Bates' Advanced Health Assessment
Chapters 1-4, & 7 (Health History, HEENT)
For which of the following patients would a comprehensive health history be appropriate? -
ANSA new patient with the chief complaint of "I am here to establish care"
comprehensive assessment - ANSall the elements of the health history and the complete
physical examination
focused or problem-oriented assessment - ANSfor patients that you know well that are returning
for routine office care or for patients with specific "urgent care" concerns
subjective data - ANSwhat the patient tells you
objective data - ANSwhat you detect during the examination. All physical examination findings.
Name the components of the health history. - ANSReview of systems, present illness, personal
and social items.
Also: identifying data and source of the history; reliability, chief complaints, present illness, past
history, family history, personal and social history, review of systems.
Is the following information subjective or objective?
Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity
and relieved by rest - ANSSubjective
Is the following information subjective or objective?
Mr. M. has a respiratory rate of 32 and a pulse rate of 120 - ANSObjective
seven attributes of a symptom - ANS1. Location
2. Quality
3. Quantity or severity
4. Timing (including onset, duration, and frequency)
5. The setting in which it occurs
6. factors that have aggravated or relieved the symptom
7. associated manifestations
The following information is recorded in the health history: "The patient has had abdominal pain
for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on
a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric
area."
,Which of these categories does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSpresent illness
The following information is recorded in the health history: "The patient completed 8th grade. He
currently lives with his wife and two children. He works on old cars on the weekend. He works in
a glass factory during the week."
Which category does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSpersonal and social history
The following information is recorded in the health history: "I feel really tired."
Which category does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSchief complaint
The following information is recorded in the health history: "Patient denies chest pain,
palpitations, orthopnea, and paroxysmal nocturnal dyspnea."
Which category does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSreview of systems
The following information is best placed in which category?
"The patient has had three cesarean sections."
Adult illness
Surgeries
Obstetric/gynecology
psychiatric - ANSSurgeries
The following information is best placed in which category?
"The patient had a stent placed in the left anterior descending artery (LAD) in 1999."
Adult illness
Surgeries
Obstetric/gynecology
psychiatric - ANSAdult illness
, The following information is best placed in which category?
"The patient was treated for an asthma exacerbation in the hospital last year; the patient has
never been intubated."
Adult illness
Surgeries
Obstetric/gynecology
psychiatric - ANSAdult illness
inspection - ANSclose observation of the details of the patient's appearance, behavior, and
movement such as facial expression, mood, body habitus and conditioning, skin conditions such
as petechiae or ecchymoses, eye movements, pharyngeal color, symmetry of the thorax, height
of jugular venous pulsations, abdominal contour, lower extremity edema, and gait.
palpation - ANStactile pressure from the palmar fingers or fingerpads to assess areas of skin
elevation, depression, warmth, or tenderness, lymph nodes, pulses, contours and sizes of
organs and masses, and crepitus in the joints.
Percussion - ANSuse of the striking or plexor finger, usually the third, to deliver a rapid tap or
blow against the distal pleximeter finger, usually the distal third finger of the left hand laid
against the surface of the chest or abdomen, to evoke a sound wave such as resonance or
dullness from the underlying tissue or organs. This sound wave also generates a tactile
vibration against the pleximeter finger.
auscultation - ANSuse of the diaphragm and bell of the stethoscope to detect the characteristics
of heart, lung, and bowel sounds, including location, timing, duration, pitch, and intensity. For the
heart, this involves sounds from closing of the four valves and flow into the ventricles as well as
murmurs. Auscultation also permits detection of bruits or turbulence over arterial vessels.
A patient presents for evaluation of a sharp, aching chest pain which increases with breathing.
Which anatomic area would you localize the symptom to?
Musculoskeletal
Reproductive
Urinary
Endocrine - ANSChest pain may be due to a musculoskeletal condition, such as
costochondritis or intercostal muscle cramp. This would be worsened by motion of the chest
wall. Pleuritic chest pain is also a sharp chest pain which increases with a deep breath. This
type of pain can occur with inflammation of the pleura from pneumonia or other conditions and
pulmonary embolus.
A patient comes to the emergency room for evaluation of shortness of breath. To which
anatomic region would you assign the symptom?
Reproductive
Urinary
Cardiac
Chapters 1-4, & 7 (Health History, HEENT)
For which of the following patients would a comprehensive health history be appropriate? -
ANSA new patient with the chief complaint of "I am here to establish care"
comprehensive assessment - ANSall the elements of the health history and the complete
physical examination
focused or problem-oriented assessment - ANSfor patients that you know well that are returning
for routine office care or for patients with specific "urgent care" concerns
subjective data - ANSwhat the patient tells you
objective data - ANSwhat you detect during the examination. All physical examination findings.
Name the components of the health history. - ANSReview of systems, present illness, personal
and social items.
Also: identifying data and source of the history; reliability, chief complaints, present illness, past
history, family history, personal and social history, review of systems.
Is the following information subjective or objective?
Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity
and relieved by rest - ANSSubjective
Is the following information subjective or objective?
Mr. M. has a respiratory rate of 32 and a pulse rate of 120 - ANSObjective
seven attributes of a symptom - ANS1. Location
2. Quality
3. Quantity or severity
4. Timing (including onset, duration, and frequency)
5. The setting in which it occurs
6. factors that have aggravated or relieved the symptom
7. associated manifestations
The following information is recorded in the health history: "The patient has had abdominal pain
for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on
a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric
area."
,Which of these categories does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSpresent illness
The following information is recorded in the health history: "The patient completed 8th grade. He
currently lives with his wife and two children. He works on old cars on the weekend. He works in
a glass factory during the week."
Which category does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSpersonal and social history
The following information is recorded in the health history: "I feel really tired."
Which category does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSchief complaint
The following information is recorded in the health history: "Patient denies chest pain,
palpitations, orthopnea, and paroxysmal nocturnal dyspnea."
Which category does it belong to?
Present illness
chief complaint
personal and social history
review of systems - ANSreview of systems
The following information is best placed in which category?
"The patient has had three cesarean sections."
Adult illness
Surgeries
Obstetric/gynecology
psychiatric - ANSSurgeries
The following information is best placed in which category?
"The patient had a stent placed in the left anterior descending artery (LAD) in 1999."
Adult illness
Surgeries
Obstetric/gynecology
psychiatric - ANSAdult illness
, The following information is best placed in which category?
"The patient was treated for an asthma exacerbation in the hospital last year; the patient has
never been intubated."
Adult illness
Surgeries
Obstetric/gynecology
psychiatric - ANSAdult illness
inspection - ANSclose observation of the details of the patient's appearance, behavior, and
movement such as facial expression, mood, body habitus and conditioning, skin conditions such
as petechiae or ecchymoses, eye movements, pharyngeal color, symmetry of the thorax, height
of jugular venous pulsations, abdominal contour, lower extremity edema, and gait.
palpation - ANStactile pressure from the palmar fingers or fingerpads to assess areas of skin
elevation, depression, warmth, or tenderness, lymph nodes, pulses, contours and sizes of
organs and masses, and crepitus in the joints.
Percussion - ANSuse of the striking or plexor finger, usually the third, to deliver a rapid tap or
blow against the distal pleximeter finger, usually the distal third finger of the left hand laid
against the surface of the chest or abdomen, to evoke a sound wave such as resonance or
dullness from the underlying tissue or organs. This sound wave also generates a tactile
vibration against the pleximeter finger.
auscultation - ANSuse of the diaphragm and bell of the stethoscope to detect the characteristics
of heart, lung, and bowel sounds, including location, timing, duration, pitch, and intensity. For the
heart, this involves sounds from closing of the four valves and flow into the ventricles as well as
murmurs. Auscultation also permits detection of bruits or turbulence over arterial vessels.
A patient presents for evaluation of a sharp, aching chest pain which increases with breathing.
Which anatomic area would you localize the symptom to?
Musculoskeletal
Reproductive
Urinary
Endocrine - ANSChest pain may be due to a musculoskeletal condition, such as
costochondritis or intercostal muscle cramp. This would be worsened by motion of the chest
wall. Pleuritic chest pain is also a sharp chest pain which increases with a deep breath. This
type of pain can occur with inflammation of the pleura from pneumonia or other conditions and
pulmonary embolus.
A patient comes to the emergency room for evaluation of shortness of breath. To which
anatomic region would you assign the symptom?
Reproductive
Urinary
Cardiac
