMBLEDON
LAWS OF CROQUET
F.H.AYRES Ltd THE “WIMBLEDON”
Ayres’ Wimbledon Croquet.
No. 1. Four superior Boxwood Mallets with 3 ft. whipcord
bound cane spliced Octagon Handles 9 in. × 3 in. scored both
ends and black sighting line; four best quality improved paint
protected Boxwood Balls, 3⅝ in. diameter, warranted not
loaded or plugged; ½ in. × 4 in. Davidson’s Patent Hoops; one
pair of “Kenrick” Turning and Winning Posts; 4 Improved Spring
Clips; 4 Corner Flags; 8 Boundary Pegs; 4 Improved Indicating
Discs for indicating position of balls in interrupted games; steel
Hoop Gauge; strong Hammer; Driving Block, iron Drill; Book of
Association Laws; Implements painted regulation colours.
Complete in Strong Box. Price 60/0
Ayres’ Wimbledon Croquet.
No. 7. Four superior Boxwood Mallets with 3 ft. polished
Octagon Handles, heads 9 in. × 3 in. scored ends; four best
quality Boxwood Balls. 3⅝ in. diameter; six enamelled Hoops,
4 in. wide, 20 in. long; one pair regulation Turning and Winning
Posts; improved Drill; strong Hammer; Book. Price 45/0
Gardiner’s “Conqueror” Croquet Ball ... 18/0 set
Slazenger’s “Stadium” Composition Croquet Price 16/6
Balls ... set
Ayres’ Championship Croquet Balls.
F. H. AYRES Ltd
“CHAMPIONSHIP”
LONDON
“The Championship Croquet Balls
have met with the approval of all
who have used them as
approximating most closely to the
play of the Boxwood balls, and as
proving themselves thoroughly
durable under trying conditions.
The greatest possible care is
taken in the special processes of their manufacture to
ensure correct resiliency, gauge and weight as well as
freedom from bias and the danger of the cracking of the
cover. They will be found impervious to wet or sun, and
most lasting and satisfactory in use.” They were used at
the most important Croquet Meetings last season,
including the Open Championships, the Irish Gold
Medal, Champion Cup, Hurlingham, Windlesham,
Hooton Park and elsewhere. Price 21/0
Marking Pins.
Painted in 4 colours, to indicate the position of balls in
interrupted games, set 1/0
 “Excelite” Composition Croquet Balls.
“Excelite” REGd
Every ball perfectly spherical and
true to 3⅝ in. gauge. Sun, wet
and climate have no effect on
them. All one weight. Colours
never knock or chip off. Last long,
play true and greater satisfaction
to players. Price per set of 4 ...
21/0
The New “Tournament” “Excelite” Ball.
Absolutely a perfect ball. These have been specially
tested to meet the requirements of the Croquet
Association. Price 25/0
“Excelite” Practice Ball, 16/0 set.
The Glis-Glos Ball.
As durable as composition, with all the fine playing
qualities of boxwood. The colours will not set off from
one ball to the other or mark the mallets. Set of 4,
match quality, in box, 16/8
The “Whichelo” Wired Ball Tester.
Set containing wire arch, screen, peg and cord, in box
complete, with instructions for use. Set 2/6
 The “Klark” Bisque Recording Croquet Post.
Provisional Patent No. 44/1908.
Advantages: (1) It is not only a record but a reminder of
bisques. (2) It is visible alike to players and spectators.
(3) It prevents the slightest doubt as to how many
bisques have been taken. (4) It does not interfere with
the play. (5) It is especially necessary and convenient at
Tournaments.
each
The “Klark” Bisque Post, in box ... 7/6
Do., with Ordinary Pattern Kenrick Turning per set
Post, in box complete ... 9/6
Croquet Painting Compendium.
Price, with paints, brushes, painting stand. &c., 5/3
Boundary Pegs, per set of 8, 1/3
The “Wimbledon” Boxwood Balls.
“F. H. Ayres” best quality balanced sets, improved paint
protected, painted in four colours and guaranteed to
conform in all particulars with the Laws of the
Association. Used at the Championship Meetings and
the leading Tournaments.
Per set, in card boxes ... 11/6
,, wood boxes, with lock and key ... 13/6
Jaques’ Boxwood Croquet Balls, per set 10/
[416]
 Croquet Hoops.
The “Davidson” Croquet Hoops.
Adopted exclusively as the official
hoop to be used in all the
tournaments held by the Croquet
Association.
3¾ in. wide by ½ in. thick, 20/6 set.
3¾ in. wide by ¾ in. thick, 27/6
3¾ in. wide by ⅝ in. thick, 24/6
4 in. wide by ½ in. thick.
4 ,, ,, ¾ ,,
4 ,, ,, ⅝ ,,
Same prices as above.
Regulation Hoops.
½ in. round iron, 20 in. high, painted. In wooden
box, per set, 5/9
 No. 1. No. 2.
Jaques’ Eclipse Croquet Hoops.
An easy and quick method of setting out a
croquet lawn. When once the sockets are
fixed the hoops may be instantly removed
after play to enable the lawn to be mown
or rolled, while the sockets are left
undisturbed. No. 1 Set. Containing 6
Hoops, 6 pairs No. 1 Sockets, Drill, Gauge
Plate, etc., in wood box, 11/8 set. No. 2
Set. Ditto, but with 6 pairs of No. 2
Sockets, etc. Price 12/11 set. Sockets
only, as No. 1, 7/0 per set.
 The Association Hoops.
The firmest and best fixture yet produced.
This is the most up-to-date pattern of
hoop in existence. The design conforms to
the regulations laid down by the Croquet
Association; there is no projection at the
crown, which is square, and each hoop is
of uniform width from the base upwards.
The flanges on each base being
cruciform, a firm support in all directions
is obtained. They cannot work loose, and
leave no large holes in the lawn when
removed.
Set of 6 regulation ⅝ in. (4 in. gauge)
iron hoops, and manacle hoop grip,
complete in box, 19/0
Mallet Case.

Mail Canvas, and fastened with Leather

Straps. 3/9 each.
 Composition Spring-Clips.
Very light, coloured right throughout,
miniature size. Price per Set of 4, 2/2
Association Clips, small size, painted
Tournament Colours, 1/3 per Set.

F. H. AYRES
The “Kenrick” Starting Posts.
8/9 pair. Ditto, with steel shoes, 4/6 pair.
The Manacle Hoop Grip and Gauge.
Patent applied for. Ensures accuracy.
Saves time. 1/8 each.
Rules of Croquet for 1912, 0/5
Croquet Ball Stand.
In Mahogany or Walnut, with Brass
Fittings to hold 4 Balls and 4 Clips. Price
3/3 each.
Croquet Corner Flags.
In Association Colours ... ... 2/5 set.
 Mallets.

PEEL
JAQUES LONDON
The “Peel” Mallets. Flat Bottom.
No. 1 P. Head 9 × 3 ... ... ... 7/11
,, Ditto, with Brass Sole ... 9/9
,, Ditto, with Brass Sole and Horn Tips at ends 11/9
No. 5 P. Ditto, with Brass Sole and Brass Rings at ends 12/6
Jaques’ “Association.” From finest boxwood, shaft of special
shape and taper handle spliced and bound with whipcord.
No. S G 1A. 8 × 3 in. ... ... each 6/6
,, ,, 3A. 9 ,, 3 ,, ... ... ,, 7/6
 F. H. Ayres’ Make.—Boxwood Head, Polished
Octagonal Handle.
8 × 3 Head ... ... each 5/6
9 × 3 ,, ... ... ,, 6/0
Harrods’ Make. Boxwood Head with Sight-line.
Size of Head, 7½ × 2¾ in. octagon handles each 4/0
,, ,, 8×3 ,, ,, ,, 5/0
,, ,, 9×3 ,, ,, ,, 5/6

F H AYRES Ltd LONDON

 Sabicu Wood Mallet.
Heavy and durable. With 9 × 3 Sabicu head bound with brass
ring, white inlaid sighting line, whalebone spliced and whipcord
bound handle ... ... each 12/6
The “Malacca” Mallet.
This new style of mallet will find favour with those players who
like a mallet with a handle possessing plenty of spring, 9 ×
3 in. each 12/6
The “Barry” Mallet.
Boxwood head, 9 × 3, with sighting line, round
handle, length of shaft, including head, 2 ft. 8 in.
... each 9/6
Ditto, ditto, Lignum Vitæ head, plain handle only,
no sighting line ... each 10/6
The “Roehampton” Mallet. 9 × 3 head, fitted
with metal rings each 10/6
The “Kenrick” Mallet. As used by the well-
known player of that name. The shaft of this
mallet is stiff ... ... ... ... each 10/6
 Juvenile Mallets, 3/0 and 4/6 each.
Croquet Court Marker.
The Queen’s Marker is one of great utility. No
India-rubber bands or parts to perish. The tank is
large, and holds sufficient whitening for a large-
size Tennis Court. The machine is provided with a
scraper for removing all adherence to the
wheels, 13/6
The “Corbally” Mallet.
As used by Mr. Corbally and leading players.
With Boxwood or Lignum Vitæ head
... 10/0
Ditto, ditto, with Brass or Aluminium
Ends... 12/6
The “Ascot” Mallet.
9 × 3 in. ... ... ... ... each 14/6
Croquet Stands.
The “Wimbledon.”
To hold 4 mallets, 4 balls, 4
clips, and turning and
winning posts. In polished
whitewood.
Each, 10/9

The “International”
Carrier Stand.
To hold 4 mallets, 4 balls,
and 4 clips. Superior,
polished oak.
Each, 18/0

The “Carlton” Stand.

This stand is made so that
it occupies a very small
amount of floor space,
while the implements can
be carried in it by one
person. Polished Birch Brass
Fittings.
Price 9/9
 Orders by post
promptly and
accurately executed.

7
Austin’s Self-registering Croquet Target.
A never-ending source of amusement on
a Croquet lawn, by the use of which
players may considerably improve the
accuracy of their shooting.
Price, with ground brackets, complete, 18/4
 Wire Boundary Netting.

The wire netting is supplied with the wire

supports fitted, and need not be removed. These
are easily pressed into the ground with the hand,
consequently the netting can be quickly set up
and packed away after play without leaving any
holes in the lawn. Improved Pattern. Consisting
of 2 each 30-yd. and 37-yd. lengths, 6-in. deep,
with stout wire supports fixed every 6 ft., and
extra stout end supports. Set complete, 47/0
The Eclipse Boundary Netting
Two lengths each of 7 in. Tarred Cord Netting,
fitted with top and bottom straining lines, thumb-
screws at ends, patent holding-down pins and
slides. Four corner ground sockets and
removable uprights, eight removable bracket
arms to carry the wire straining lines. Price,
complete for one full-sized Croquet Court, 47/0
[417]

LAWN BOWLS.
 STANDARD BOWL
JAQUES LONDON
ENGLISH BOWLING ASSOCIATION
Match and Presentation Bowls.
JAQUES.
Accuracy in size and bias guaranteed. Made from
the finest selected Lignum Vitæ. Tested and
officially stamped by an appointed officer of the
leading Association.
 Extra Special Quality.
Made from the heaviest wood of the finest
growth and fitted with extra large Ivory
Mounts, richly ornamental ... ... per pair 17/9
Extra Quality.
Fitted with large Ivory Mounts, richly
ornamented ... per pair 16/0
Special Club Quality.
An excellent Bowl, Ivory mounted, with
plenty of weight, recommended for the
use of experts ... ... ... ... ... per pair 14/0
Lawn Bowl Sundries.
Bowl Bags.
Waterproof Duck ... ... ... 4/9 each.
Waterproof Solid Leather ... ... ... 8/0 ,,
Waterproof Green Leather, lined plush 14/0 ,,
Bowl Boxes, polished mahogany, baize lined.
Brass handle, lock and key, 10/0 each. Laws of
the game, 0/3. China Jacks, 0/10 per pair.
India-rubber Footers, 2/9, 4/6 each. Callipers, 2/3 pair.
Lawn Bowl Measure. 3/6 each.
An excellent Garden Game for Large or Small Lawns.
Complete Sets, containing Bowls made from selected
Lignum Vitæ, Jacks and Rules in Wood Box.

ASSOCIATION REGULATION BOWLS

RULES BOWLS
3 4 4
1 1
3 2 2
The “Tournament” Set.
The “Tournament” Set, containing Four Pairs of 53/16 in.
Match Bowls, Black, with Ivory number plates, each
bowl of standard size, weight and bias, and bearing the
official stamp of the English Bowling Association,
complete with 2 china jacks, and book of laws,
measuring-gauge, in iron-bound case with lock and key.
Price 63/0
 The “Association” Set.
Containing 8 53/16 in. Bowls with Ivory Plates, Association
Pattern, No. 3 Bias, Black, with 2 China Jacks. Price, 47/6
The “Club” Set.
Consisting of 8 Bowls, French polished, 2 Jacks, complete with
rules, in box. Price, 37/6
Bowls in sets of 8 and 2 Jacks complete in Box.
No. 2 (small, for Ladies) bowls, 4 in. ... ... 14/3 per set
,, 3 Bowls, 4½ in. ... ... ... ... 16/6 ,,
,, 4 ,, 5 in. ... ... ... ... 19/9 ,,
,, 5 ,, 5 /16 in. ... ... ... ...
3
24/0 ,,
Ladies’ and Gentlemen’s set (2 each bowls,
,, 7 4¾ in., 5 in., 5⅛ in., 53/16 in.) 24/0 ,,
Bowling Green Shoes. Slip on with Rubber
Soles, 4/6 pair.
2/6, 3/9
Rink Markers with Chalk Holders each.
Scoring Cards 0/2 doz.
Canvas Sheets for covering the ends of
Greens, 9 ft. × 6 ft. ... ... ... 4/0 each.
 Standard Bowl
F. H. AYRES LONDON
ENGLISH BOWLING ASSOCIATION
AYRES’ MAKE.
These Bowls (except Nos. 1 and 2) are guaranteed to
conform in every respect to the laws of the Imperial
Bowling Association, and to have passed the
examination of one of its Official Testers.
Association Bias, but not guaranteed to weight ... 8/8
Ditto, ditto, selected wood and superior finish ... 11/0
Standard size, weight and bias, and bearing the
Official Stamp of the Imperial Bowling
Association ... ... ... 13/0
Ditto, ditto, Medium quality ... 16/0
 Excelite Lawn Bowls.
Guaranteed not to crack or Warp. Absolutely
Waterproof. Unaffected by Climatic Influence. Never
require Oiling. Easily cleaned with damp cloth. These
Bowls conform to all the requirements of the English
Bowling Association, and possess enormous advantages
over the Wood Bowl—the running power being perfect.
Stocked in No. 3 Bias, but any bias can be procured to
order in a few days. The following sizes we can
generally supply from stock:—51/16, 5⅛, 53/16. Per pair,
30/0
Excelite Jacks, 1/6 each.
Taylor’s Celebrated Scotch Bowls.
Made to any bias. Sizes 5 in., 51/16 in., 5⅛ in., 53/16 in.
Third Quality Bowls ... ... ... per pair 10/0
Second ,, ,, ... ... ... ,, 12/0
First ,, ,, ... ... ... ,, 15/0
Extra ,, ,, ... ... ... ,, 19/0
 The Bowler’s Kit Bag.
Reg. No. 594,939.
In Nut Brown Leather, nickel fittings and clips. Double action
lock. Lined waterproof twill. Fitted inside to take pair of Bowls,
Shoes, and has a protecting flap for cap, &c.
Price, 14/6
Do. do. do. to take 2 pairs Bowls, &c. 31/0 each.

Fives Gloves.
Gents or Boys’ Tan, with or without Padded Finger Tips, 4/0 per
pair.
RACQUETS AND FIVES.

Racquet Bats.
Nusser’s make, as used at Princes Club, 13/6, 16/6 Prosser’s
make, 13/9, 15/9

SQUASH BATS.

Squash Racquets. 7/0, 8/9, 12/6 each.

Fives Balls.
Rugby, best quality ... per gross 37/6
Eton ... ... ... ... ... ,, 52/6
Racquet Balls.
Best Quality (Prosser’s) ... ... per gross 31/0