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 — Stage 1: Initiating
the Encounter
Stem
A 62-year-old woman arrives for a new-patient visit complaining
of “tiredness.” You have 15 minutes; she looks anxious and
avoids eye contact. Her chart lists English as a second language
and a hearing impairment. Which initial approach most aligns
with Bates’ recommended technique to establish rapport and
collect accurate history?
,A. Begin with closed yes/no questions to save time and rely on
the chart for details.
B. Use open-ended questions, ensure appropriate
accommodations (interpreter/hearing aids), and allow silence
for patient responses.
C. Ask family to summarize the chief complaint to expedite the
visit.
D. Start the physical exam immediately to observe nonverbal
cues before history.
Correct Answer
B
Rationale — Correct
Bates emphasizes initiating the encounter with patient-centered
open-ended questions to elicit the patient’s narrative. Ensuring
accommodations (qualified interpreter, hearing device
assistance) and using silence promotes accurate information
and rapport. This approach reduces miscommunication and
respects patient autonomy and dignity.
Rationale — A
Closed questions early limit the patient narrative and risk
missing key psychosocial or symptom details.
Rationale — C
Relying on family risks violating privacy and misses the patient’s
own perspective unless patient consents.
,Rationale — D
Starting the exam before history misses important symptom
context and can impede patient trust.
Teaching Point
Start with open questions and ensure communication
accommodations to get an accurate history.
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 2: Gathering Information
Stem
A 28-year-old pregnant patient presents for prenatal care with
intermittent dizziness. History reveals lightheadedness when
standing. Orthostatic vitals show a 12 mm Hg systolic drop and
8 bpm heart rate increase. Which interpretation best follows
Bates’ guidance when integrating history and focused exam?
A. Orthostatic hypotension is ruled out because systolic drop is
<20 mm Hg.
B. Findings suggest possible orthostatic intolerance; correlate
with medication, volume status, and pregnancy physiology.
, C. Dizziness is psychogenic because orthostatic criteria are not
fully met.
D. Immediate head CT is required for dizziness in pregnancy.
Correct Answer
B
Rationale — Correct
Bates advises integrating history and exam: a modest systolic
drop with symptoms in pregnancy suggests orthostatic
intolerance or volume depletion; consider medications,
intravascular volume, and physiologic changes of pregnancy.
Correlation with additional history (fluid intake, emesis) and
repeat measurements is warranted. Management focuses on
reversible causes before aggressive diagnostics.
Rationale — A
Strict numeric cutoffs are guidance, not absolutes; symptoms
and context matter.
Rationale — C
Labeling as psychogenic ignores physiologic contributors and is
not supported by Bates’ patient-centered reasoning.
Rationale — D
Head CT is not first-line without focal neurological signs or red
flags.
Teaching Point
Integrate symptom context with vitals; numeric thresholds
guide but do not replace clinical correlation.
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 — Stage 1: Initiating
the Encounter
Stem
A 62-year-old woman arrives for a new-patient visit complaining
of “tiredness.” You have 15 minutes; she looks anxious and
avoids eye contact. Her chart lists English as a second language
and a hearing impairment. Which initial approach most aligns
with Bates’ recommended technique to establish rapport and
collect accurate history?
,A. Begin with closed yes/no questions to save time and rely on
the chart for details.
B. Use open-ended questions, ensure appropriate
accommodations (interpreter/hearing aids), and allow silence
for patient responses.
C. Ask family to summarize the chief complaint to expedite the
visit.
D. Start the physical exam immediately to observe nonverbal
cues before history.
Correct Answer
B
Rationale — Correct
Bates emphasizes initiating the encounter with patient-centered
open-ended questions to elicit the patient’s narrative. Ensuring
accommodations (qualified interpreter, hearing device
assistance) and using silence promotes accurate information
and rapport. This approach reduces miscommunication and
respects patient autonomy and dignity.
Rationale — A
Closed questions early limit the patient narrative and risk
missing key psychosocial or symptom details.
Rationale — C
Relying on family risks violating privacy and misses the patient’s
own perspective unless patient consents.
,Rationale — D
Starting the exam before history misses important symptom
context and can impede patient trust.
Teaching Point
Start with open questions and ensure communication
accommodations to get an accurate history.
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 2: Gathering Information
Stem
A 28-year-old pregnant patient presents for prenatal care with
intermittent dizziness. History reveals lightheadedness when
standing. Orthostatic vitals show a 12 mm Hg systolic drop and
8 bpm heart rate increase. Which interpretation best follows
Bates’ guidance when integrating history and focused exam?
A. Orthostatic hypotension is ruled out because systolic drop is
<20 mm Hg.
B. Findings suggest possible orthostatic intolerance; correlate
with medication, volume status, and pregnancy physiology.
, C. Dizziness is psychogenic because orthostatic criteria are not
fully met.
D. Immediate head CT is required for dizziness in pregnancy.
Correct Answer
B
Rationale — Correct
Bates advises integrating history and exam: a modest systolic
drop with symptoms in pregnancy suggests orthostatic
intolerance or volume depletion; consider medications,
intravascular volume, and physiologic changes of pregnancy.
Correlation with additional history (fluid intake, emesis) and
repeat measurements is warranted. Management focuses on
reversible causes before aggressive diagnostics.
Rationale — A
Strict numeric cutoffs are guidance, not absolutes; symptoms
and context matter.
Rationale — C
Labeling as psychogenic ignores physiologic contributors and is
not supported by Bates’ patient-centered reasoning.
Rationale — D
Head CT is not first-line without focal neurological signs or red
flags.
Teaching Point
Integrate symptom context with vitals; numeric thresholds
guide but do not replace clinical correlation.
