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 late to an initial primary care visit and
appears anxious, speaking rapidly. He tells you he "doesn't have
much time" and wants you to "just check his labs," but his chart
shows uncontrolled diabetes. Using Bates’ recommended
initiating approach, what is the best immediate clinician action
to optimize the encounter?
,Options
A. Begin a focused review of systems and immediately draw
labs.
B. Acknowledge time constraints, briefly set an agenda, and ask
the patient his top concerns.
C. Proceed with a rapid physical exam to maximize efficiency.
D. Reschedule for a longer appointment to gather complete
history.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes establishing rapport, clarifying
the reason for visit, and agenda setting at initiation to focus the
encounter; acknowledging time constraints both validates and
enables prioritization of patient concerns while allowing
necessary diabetes assessment.
A: Jumping straight to labs skips agenda setting and risks
missing urgent symptoms or context; Bates recommends
collaborative agenda setting first.
C: A rapid exam without agenda setting may miss important
history and reduces patient engagement per Bates’ framework.
D: Rescheduling may delay needed care for uncontrolled
diabetes and ignores immediate triage options; use agenda
setting to prioritize now.
,Teaching Point
Set an agenda quickly—acknowledge constraints, elicit top
concerns, then prioritize exam and testing.
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 reports episodic palpitations and near-
syncope. You have limited time; her history is vague. According
to Bates’ recommended sequence for gathering information,
which approach best balances safety and diagnostic yield?
Options
A. Skip focused past medical history and proceed to a
comprehensive ROS.
B. Perform a targeted history on cardiopulmonary and
neurologic red flags, then focused exam.
C. Rely primarily on vital signs and schedule ambulatory
monitoring later.
D. Ask only open-ended questions to allow her to narrate fully.
, Correct Answer
B
Rationales
Correct (B): Bates advocates prioritizing time-sensitive systems
and red-flag questions when time is limited; targeted
cardiopulmonary and neuro history plus focused exam yields
immediate safety data.
A: Skipping past medical history loses medication and
comorbidity information crucial for syncope evaluation.
C: Vital signs alone are insufficient to triage near-syncope;
immediate targeted history/exam improves risk stratification.
D: Open narration is useful but, when time is limited and red
flags possible, focused inquiries are needed per Bates.
Teaching Point
Prioritize red-flag systems first; targeted history + focused exam
triages urgent risk.
Citation
Bickley et al., (2021). Ch. 1.
3
Reference
Ch. 1 — Performing the Physical Examination — Foundational
Skills Essential to the Clinical Encounter
APRN-Level Question Stem
During a routine exam, you notice a faint systolic murmur in a
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 late to an initial primary care visit and
appears anxious, speaking rapidly. He tells you he "doesn't have
much time" and wants you to "just check his labs," but his chart
shows uncontrolled diabetes. Using Bates’ recommended
initiating approach, what is the best immediate clinician action
to optimize the encounter?
,Options
A. Begin a focused review of systems and immediately draw
labs.
B. Acknowledge time constraints, briefly set an agenda, and ask
the patient his top concerns.
C. Proceed with a rapid physical exam to maximize efficiency.
D. Reschedule for a longer appointment to gather complete
history.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes establishing rapport, clarifying
the reason for visit, and agenda setting at initiation to focus the
encounter; acknowledging time constraints both validates and
enables prioritization of patient concerns while allowing
necessary diabetes assessment.
A: Jumping straight to labs skips agenda setting and risks
missing urgent symptoms or context; Bates recommends
collaborative agenda setting first.
C: A rapid exam without agenda setting may miss important
history and reduces patient engagement per Bates’ framework.
D: Rescheduling may delay needed care for uncontrolled
diabetes and ignores immediate triage options; use agenda
setting to prioritize now.
,Teaching Point
Set an agenda quickly—acknowledge constraints, elicit top
concerns, then prioritize exam and testing.
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 reports episodic palpitations and near-
syncope. You have limited time; her history is vague. According
to Bates’ recommended sequence for gathering information,
which approach best balances safety and diagnostic yield?
Options
A. Skip focused past medical history and proceed to a
comprehensive ROS.
B. Perform a targeted history on cardiopulmonary and
neurologic red flags, then focused exam.
C. Rely primarily on vital signs and schedule ambulatory
monitoring later.
D. Ask only open-ended questions to allow her to narrate fully.
, Correct Answer
B
Rationales
Correct (B): Bates advocates prioritizing time-sensitive systems
and red-flag questions when time is limited; targeted
cardiopulmonary and neuro history plus focused exam yields
immediate safety data.
A: Skipping past medical history loses medication and
comorbidity information crucial for syncope evaluation.
C: Vital signs alone are insufficient to triage near-syncope;
immediate targeted history/exam improves risk stratification.
D: Open narration is useful but, when time is limited and red
flags possible, focused inquiries are needed per Bates.
Teaching Point
Prioritize red-flag systems first; targeted history + focused exam
triages urgent risk.
Citation
Bickley et al., (2021). Ch. 1.
3
Reference
Ch. 1 — Performing the Physical Examination — Foundational
Skills Essential to the Clinical Encounter
APRN-Level Question Stem
During a routine exam, you notice a faint systolic murmur in a
