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
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 58-year-old man arrives for evaluation of intermittent chest
pressure. He appears anxious and speaks limited English. His
adult daughter accompanies him and offers to translate. The
patient avoids eye contact and gives short answers when the
daughter interprets. As the APRN preparing to begin the
encounter, which approach best aligns with Bates’ guidance to
obtain an accurate history while respecting patient autonomy
and communication needs?
,Options
A. Accept the daughter as translator and continue, since she is
family and can provide cultural context.
B. Ask a clinic bilingual staff member to interpret to speed the
visit, documenting the interpreter’s name.
C. Pause and request a trained medical interpreter (remote or
in-person), explain confidentiality, and obtain the patient's
preference.
D. Proceed in English slowly and use the daughter only for
clarifying personal details to avoid delays.
Correct Answer
C
Rationales
Correct Option: Bates emphasizes using trained interpreters to
ensure accurate history, preserve confidentiality, and respect
patient autonomy; asking the patient's preference and
explaining confidentiality supports trust and informed
communication. Trained interpreters reduce errors compared
with ad hoc family interpreting.
Incorrect A: Family members as interpreters risk omissions,
misinterpretations, breaches of confidentiality and power
dynamics; Bates discourages relying on family for complex
clinical visits.
Incorrect B: Using bilingual staff can be acceptable if trained,
but choosing staff without patient consent may still violate
preferences; always confirm the patient’s choice and document
,interpreter identity.
Incorrect D: Using the daughter to “clarify” favors ad hoc
interpretation, risking inaccurate symptom description; Bates
advises against relying on family for clinical interpretation.
Teaching Point
Always use trained medical interpreters; document identity and
patient preference.
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
APRN-Level Question Stem
A 34-year-old woman with poorly controlled diabetes reports
“tingling in my feet.” You obtain a focused history but the
screening physical is not yet done. According to Bates’
recommended sequence for efficient, targeted data collection
in a time-limited primary care visit, which next step best
balances diagnostic yield and clinic workflow?
Options
A. Perform a full head-to-toe physical exam now to capture any
, other signs.
B. Conduct focused neurologic and vascular examinations of the
lower extremities first, then plan additional systems if indicated.
C. Schedule an urgent separate visit for the physical exam and
order nerve conduction studies immediately.
D. Rely on the patient’s description and schedule routine follow-
up; exam is not urgent.
Correct Answer
B
Rationales
Correct Option: Bates recommends tailoring the sequence to
the chief concerns: focused exams directed at the presenting
problem maximize diagnostic yield and efficiency—here,
peripheral neuropathy signs and vascular status are high-yield.
Incorrect A: A full head-to-toe exam wastes time and may
reduce focus; Bates supports problem-focused exams when
appropriate.
Incorrect C: Immediate advanced testing without targeted
physical findings is premature; exam findings guide appropriate
testing and urgency.
Incorrect D: Dismissing the exam overlooks red flags
(ulceration, loss of protective sensation), contrary to Bates’
emphasis on physical confirmation.
Teaching Point
Start with problem-focused exam maneuvers that directly
address the chief complaint.
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 58-year-old man arrives for evaluation of intermittent chest
pressure. He appears anxious and speaks limited English. His
adult daughter accompanies him and offers to translate. The
patient avoids eye contact and gives short answers when the
daughter interprets. As the APRN preparing to begin the
encounter, which approach best aligns with Bates’ guidance to
obtain an accurate history while respecting patient autonomy
and communication needs?
,Options
A. Accept the daughter as translator and continue, since she is
family and can provide cultural context.
B. Ask a clinic bilingual staff member to interpret to speed the
visit, documenting the interpreter’s name.
C. Pause and request a trained medical interpreter (remote or
in-person), explain confidentiality, and obtain the patient's
preference.
D. Proceed in English slowly and use the daughter only for
clarifying personal details to avoid delays.
Correct Answer
C
Rationales
Correct Option: Bates emphasizes using trained interpreters to
ensure accurate history, preserve confidentiality, and respect
patient autonomy; asking the patient's preference and
explaining confidentiality supports trust and informed
communication. Trained interpreters reduce errors compared
with ad hoc family interpreting.
Incorrect A: Family members as interpreters risk omissions,
misinterpretations, breaches of confidentiality and power
dynamics; Bates discourages relying on family for complex
clinical visits.
Incorrect B: Using bilingual staff can be acceptable if trained,
but choosing staff without patient consent may still violate
preferences; always confirm the patient’s choice and document
,interpreter identity.
Incorrect D: Using the daughter to “clarify” favors ad hoc
interpretation, risking inaccurate symptom description; Bates
advises against relying on family for clinical interpretation.
Teaching Point
Always use trained medical interpreters; document identity and
patient preference.
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
APRN-Level Question Stem
A 34-year-old woman with poorly controlled diabetes reports
“tingling in my feet.” You obtain a focused history but the
screening physical is not yet done. According to Bates’
recommended sequence for efficient, targeted data collection
in a time-limited primary care visit, which next step best
balances diagnostic yield and clinic workflow?
Options
A. Perform a full head-to-toe physical exam now to capture any
, other signs.
B. Conduct focused neurologic and vascular examinations of the
lower extremities first, then plan additional systems if indicated.
C. Schedule an urgent separate visit for the physical exam and
order nerve conduction studies immediately.
D. Rely on the patient’s description and schedule routine follow-
up; exam is not urgent.
Correct Answer
B
Rationales
Correct Option: Bates recommends tailoring the sequence to
the chief concerns: focused exams directed at the presenting
problem maximize diagnostic yield and efficiency—here,
peripheral neuropathy signs and vascular status are high-yield.
Incorrect A: A full head-to-toe exam wastes time and may
reduce focus; Bates supports problem-focused exams when
appropriate.
Incorrect C: Immediate advanced testing without targeted
physical findings is premature; exam findings guide appropriate
testing and urgency.
Incorrect D: Dismissing the exam overlooks red flags
(ulceration, loss of protective sensation), contrary to Bates’
emphasis on physical confirmation.
Teaching Point
Start with problem-focused exam maneuvers that directly
address the chief complaint.
