,Chapter 01: The History and Interviewing Process
n n n n n n
Ball: Seidel’s Guide to Physical Examination, 9th Edition
n n n n n n n
MULTIPLEnCHOICE
1. Whichnquestionnwouldnbenconsiderednan“leadingnquestion?”
a. “Pleasendescribenanynassociatednsymptomsnwithnyournheadaches?”
b. “Youndon'tn getn headachesnoften,ndon you?”
c. “Whatnactivitiesnaffectnthenseveritynofnyournheadaches?”
d. “Whatntimesnofnthendaynarenyournheadachesnthenmostnsevere?”
e. “Whatnworriesnyounmostnaboutnyournheadache?”
ANS:n B
Thisnquestionnwouldnlimitntheninformationninnthenpatient'snanswer.nThenothernchoicesnallownthenpati
entnmorendiscretionnaboutnthenextentnofnannanswer.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
2. Whichnactionnwouldnbestnpromotenaccuratentranslationsnasnwellnasnconfidentialitynwhennthenc
aregiverndoesnnotnspeaknthenpatient'snlanguage?
a. Asknanpersonnunfamiliarnwithnthenpatientntontranslate.
b. Havenanfriendnofnthenpatientntranslate.
c. Asknsimplenleadingnquestionsnthatnthenpatientnmaynunderstand.
d. Usenanneighbornasntranslator.
e. Involventhenfamilynwithnthentranslation.
ANS:n A
Whennyoundonnotnspeaknthenpatient'snlanguage,nfamilynmembersnornfriendsnmaynposenancommun
icationnbarriernandnmaynhavenissuesnofnconfidentiality;nanstrangernasnanninterpreternisnlessnbiased.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
3. Periodsnofnsilencenduringntheninterviewncannservenimportantnpurposes,nsuchnas:
a. allowingnthenclinicianntoncatchnupnonndocumentation.
b. givingnyounancluenthatnyounshouldnspeednupntheninterview.
c. providingntimenfornreflection.
d. increasingnthenlengthnofnthenvisit.
e. promotingnancalmnenvironment.
ANS:n C
Silencenisnanusefulntoolnduringninterviewsnfornthenpurposesnofnreflection,nsummoningnofncourage
,nandndisplayingncompassion.nItnisnusuallynancluenfornyountongonslowernandnnotntonpushntoonhard.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
4. Whichntechniquenisnmostn likelyntonresultninnthenpatient'snunderstandingnofnquestions?
a. Usenphrasesnthatnarencommonlynusednbynothernpatientsninnthenarea.
b. Usenthen patient'sn ownn termsn ifn possible.
, c. Usenlanguagenthatnkeepsnthenpatientnfromnbeingnexpansiveninnhisnornhernanswer.
d. Usenpropernmedicalnandntechnicalnterminology.
e. Usenthensimplestnlanguagenpossible.
ANS:n B
Tonensurenthatnyournquestionsnhavenbeenncorrectlynunderstood,nbenclear,nandnexplicitnwhilenusin
gnthenpatient'snidiomnandnlevelnofnunderstanding.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
5. Anpatientnbecomesnrestlessnduringnthenhistorynandnsays,n“Indon'tnhaventimenfornallnofnthisnco
nversation.nI'vengotntongetnbackntonwork.”nYournmostnappropriatenresponsenwouldnbento:
a. stopnusingnopen-endednquestionsnandnbecomenmorendirect.
b. asknanothernopen-endednquestionnandninsistnonnannanswer.
c. asknquestionsnaboutnhisnangernandnmovencloserntonhim.
d. acknowledgenhisnangernandnproceednwithnthenhistorynandnexamination.
e. ignorenhisndispleasurenandnbecomenmorenassertivenaboutngettingnanswers.
ANS:n D
Thisnisnthenonlynanswernthatnresistsnthentendencynfornpatientnmanipulation,npursuesntheninformation,n
andnconfrontsnthenpatient'snanger.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
6. Whennquestioningnanpatientnregardingnalcoholnintake,nshentellsnyounthatnshenisn“onlynansocialnd
rinker.”nWhichninitialnresponsenisnappropriate?
a. “I'mngladnthatn younarenanresponsiblendrinker.”
b. “Manyn peoplen whon aren reN
allyRalcIohoG lic n sBay.tChe yMare n socialn drinkers.”
c. “Whatnamountnandnwhatnkind UnnSof
nNnT
nalcoholndon youndrinkninnanweek?”
d. “Ifnyounonlyndrinknsocially,n younwon'tnneedntonworrynaboutnalwaysnhavingnand
esignatedndriver.”
e. “Donthenothernpeopleninn yournhouseholdnconsumenalcohol?”
ANS:n C
Thisnanswernclarifiesnthenpatient'snownntermnwithoutnaskingnanleadingnquestionnornbeingnjudgmenta
l.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
7. An50-year-
oldnmanncomesntonthenprimaryncarenclinic.nHentellsnyounhenisnworriednbecausenhenhasnhadnseverenc
hestnpainsnfornthenpastn2nweeks.nWhichninitialnhistoryninterviewnquestionnisnmostnappropriate?
a. “Cannyoundescribenthenpain?”
b. “Thenpainndoesn'tn radiatenton yournarm,ndoesnit?”
c. “Haven younbeenntreatednfornanxietynbefore?”
d. “Doesnyournfathernhavenheartndisease?”
e. “Arenthenpainsnworsenafternyouneat?”
ANS:n A
Initially,nannopen-
endednquestionnisnanmorenappropriatenresponse.n“Cannyoundescribenthenpain?”nisnannopen-
endednquestionnthatnoffersncluesntonthenchiefnconcern.
, TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
8. Ms.nA.nstates,n“Mynlifenisnjustntoonpainful.nItnisn'tnworthnit.”nShenappearsndepressed.nWhichnoneno
fnthenfollowingnstatementsnisnthenmostnappropriatencaregivernresponse?
a. “Tryntonthinknaboutnthengoodnthingsninnlife.”
b. “Younshouldn'tnfeelnthatnway;nlooknatnallnthengoodnthingsninn yournlife.”
c. “Youncan'tn meann whatn you'ren saying.”
d. “Ifnyounthinknaboutnit,nnothingnisnworthngettingnthisnupsetnabout.”
e. “Whatninnlifenisncausingn younsuchnpain?”
ANS:n E
Specificnyetnopen-
endednquestionsnarenbestnusednwhennthenpatientnhasnfeelingsnofnlossnofnself-
worthnandndepression.nThenothernresponsesnhurrynthenpatientnandnoffernsuperficialnassura
nce.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
9. Duringnanninterview,nyounhaventhenimpressionnthatnanpatientnmaynbenconsideringnsuicide.n
Whichnactionnisnessential?
a. Immediatelynbeginnproceedingsnfornanninvoluntaryncommitment.
b. Asknwhethernthenpatientnhasnconsiderednself-harm.
c. Asknwhethernthenpatientnwouldnlikentonvisitnanpsychiatrist.
d. Recordnthenimpressionninnthenpatient'snchartnandnrefernthenpatientnforn
hospitalization.
e. Avoidndirectlynconfrontingnthenpatientnregardingn yournimpression.
ANS:n B
IfnyounthinknthenpatientnmaynbNenc R
oUnnS IdnT
s inN e r iGn g nB
su.
icC
ide,Mhenornshenprobablynis.nMentioningnitngivesnper
O
missionntontalknaboutnit.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
10. Younarencollectingnanhistorynfromnann11-year-
oldngirl.nHernmothernisnsittingnnextntonherninnthenexaminationnroom.nWhenncollectingnhistorynfr
omnoldernchildrennornadolescents,ntheynshould:
a. nevernbeninterviewednalonenbecausenthisnmaynalienatenthenparent.
b. benmailednanquestionnaireninnadvancentonavoidnthenneednfornherntontalk.
c. bengivennthenopportunityntonbeninterviewednwithoutnthenparentnatnsomenpoint.
d. benallowedntondirectnthenflownofntheninterview.
e. benignorednwhilenyounaddressnallnquestionsntonthenparent.
ANS:n C
Annoldernchildnshouldnbengivennthenopportunityntongiveninformationndirectly.nThisnenhancesnthenpro
babilitynthatnthenchildnwillnfollownyournadvice.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
11. Whenncommunicatingnwithnoldernchildrennandnteenagers,n younshouldnbensensitiventontheir:
a. parent'snneeds.
b. naturalnurgentoncommunicate.
c. neednfornverbalninstructions.
d. typicalnreluctancentontalk.
n n n n n n
Ball: Seidel’s Guide to Physical Examination, 9th Edition
n n n n n n n
MULTIPLEnCHOICE
1. Whichnquestionnwouldnbenconsiderednan“leadingnquestion?”
a. “Pleasendescribenanynassociatednsymptomsnwithnyournheadaches?”
b. “Youndon'tn getn headachesnoften,ndon you?”
c. “Whatnactivitiesnaffectnthenseveritynofnyournheadaches?”
d. “Whatntimesnofnthendaynarenyournheadachesnthenmostnsevere?”
e. “Whatnworriesnyounmostnaboutnyournheadache?”
ANS:n B
Thisnquestionnwouldnlimitntheninformationninnthenpatient'snanswer.nThenothernchoicesnallownthenpati
entnmorendiscretionnaboutnthenextentnofnannanswer.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
2. Whichnactionnwouldnbestnpromotenaccuratentranslationsnasnwellnasnconfidentialitynwhennthenc
aregiverndoesnnotnspeaknthenpatient'snlanguage?
a. Asknanpersonnunfamiliarnwithnthenpatientntontranslate.
b. Havenanfriendnofnthenpatientntranslate.
c. Asknsimplenleadingnquestionsnthatnthenpatientnmaynunderstand.
d. Usenanneighbornasntranslator.
e. Involventhenfamilynwithnthentranslation.
ANS:n A
Whennyoundonnotnspeaknthenpatient'snlanguage,nfamilynmembersnornfriendsnmaynposenancommun
icationnbarriernandnmaynhavenissuesnofnconfidentiality;nanstrangernasnanninterpreternisnlessnbiased.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
3. Periodsnofnsilencenduringntheninterviewncannservenimportantnpurposes,nsuchnas:
a. allowingnthenclinicianntoncatchnupnonndocumentation.
b. givingnyounancluenthatnyounshouldnspeednupntheninterview.
c. providingntimenfornreflection.
d. increasingnthenlengthnofnthenvisit.
e. promotingnancalmnenvironment.
ANS:n C
Silencenisnanusefulntoolnduringninterviewsnfornthenpurposesnofnreflection,nsummoningnofncourage
,nandndisplayingncompassion.nItnisnusuallynancluenfornyountongonslowernandnnotntonpushntoonhard.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
4. Whichntechniquenisnmostn likelyntonresultninnthenpatient'snunderstandingnofnquestions?
a. Usenphrasesnthatnarencommonlynusednbynothernpatientsninnthenarea.
b. Usenthen patient'sn ownn termsn ifn possible.
, c. Usenlanguagenthatnkeepsnthenpatientnfromnbeingnexpansiveninnhisnornhernanswer.
d. Usenpropernmedicalnandntechnicalnterminology.
e. Usenthensimplestnlanguagenpossible.
ANS:n B
Tonensurenthatnyournquestionsnhavenbeenncorrectlynunderstood,nbenclear,nandnexplicitnwhilenusin
gnthenpatient'snidiomnandnlevelnofnunderstanding.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
5. Anpatientnbecomesnrestlessnduringnthenhistorynandnsays,n“Indon'tnhaventimenfornallnofnthisnco
nversation.nI'vengotntongetnbackntonwork.”nYournmostnappropriatenresponsenwouldnbento:
a. stopnusingnopen-endednquestionsnandnbecomenmorendirect.
b. asknanothernopen-endednquestionnandninsistnonnannanswer.
c. asknquestionsnaboutnhisnangernandnmovencloserntonhim.
d. acknowledgenhisnangernandnproceednwithnthenhistorynandnexamination.
e. ignorenhisndispleasurenandnbecomenmorenassertivenaboutngettingnanswers.
ANS:n D
Thisnisnthenonlynanswernthatnresistsnthentendencynfornpatientnmanipulation,npursuesntheninformation,n
andnconfrontsnthenpatient'snanger.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
6. Whennquestioningnanpatientnregardingnalcoholnintake,nshentellsnyounthatnshenisn“onlynansocialnd
rinker.”nWhichninitialnresponsenisnappropriate?
a. “I'mngladnthatn younarenanresponsiblendrinker.”
b. “Manyn peoplen whon aren reN
allyRalcIohoG lic n sBay.tChe yMare n socialn drinkers.”
c. “Whatnamountnandnwhatnkind UnnSof
nNnT
nalcoholndon youndrinkninnanweek?”
d. “Ifnyounonlyndrinknsocially,n younwon'tnneedntonworrynaboutnalwaysnhavingnand
esignatedndriver.”
e. “Donthenothernpeopleninn yournhouseholdnconsumenalcohol?”
ANS:n C
Thisnanswernclarifiesnthenpatient'snownntermnwithoutnaskingnanleadingnquestionnornbeingnjudgmenta
l.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
7. An50-year-
oldnmanncomesntonthenprimaryncarenclinic.nHentellsnyounhenisnworriednbecausenhenhasnhadnseverenc
hestnpainsnfornthenpastn2nweeks.nWhichninitialnhistoryninterviewnquestionnisnmostnappropriate?
a. “Cannyoundescribenthenpain?”
b. “Thenpainndoesn'tn radiatenton yournarm,ndoesnit?”
c. “Haven younbeenntreatednfornanxietynbefore?”
d. “Doesnyournfathernhavenheartndisease?”
e. “Arenthenpainsnworsenafternyouneat?”
ANS:n A
Initially,nannopen-
endednquestionnisnanmorenappropriatenresponse.n“Cannyoundescribenthenpain?”nisnannopen-
endednquestionnthatnoffersncluesntonthenchiefnconcern.
, TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
8. Ms.nA.nstates,n“Mynlifenisnjustntoonpainful.nItnisn'tnworthnit.”nShenappearsndepressed.nWhichnoneno
fnthenfollowingnstatementsnisnthenmostnappropriatencaregivernresponse?
a. “Tryntonthinknaboutnthengoodnthingsninnlife.”
b. “Younshouldn'tnfeelnthatnway;nlooknatnallnthengoodnthingsninn yournlife.”
c. “Youncan'tn meann whatn you'ren saying.”
d. “Ifnyounthinknaboutnit,nnothingnisnworthngettingnthisnupsetnabout.”
e. “Whatninnlifenisncausingn younsuchnpain?”
ANS:n E
Specificnyetnopen-
endednquestionsnarenbestnusednwhennthenpatientnhasnfeelingsnofnlossnofnself-
worthnandndepression.nThenothernresponsesnhurrynthenpatientnandnoffernsuperficialnassura
nce.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
9. Duringnanninterview,nyounhaventhenimpressionnthatnanpatientnmaynbenconsideringnsuicide.n
Whichnactionnisnessential?
a. Immediatelynbeginnproceedingsnfornanninvoluntaryncommitment.
b. Asknwhethernthenpatientnhasnconsiderednself-harm.
c. Asknwhethernthenpatientnwouldnlikentonvisitnanpsychiatrist.
d. Recordnthenimpressionninnthenpatient'snchartnandnrefernthenpatientnforn
hospitalization.
e. Avoidndirectlynconfrontingnthenpatientnregardingn yournimpression.
ANS:n B
IfnyounthinknthenpatientnmaynbNenc R
oUnnS IdnT
s inN e r iGn g nB
su.
icC
ide,Mhenornshenprobablynis.nMentioningnitngivesnper
O
missionntontalknaboutnit.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
10. Younarencollectingnanhistorynfromnann11-year-
oldngirl.nHernmothernisnsittingnnextntonherninnthenexaminationnroom.nWhenncollectingnhistorynfr
omnoldernchildrennornadolescents,ntheynshould:
a. nevernbeninterviewednalonenbecausenthisnmaynalienatenthenparent.
b. benmailednanquestionnaireninnadvancentonavoidnthenneednfornherntontalk.
c. bengivennthenopportunityntonbeninterviewednwithoutnthenparentnatnsomenpoint.
d. benallowedntondirectnthenflownofntheninterview.
e. benignorednwhilenyounaddressnallnquestionsntonthenparent.
ANS:n C
Annoldernchildnshouldnbengivennthenopportunityntongiveninformationndirectly.nThisnenhancesnthenpro
babilitynthatnthenchildnwillnfollownyournadvice.
TOP:n Discipline:nBehavioralnScience MSC:n OrgannSystem:nGeneral
11. Whenncommunicatingnwithnoldernchildrennandnteenagers,n younshouldnbensensitiventontheir:
a. parent'snneeds.
b. naturalnurgentoncommunicate.
c. neednfornverbalninstructions.
d. typicalnreluctancentontalk.
