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
APRN-Level Question Stem
A 52-year-old man arrives complaining of intermittent chest
tightness. You note he appears anxious and speaks quickly; his
wife looks worried and interrupts frequently. Using Bates’
recommended initiating techniques, which opening approach
best balances rapid rapport with focused safety assessment?
,Options
A. Begin with an open-ended, “Tell me what brought you in
today,” then allow uninterrupted narrative for at least 5
minutes.
B. Perform a focused, closed-question history immediately to
rule out acute coronary syndrome, postponing rapport building.
C. Open with a concise, empathic statement (e.g., “You look
worried — tell me the most important problem now”), then ask
brief focused safety questions.
D. Ask the wife to give the history while you observe the
patient’s affect and vitals.
Correct Answer
C
Rationales
Correct Option: Bates emphasizes initiating the encounter with
respectful rapport and a focused opening when acuity is
possible; a concise empathic opener quickly establishes trust
then permits immediate targeted safety screening for red flags.
This balances patient-centered communication with urgent
clinical priorities.
A: Leaving an anxious patient to speak for prolonged minutes
risks delaying identification of life-threatening signs; Bates
advises balance between open narration and focused
assessment.
B: Starting only with closed questions neglects immediate
rapport and may miss contextual cues Bates recommends to
,gather initial patient cues.
D: Asking the companion to provide history first bypasses direct
patient engagement and may miss the patient’s own concerns
and nonverbal cues, which Bates cautions against.
Teaching Point
Use concise empathy then focused safety questions when
acuity is possible.
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 28-year-old woman with unintentional weight loss and fatigue
presents for primary care. You obtain a thorough history that
reveals high work stress and limited sleep. According to Bates’
recommended structure, which element is most important to
include next to distinguish medical from psychosocial causes?
Options
A. Detailed diet recall for the prior 7 days.
B. A focused review of systems emphasizing endocrine and
, gastrointestinal symptoms.
C. A genogram of three generations to assess family dynamics.
D. Immediate standardized depression screening without
symptom review.
Correct Answer
B
Rationales
Correct Option: Bates recommends a targeted review of
systems guided by the problem to discern organ-system clues
(endocrine, GI) that help separate medical from psychosocial
causes; this complements history and identifies red-flag
symptoms.
A: A 7-day diet recall is helpful but less efficient than a systems
review when differentiating physiologic etiologies.
C: A genogram may reveal psychosocial context but is lower
yield for immediate differential diagnosis of weight loss.
D: Depression screening is useful, but Bates advocates
integrating symptom review first to prioritize organic causes
before applying screening tools.
Teaching Point
Use problem-directed ROS to separate systemic from
psychosocial causes.
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 — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 52-year-old man arrives complaining of intermittent chest
tightness. You note he appears anxious and speaks quickly; his
wife looks worried and interrupts frequently. Using Bates’
recommended initiating techniques, which opening approach
best balances rapid rapport with focused safety assessment?
,Options
A. Begin with an open-ended, “Tell me what brought you in
today,” then allow uninterrupted narrative for at least 5
minutes.
B. Perform a focused, closed-question history immediately to
rule out acute coronary syndrome, postponing rapport building.
C. Open with a concise, empathic statement (e.g., “You look
worried — tell me the most important problem now”), then ask
brief focused safety questions.
D. Ask the wife to give the history while you observe the
patient’s affect and vitals.
Correct Answer
C
Rationales
Correct Option: Bates emphasizes initiating the encounter with
respectful rapport and a focused opening when acuity is
possible; a concise empathic opener quickly establishes trust
then permits immediate targeted safety screening for red flags.
This balances patient-centered communication with urgent
clinical priorities.
A: Leaving an anxious patient to speak for prolonged minutes
risks delaying identification of life-threatening signs; Bates
advises balance between open narration and focused
assessment.
B: Starting only with closed questions neglects immediate
rapport and may miss contextual cues Bates recommends to
,gather initial patient cues.
D: Asking the companion to provide history first bypasses direct
patient engagement and may miss the patient’s own concerns
and nonverbal cues, which Bates cautions against.
Teaching Point
Use concise empathy then focused safety questions when
acuity is possible.
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 28-year-old woman with unintentional weight loss and fatigue
presents for primary care. You obtain a thorough history that
reveals high work stress and limited sleep. According to Bates’
recommended structure, which element is most important to
include next to distinguish medical from psychosocial causes?
Options
A. Detailed diet recall for the prior 7 days.
B. A focused review of systems emphasizing endocrine and
, gastrointestinal symptoms.
C. A genogram of three generations to assess family dynamics.
D. Immediate standardized depression screening without
symptom review.
Correct Answer
B
Rationales
Correct Option: Bates recommends a targeted review of
systems guided by the problem to discern organ-system clues
(endocrine, GI) that help separate medical from psychosocial
causes; this complements history and identifies red-flag
symptoms.
A: A 7-day diet recall is helpful but less efficient than a systems
review when differentiating physiologic etiologies.
C: A genogram may reveal psychosocial context but is lower
yield for immediate differential diagnosis of weight loss.
D: Depression screening is useful, but Bates advocates
integrating symptom review first to prioritize organic causes
before applying screening tools.
Teaching Point
Use problem-directed ROS to separate systemic from
psychosocial causes.
Citation
Bickley et al. (2021). Ch. 1.
