BATES' GUIDE TO PHYSICAL
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Foundational
Skills Essential to the Clinical Encounter
Stem
A 68-year-old man with multi-morbid chronic disease arrives for
a routine visit and appears fatigued and distracted. You have 15
minutes remaining in a clinic slot and a long checklist to
complete. Which approach best balances rapport-building,
problem prioritization, and efficient data gathering?
Options
A. Use a structured checklist to gather complete systems review
,first, deferring rapport to the closing.
B. Begin with an open-ended question about the patient’s main
concern, briefly summarize priorities, then target focused
history and focused exam.
C. Immediately perform a focused physical exam and then ask
brief yes/no questions to complete the history.
D. Delegate history gathering to nursing staff and proceed with
full physical exam while patient waits.
Correct Answer
B
Rationales
Correct: Bates emphasizes initiating with open-ended questions
to elicit concerns, then negotiating priorities and focusing exam
— this preserves rapport and yields the highest-value data in
limited time. It fits patient-centered care and efficient
reasoning.
A: A checklist-first approach risks missing the patient’s agenda
and harms rapport; Bates recommends beginning with patient
concerns.
C: Exam before eliciting narrative misses contextual cues and
may lead to irrelevant testing; Bates prioritizes history first.
D: Delegation can miss subtle clues and violates the clinician’s
responsibility to establish rapport and trust.
Teaching Point
Begin with open-ended concerns, negotiate priorities, then
focus history/exam.
,Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Structure and Sequence of the Clinical Encounter —
Stage 1: Initiating the Encounter
Stem
A 32-year-old woman appears anxious and avoids eye contact
when you enter. She’s accompanied by her mother. Before
asking clinical questions, what is the highest-priority initial
action to ensure an effective, ethical encounter?
Options
A. Start with clinical questions; the presence of a family
member saves time.
B. Privately confirm patient’s preference for the mother’s
presence and explain confidentiality and roles.
C. Ask the mother to leave immediately without explanation.
D. Assume consent for mother to remain since she
accompanied the patient.
Correct Answer
B
, Rationales
Correct: Bates stresses initiating the encounter by clarifying
roles, confirming confidentiality, and obtaining permission for
third-party presence — this protects autonomy and builds trust.
A: Jumping into clinical questions with a third party risks
breaching confidentiality and misses patient preference.
C: Forcing immediate removal is disrespectful and can increase
anxiety; negotiation is recommended.
D: Assumption of consent violates ethical standards and Bates’
guidance on informed participation.
Teaching Point
Always confirm presence/permission for third parties and
explain confidentiality.
Citation
Bickley et al. (2021). Ch. 1.
3
Reference
Ch. 1 — Structure and Sequence of the Clinical Encounter —
Stage 2: Gathering Information
Stem
A 45-year-old presents with intermittent chest discomfort. You
obtain a focused history but the patient minimizes smoking
history. Which technique best uncovers accurate social history
relevant to cardiovascular risk?
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Foundational
Skills Essential to the Clinical Encounter
Stem
A 68-year-old man with multi-morbid chronic disease arrives for
a routine visit and appears fatigued and distracted. You have 15
minutes remaining in a clinic slot and a long checklist to
complete. Which approach best balances rapport-building,
problem prioritization, and efficient data gathering?
Options
A. Use a structured checklist to gather complete systems review
,first, deferring rapport to the closing.
B. Begin with an open-ended question about the patient’s main
concern, briefly summarize priorities, then target focused
history and focused exam.
C. Immediately perform a focused physical exam and then ask
brief yes/no questions to complete the history.
D. Delegate history gathering to nursing staff and proceed with
full physical exam while patient waits.
Correct Answer
B
Rationales
Correct: Bates emphasizes initiating with open-ended questions
to elicit concerns, then negotiating priorities and focusing exam
— this preserves rapport and yields the highest-value data in
limited time. It fits patient-centered care and efficient
reasoning.
A: A checklist-first approach risks missing the patient’s agenda
and harms rapport; Bates recommends beginning with patient
concerns.
C: Exam before eliciting narrative misses contextual cues and
may lead to irrelevant testing; Bates prioritizes history first.
D: Delegation can miss subtle clues and violates the clinician’s
responsibility to establish rapport and trust.
Teaching Point
Begin with open-ended concerns, negotiate priorities, then
focus history/exam.
,Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Structure and Sequence of the Clinical Encounter —
Stage 1: Initiating the Encounter
Stem
A 32-year-old woman appears anxious and avoids eye contact
when you enter. She’s accompanied by her mother. Before
asking clinical questions, what is the highest-priority initial
action to ensure an effective, ethical encounter?
Options
A. Start with clinical questions; the presence of a family
member saves time.
B. Privately confirm patient’s preference for the mother’s
presence and explain confidentiality and roles.
C. Ask the mother to leave immediately without explanation.
D. Assume consent for mother to remain since she
accompanied the patient.
Correct Answer
B
, Rationales
Correct: Bates stresses initiating the encounter by clarifying
roles, confirming confidentiality, and obtaining permission for
third-party presence — this protects autonomy and builds trust.
A: Jumping into clinical questions with a third party risks
breaching confidentiality and misses patient preference.
C: Forcing immediate removal is disrespectful and can increase
anxiety; negotiation is recommended.
D: Assumption of consent violates ethical standards and Bates’
guidance on informed participation.
Teaching Point
Always confirm presence/permission for third parties and
explain confidentiality.
Citation
Bickley et al. (2021). Ch. 1.
3
Reference
Ch. 1 — Structure and Sequence of the Clinical Encounter —
Stage 2: Gathering Information
Stem
A 45-year-old presents with intermittent chest discomfort. You
obtain a focused history but the patient minimizes smoking
history. Which technique best uncovers accurate social history
relevant to cardiovascular risk?
