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
APRN-Level Question Stem
A 62-year-old man arrives for a new-patient visit. He appears
anxious, avoids eye contact, and gives terse answers. You must
decide how to begin the encounter to optimize information
gathering and rapport while respecting time constraints. Which
initial clinician approach is most consistent with Bates’
recommended foundational skills?
,Options
A. Begin with a focused closed-question history to expedite
identification of urgent problems.
B. Open with a brief, empathetic statement and an open
question about the chief concern.
C. Start the physical exam immediately to signal efficiency and
avoid patient anxiety.
D. Ask the patient to complete a long demographic and social
history form before speaking.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating with rapport, an
empathetic opening, and an open question to elicit the
patient’s agenda and build trust, which improves information
quality and reduces anxiety. This approach balances efficiency
with patient-centeredness and is foundational to the clinical
encounter.
A: Closed questions limit patient narrative and may miss
context; Bates discourages starting with only closed queries for
a new encounter.
C: Beginning with the exam neglects history and rapport; Bates
prioritizes patient story first.
D: Paperwork before interaction may inhibit rapport and misses
the chance to address immediate concerns; Bates recommends
conversational opening.
,Teaching Point
Open, empathetic openings elicit the patient’s agenda and
improve diagnostic yield.
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 — Approach to the Clinical Encounter — STRUCTURE AND
SEQUENCE OF THE CLINICAL ENCOUNTER
APRN-Level Question Stem
During a busy clinic, a patient presents with multiple
complaints: fatigue, intermittent chest discomfort, and difficulty
sleeping. You must structure the visit. According to Bates’
recommended sequence, which strategy best balances
thoroughness with efficiency?
Options
A. Triage immediate red-flag complaints first, then request a
complete review of systems before the exam.
B. Allow the patient to narrate freely without redirection until
they stop, then perform the physical exam.
C. Elicit the patient’s chief concerns, identify urgent issues,
gather focused history, then perform exam.
, D. Perform a full head-to-toe exam first to avoid missing
physical findings, then ask about symptoms.
Correct Answer
C
Rationales
Correct (C): Bates recommends a structured sequence: initiate,
gather information (with priority to urgent problems), perform
focused physical examination, then explain and plan. This
approach addresses red flags while remaining efficient.
A: While triaging red flags is essential, requesting a complete
ROS before prioritizing may waste time and increase burden.
B: Unstructured narration can be valuable but may be
inefficient and fail to prioritize urgent symptoms early.
D: Exam before history can miss key contextual clues; Bates
favors history-first sequencing.
Teaching Point
Elicit concerns, prioritize red flags, then gather focused history
before the exam.
Citation
Bickley et al. (2021). Bates’ Guide to Physical Examination &
History Taking (13th Ed.). Ch. 1.
3
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
APRN-Level Question Stem
A 62-year-old man arrives for a new-patient visit. He appears
anxious, avoids eye contact, and gives terse answers. You must
decide how to begin the encounter to optimize information
gathering and rapport while respecting time constraints. Which
initial clinician approach is most consistent with Bates’
recommended foundational skills?
,Options
A. Begin with a focused closed-question history to expedite
identification of urgent problems.
B. Open with a brief, empathetic statement and an open
question about the chief concern.
C. Start the physical exam immediately to signal efficiency and
avoid patient anxiety.
D. Ask the patient to complete a long demographic and social
history form before speaking.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating with rapport, an
empathetic opening, and an open question to elicit the
patient’s agenda and build trust, which improves information
quality and reduces anxiety. This approach balances efficiency
with patient-centeredness and is foundational to the clinical
encounter.
A: Closed questions limit patient narrative and may miss
context; Bates discourages starting with only closed queries for
a new encounter.
C: Beginning with the exam neglects history and rapport; Bates
prioritizes patient story first.
D: Paperwork before interaction may inhibit rapport and misses
the chance to address immediate concerns; Bates recommends
conversational opening.
,Teaching Point
Open, empathetic openings elicit the patient’s agenda and
improve diagnostic yield.
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 — Approach to the Clinical Encounter — STRUCTURE AND
SEQUENCE OF THE CLINICAL ENCOUNTER
APRN-Level Question Stem
During a busy clinic, a patient presents with multiple
complaints: fatigue, intermittent chest discomfort, and difficulty
sleeping. You must structure the visit. According to Bates’
recommended sequence, which strategy best balances
thoroughness with efficiency?
Options
A. Triage immediate red-flag complaints first, then request a
complete review of systems before the exam.
B. Allow the patient to narrate freely without redirection until
they stop, then perform the physical exam.
C. Elicit the patient’s chief concerns, identify urgent issues,
gather focused history, then perform exam.
, D. Perform a full head-to-toe exam first to avoid missing
physical findings, then ask about symptoms.
Correct Answer
C
Rationales
Correct (C): Bates recommends a structured sequence: initiate,
gather information (with priority to urgent problems), perform
focused physical examination, then explain and plan. This
approach addresses red flags while remaining efficient.
A: While triaging red flags is essential, requesting a complete
ROS before prioritizing may waste time and increase burden.
B: Unstructured narration can be valuable but may be
inefficient and fail to prioritize urgent symptoms early.
D: Exam before history can miss key contextual clues; Bates
favors history-first sequencing.
Teaching Point
Elicit concerns, prioritize red flags, then gather focused history
before the exam.
Citation
Bickley et al. (2021). Bates’ Guide to Physical Examination &
History Taking (13th Ed.). Ch. 1.
3
