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 —
Structure and Sequence of the Clinical Encounter: Stage 1:
Initiating the Encounter
Stem: A 62-year-old male with COPD arrives for a routine
follow-up. You note he looks anxious as you enter. During the
first 60 seconds you must decide how to open the encounter.
Which of the following opening strategies best balances rapport
building and efficient information gathering for this patient with
chronic disease and possible health literacy limitations?
,A. Begin with, “Tell me why you came in today,” and wait
silently for his answer.
B. Say, “I know you have COPD — I’ll ask some specific
questions about breathing first, then other issues,” and begin
structured questioning.
C. Use closed questions such as, “Are you short of breath
today?” repeatedly to save time.
D. Start with a full review of systems checklist before asking
about his chief concern.
Correct Answer: B
Rationale — Correct (B):
Bates emphasizes initiating the encounter with a brief orienting
statement, setting an agenda and explaining the plan. This
approach builds rapport, reduces anxiety, and clarifies priorities
while accommodating limited health literacy. It balances
patient-centeredness with efficient data gathering.
Rationale — Incorrect (A):
Open invitation alone may be appropriate, but waiting silently
without orienting statements can increase anxiety and produce
unfocused answers in older patients with chronic disease.
Rationale — Incorrect (C):
Repeated closed questions risk missing context and reduce
rapport; Bates recommends a mix of open and focused
questions.
,Rationale — Incorrect (D):
Starting with a full ROS is inefficient and may frustrate patients;
Bates advises prioritizing the chief concerns first.
Teaching Point:
Start with a concise agenda statement—clarify plan, set
priorities, and build rapport.
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: Stage 2: Gathering Information
Stem: A 29-year-old woman presents with intermittent
palpitations. You already know from triage that she is anxious.
Which probing strategy best follows Bates’ recommendations to
elicit a reliable history while minimizing bias introduced by your
prior knowledge?
A. Ask, “You were anxious in triage; are your palpitations
related to anxiety?”
B. Start with an open question: “Can you tell me about the
palpitations from when they started?” then explore triggers.
C. Rely on triage note and document anxiety as the cause
, without further questions.
D. Immediately perform an ECG to avoid leading the history.
Correct Answer: B
Rationale — Correct (B):
Bates recommends beginning with open-ended questions to
allow the patient’s narrative before focusing—this reduces
confirmation bias from prior notes. It elicits context, timing, and
associated symptoms essential for differential diagnosis.
Rationale — Incorrect (A):
Linking triage observation in the stem risks anchoring and may
lead the patient to confirm anxiety as cause, limiting diagnostic
exploration.
Rationale — Incorrect (C):
Documenting without further inquiry violates Bates’ guidance
to verify and expand initial information.
Rationale — Incorrect (D):
ECG can be appropriate but should not replace a focused,
unbiased history; tests should follow clinical reasoning.
Teaching Point:
Begin with open narrative, then focus to avoid anchoring and
build a thorough timeline.
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 —
Structure and Sequence of the Clinical Encounter: Stage 1:
Initiating the Encounter
Stem: A 62-year-old male with COPD arrives for a routine
follow-up. You note he looks anxious as you enter. During the
first 60 seconds you must decide how to open the encounter.
Which of the following opening strategies best balances rapport
building and efficient information gathering for this patient with
chronic disease and possible health literacy limitations?
,A. Begin with, “Tell me why you came in today,” and wait
silently for his answer.
B. Say, “I know you have COPD — I’ll ask some specific
questions about breathing first, then other issues,” and begin
structured questioning.
C. Use closed questions such as, “Are you short of breath
today?” repeatedly to save time.
D. Start with a full review of systems checklist before asking
about his chief concern.
Correct Answer: B
Rationale — Correct (B):
Bates emphasizes initiating the encounter with a brief orienting
statement, setting an agenda and explaining the plan. This
approach builds rapport, reduces anxiety, and clarifies priorities
while accommodating limited health literacy. It balances
patient-centeredness with efficient data gathering.
Rationale — Incorrect (A):
Open invitation alone may be appropriate, but waiting silently
without orienting statements can increase anxiety and produce
unfocused answers in older patients with chronic disease.
Rationale — Incorrect (C):
Repeated closed questions risk missing context and reduce
rapport; Bates recommends a mix of open and focused
questions.
,Rationale — Incorrect (D):
Starting with a full ROS is inefficient and may frustrate patients;
Bates advises prioritizing the chief concerns first.
Teaching Point:
Start with a concise agenda statement—clarify plan, set
priorities, and build rapport.
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: Stage 2: Gathering Information
Stem: A 29-year-old woman presents with intermittent
palpitations. You already know from triage that she is anxious.
Which probing strategy best follows Bates’ recommendations to
elicit a reliable history while minimizing bias introduced by your
prior knowledge?
A. Ask, “You were anxious in triage; are your palpitations
related to anxiety?”
B. Start with an open question: “Can you tell me about the
palpitations from when they started?” then explore triggers.
C. Rely on triage note and document anxiety as the cause
, without further questions.
D. Immediately perform an ECG to avoid leading the history.
Correct Answer: B
Rationale — Correct (B):
Bates recommends beginning with open-ended questions to
allow the patient’s narrative before focusing—this reduces
confirmation bias from prior notes. It elicits context, timing, and
associated symptoms essential for differential diagnosis.
Rationale — Incorrect (A):
Linking triage observation in the stem risks anchoring and may
lead the patient to confirm anxiety as cause, limiting diagnostic
exploration.
Rationale — Incorrect (C):
Documenting without further inquiry violates Bates’ guidance
to verify and expand initial information.
Rationale — Incorrect (D):
ECG can be appropriate but should not replace a focused,
unbiased history; tests should follow clinical reasoning.
Teaching Point:
Begin with open narrative, then focus to avoid anchoring and
build a thorough timeline.
Citation:
Bickley et al. (2021). Ch. 1.
