PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
Q1
Reference
Ch. 1 — Evidence-Based Assessment — Family History &
Pedigree
Stem
A 28-year-old woman presents for a preconception visit. She
reports her mother was diagnosed with early-onset coronary
artery disease at age 46 and an uncle died of a myocardial
infarction at 50. Her blood pressure and lipids are normal today.
You record a three-generation family history. Which
interpretation most accurately guides next steps?
Page 1 of 986
,Options
A. Her normal current labs rule out inherited cardiovascular
risk; routine health maintenance is sufficient.
B. Family history suggests familial premature coronary disease;
recommend early, periodic lipid screening and lifestyle risk
counseling.
C. Because only female relatives are affected, this is likely X-
linked and needs referral for genetic testing immediately.
D. The family history implies environmental causes only; advise
avoiding secondhand smoke and no genetic referral is needed.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes three-generation family histories
to detect patterns of premature disease. Early-onset coronary
disease in first- and second-degree relatives raises pretest
probability for familial risk, supporting earlier/lifelong screening
and preventive counseling. This is an evidence-based, safety-
focused plan.
Incorrect (A): Single normal labs do not exclude inherited risk;
family history can precede clinical expression and requires
tailored surveillance per Jarvis.
Incorrect (C): The pedigree shows both sexes affected (mother,
uncle); this is inconsistent with X-linked inheritance. Immediate
genetic testing without counseling is premature.
Incorrect (D): Environmental contributors matter, but familial
Page 2 of 986
,clustering of early-onset disease suggests possible genetic
predisposition; dismissing genetics risks missed prevention.
Teaching point
Three-generation pedigree identifies premature disease—start
earlier screening and preventive counseling.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Q2
Reference
Ch. 1 — Evidence-Based Assessment — Genetic Risk
Assessment & Counseling
Stem
A 35-year-old man with a sister recently diagnosed with
colorectal cancer at 44 asks if he needs colonoscopy now. He
has no symptoms. His family history includes the affected sister
and a paternal grandfather with colon cancer at 73. What is the
safest, evidence-based recommendation?
Options
A. Begin colonoscopy screening immediately and repeat every
1–2 years given family history.
B. No earlier screening needed; follow average-risk guidelines
and start at age 45–50.
C. Recommend genetic counseling and possibly testing; if no
Page 3 of 986
, identified hereditary syndrome, start colonoscopy 10 years
earlier than youngest affected relative.
D. Order a stool DNA test only; colonoscopy only if the stool
DNA is positive.
Correct answer
C
Rationales
Correct (C): Jarvis stresses that clustering at young ages
warrants genetic counseling to evaluate for hereditary
syndromes (e.g., Lynch). If no syndrome, many guideline
frameworks advise starting colonoscopy approximately 10 years
before the youngest diagnosis in the family. This balances risk
and resource use.
Incorrect (A): Immediate frequent colonoscopy without
counseling/testing may be unnecessary and not evidence-
based.
Incorrect (B): Family history of early-onset colorectal cancer
increases risk; average-risk timing is inadequate.
Incorrect (D): Stool DNA may be useful in screening populations
but is not a substitute when early family history raises concern;
colonoscopy and genetic counseling take priority.
Teaching point
For early familial cancer, refer for genetic counseling; tailor
screening to youngest affected relative.
Page 4 of 986
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
Q1
Reference
Ch. 1 — Evidence-Based Assessment — Family History &
Pedigree
Stem
A 28-year-old woman presents for a preconception visit. She
reports her mother was diagnosed with early-onset coronary
artery disease at age 46 and an uncle died of a myocardial
infarction at 50. Her blood pressure and lipids are normal today.
You record a three-generation family history. Which
interpretation most accurately guides next steps?
Page 1 of 986
,Options
A. Her normal current labs rule out inherited cardiovascular
risk; routine health maintenance is sufficient.
B. Family history suggests familial premature coronary disease;
recommend early, periodic lipid screening and lifestyle risk
counseling.
C. Because only female relatives are affected, this is likely X-
linked and needs referral for genetic testing immediately.
D. The family history implies environmental causes only; advise
avoiding secondhand smoke and no genetic referral is needed.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes three-generation family histories
to detect patterns of premature disease. Early-onset coronary
disease in first- and second-degree relatives raises pretest
probability for familial risk, supporting earlier/lifelong screening
and preventive counseling. This is an evidence-based, safety-
focused plan.
Incorrect (A): Single normal labs do not exclude inherited risk;
family history can precede clinical expression and requires
tailored surveillance per Jarvis.
Incorrect (C): The pedigree shows both sexes affected (mother,
uncle); this is inconsistent with X-linked inheritance. Immediate
genetic testing without counseling is premature.
Incorrect (D): Environmental contributors matter, but familial
Page 2 of 986
,clustering of early-onset disease suggests possible genetic
predisposition; dismissing genetics risks missed prevention.
Teaching point
Three-generation pedigree identifies premature disease—start
earlier screening and preventive counseling.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Q2
Reference
Ch. 1 — Evidence-Based Assessment — Genetic Risk
Assessment & Counseling
Stem
A 35-year-old man with a sister recently diagnosed with
colorectal cancer at 44 asks if he needs colonoscopy now. He
has no symptoms. His family history includes the affected sister
and a paternal grandfather with colon cancer at 73. What is the
safest, evidence-based recommendation?
Options
A. Begin colonoscopy screening immediately and repeat every
1–2 years given family history.
B. No earlier screening needed; follow average-risk guidelines
and start at age 45–50.
C. Recommend genetic counseling and possibly testing; if no
Page 3 of 986
, identified hereditary syndrome, start colonoscopy 10 years
earlier than youngest affected relative.
D. Order a stool DNA test only; colonoscopy only if the stool
DNA is positive.
Correct answer
C
Rationales
Correct (C): Jarvis stresses that clustering at young ages
warrants genetic counseling to evaluate for hereditary
syndromes (e.g., Lynch). If no syndrome, many guideline
frameworks advise starting colonoscopy approximately 10 years
before the youngest diagnosis in the family. This balances risk
and resource use.
Incorrect (A): Immediate frequent colonoscopy without
counseling/testing may be unnecessary and not evidence-
based.
Incorrect (B): Family history of early-onset colorectal cancer
increases risk; average-risk timing is inadequate.
Incorrect (D): Stool DNA may be useful in screening populations
but is not a substitute when early family history raises concern;
colonoscopy and genetic counseling take priority.
Teaching point
For early familial cancer, refer for genetic counseling; tailor
screening to youngest affected relative.
Page 4 of 986
