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 58-year-old man with poorly controlled diabetes arrives for a
new-patient visit. You notice he avoids eye contact, answers
questions tersely, and frequently glances at his phone. His chart
lists multiple missed appointments. Integrate these
,observations with a focused initial interview to decide the most
likely barrier to effective care.
Options
A. Health literacy limitations interfering with comprehension.
B. Distrust and prior negative healthcare experiences.
C. Active psychiatric illness (major depression) impairing
engagement.
D. Simple time-management problems unrelated to clinical
care.
Correct Answer
B
Rationale — Correct (B)
Bates emphasizes using observational skills plus open-ended
questioning to detect relational barriers; his guarded nonverbal
behavior, missed appointments, and terse responses form a
pattern consistent with distrust rooted in prior negative
experiences. This explains selective engagement rather than
global cognitive or literacy deficits. Addressing trust is central to
establishing a therapeutic relationship.
Rationale — Incorrect
A. Health literacy may cause misunderstanding, but usually
demonstrates specific comprehension gaps rather than guarded
body language and missed visits.
C. Depression can reduce engagement, but the vignette lacks
pervasive mood, anergia, or cognitive symptoms required to
prioritize this diagnosis.
,D. Time-management is plausible but doesn’t explain the
combination of body language, avoidance, and missed
appointments.
Teaching Point
Observe behavior patterns to detect relational barriers like
distrust before assuming literacy or psychiatric causes.
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 — Stage 1: Initiating
the Encounter
Stem
During a complex chronic-care visit, you must obtain consent to
examine an intimate area. The patient appears anxious and asks
for a chaperone. Which approach best aligns with Bates’
recommended initiation of the encounter and professionalism?
Options
A. Decline the chaperone and proceed to maintain privacy and
efficiency.
B. Offer the chaperone and explain their role; proceed only if
patient agrees.
, C. Require a family member as chaperone to reassure the
patient.
D. Postpone the exam to another visit to avoid immediate
discomfort.
Correct Answer
B
Rationale — Correct (B)
Bates recommends initiating encounters by establishing
rapport, explaining the exam, and offering chaperones for
intimate examinations; explaining the chaperone’s role
preserves autonomy and comfort. This respects professionalism
and informed consent standards while allowing the clinical
need to be met.
Rationale — Incorrect
A. Declining a chaperone undermines patient comfort and
violates best practices.
C. Requiring a family member isn’t appropriate; family presence
may breach confidentiality and coercion.
D. Unnecessarily postponing can delay care; only reasonable if
patient prefers to defer.
Teaching Point
Always offer and explain chaperones for intimate exams;
prioritize patient autonomy and comfort.
Citation
Bickley et al. (2021). Ch. 1.
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 58-year-old man with poorly controlled diabetes arrives for a
new-patient visit. You notice he avoids eye contact, answers
questions tersely, and frequently glances at his phone. His chart
lists multiple missed appointments. Integrate these
,observations with a focused initial interview to decide the most
likely barrier to effective care.
Options
A. Health literacy limitations interfering with comprehension.
B. Distrust and prior negative healthcare experiences.
C. Active psychiatric illness (major depression) impairing
engagement.
D. Simple time-management problems unrelated to clinical
care.
Correct Answer
B
Rationale — Correct (B)
Bates emphasizes using observational skills plus open-ended
questioning to detect relational barriers; his guarded nonverbal
behavior, missed appointments, and terse responses form a
pattern consistent with distrust rooted in prior negative
experiences. This explains selective engagement rather than
global cognitive or literacy deficits. Addressing trust is central to
establishing a therapeutic relationship.
Rationale — Incorrect
A. Health literacy may cause misunderstanding, but usually
demonstrates specific comprehension gaps rather than guarded
body language and missed visits.
C. Depression can reduce engagement, but the vignette lacks
pervasive mood, anergia, or cognitive symptoms required to
prioritize this diagnosis.
,D. Time-management is plausible but doesn’t explain the
combination of body language, avoidance, and missed
appointments.
Teaching Point
Observe behavior patterns to detect relational barriers like
distrust before assuming literacy or psychiatric causes.
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 — Stage 1: Initiating
the Encounter
Stem
During a complex chronic-care visit, you must obtain consent to
examine an intimate area. The patient appears anxious and asks
for a chaperone. Which approach best aligns with Bates’
recommended initiation of the encounter and professionalism?
Options
A. Decline the chaperone and proceed to maintain privacy and
efficiency.
B. Offer the chaperone and explain their role; proceed only if
patient agrees.
, C. Require a family member as chaperone to reassure the
patient.
D. Postpone the exam to another visit to avoid immediate
discomfort.
Correct Answer
B
Rationale — Correct (B)
Bates recommends initiating encounters by establishing
rapport, explaining the exam, and offering chaperones for
intimate examinations; explaining the chaperone’s role
preserves autonomy and comfort. This respects professionalism
and informed consent standards while allowing the clinical
need to be met.
Rationale — Incorrect
A. Declining a chaperone undermines patient comfort and
violates best practices.
C. Requiring a family member isn’t appropriate; family presence
may breach confidentiality and coercion.
D. Unnecessarily postponing can delay care; only reasonable if
patient prefers to defer.
Teaching Point
Always offer and explain chaperones for intimate exams;
prioritize patient autonomy and comfort.
Citation
Bickley et al. (2021). Ch. 1.
