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 58-year-old man arrives for a new-patient visit. He looks
anxious, avoids eye contact, and speaks tersely. You note in
triage that he brought an adult caregiver who answers most
,questions — the patient later says “I don’t remember much.”
How should you proceed initially to build rapport and ensure
accurate history?
Options
A. Continue with the caregiver providing most answers; focus
on medical checklist to save time.
B. Privately ask the caregiver to step out and invite the patient
to describe the issue in his own words.
C. Rely on caregiver answers but document the patient as
“unable to provide history.”
D. Refer immediately for cognitive testing without further
history.
Correct Answer
B
Rationales
Correct Option (B) — Bates emphasizes initiating the encounter
with patient-centered communication and assessing capacity;
privately asking the caregiver to step out allows an initial,
unpressured invitation for the patient to speak and helps
evaluate cognition and rapport. This approach follows Stage 1:
initiating the encounter by using open invitations and assessing
who gives the history.
Incorrect (A) — Delegating most history to the caregiver
violates patient-centered initiation and may miss the patient’s
perspective; Bates recommends first engaging the patient
directly.
,Incorrect (C) — Prematurely documenting “unable” without
assessing the patient’s ability to communicate contradicts
Bates’ staged approach to gather information directly when
possible.
Incorrect (D) — Immediate testing without an initial interview
and rapport building skips Stage 1 and risks unnecessary
escalation.
Teaching Point
Privately engage the patient first; assess capacity and elicit their
perspective before relying on proxies.
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 32-year-old woman presents with intermittent palpitations.
During history she volunteers frequent workplace stress and
sleep deprivation. Physical exam is normal. Which line of
questioning best follows Bates’ recommended approach to
gather actionable information?
, Options
A. Focus only on cardiac risk factors and order an ECG.
B. Use a bio-psycho-social approach to elicit stressors, sleep
patterns, substance use, and medication history.
C. Reassure and schedule routine follow-up in 6 months.
D. Immediately refer to psychiatry for anxiety management.
Correct Answer
B
Rationales
Correct Option (B) — Bates endorses a comprehensive,
biopsychosocial gathering of information. For palpitations,
integrating stress, sleep, substances, and medications helps
distinguish benign from pathologic causes and guides targeted
testing.
Incorrect (A) — Focusing solely on cardiac risk misses likely
contributing social and behavioral determinants that Bates
advises to explore.
Incorrect (C) — Reassurance without targeted data collection
risks missing treatable contributors; not aligned with Stage 2
thoroughness.
Incorrect (D) — Immediate psychiatric referral may be
premature; Bates supports comprehensive primary assessment
and targeted interventions first.
Teaching Point
Use a biopsychosocial framework to uncover contributors
before organ-specific testing.
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 58-year-old man arrives for a new-patient visit. He looks
anxious, avoids eye contact, and speaks tersely. You note in
triage that he brought an adult caregiver who answers most
,questions — the patient later says “I don’t remember much.”
How should you proceed initially to build rapport and ensure
accurate history?
Options
A. Continue with the caregiver providing most answers; focus
on medical checklist to save time.
B. Privately ask the caregiver to step out and invite the patient
to describe the issue in his own words.
C. Rely on caregiver answers but document the patient as
“unable to provide history.”
D. Refer immediately for cognitive testing without further
history.
Correct Answer
B
Rationales
Correct Option (B) — Bates emphasizes initiating the encounter
with patient-centered communication and assessing capacity;
privately asking the caregiver to step out allows an initial,
unpressured invitation for the patient to speak and helps
evaluate cognition and rapport. This approach follows Stage 1:
initiating the encounter by using open invitations and assessing
who gives the history.
Incorrect (A) — Delegating most history to the caregiver
violates patient-centered initiation and may miss the patient’s
perspective; Bates recommends first engaging the patient
directly.
,Incorrect (C) — Prematurely documenting “unable” without
assessing the patient’s ability to communicate contradicts
Bates’ staged approach to gather information directly when
possible.
Incorrect (D) — Immediate testing without an initial interview
and rapport building skips Stage 1 and risks unnecessary
escalation.
Teaching Point
Privately engage the patient first; assess capacity and elicit their
perspective before relying on proxies.
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 32-year-old woman presents with intermittent palpitations.
During history she volunteers frequent workplace stress and
sleep deprivation. Physical exam is normal. Which line of
questioning best follows Bates’ recommended approach to
gather actionable information?
, Options
A. Focus only on cardiac risk factors and order an ECG.
B. Use a bio-psycho-social approach to elicit stressors, sleep
patterns, substance use, and medication history.
C. Reassure and schedule routine follow-up in 6 months.
D. Immediately refer to psychiatry for anxiety management.
Correct Answer
B
Rationales
Correct Option (B) — Bates endorses a comprehensive,
biopsychosocial gathering of information. For palpitations,
integrating stress, sleep, substances, and medications helps
distinguish benign from pathologic causes and guides targeted
testing.
Incorrect (A) — Focusing solely on cardiac risk misses likely
contributing social and behavioral determinants that Bates
advises to explore.
Incorrect (C) — Reassurance without targeted data collection
risks missing treatable contributors; not aligned with Stage 2
thoroughness.
Incorrect (D) — Immediate psychiatric referral may be
premature; Bates supports comprehensive primary assessment
and targeted interventions first.
Teaching Point
Use a biopsychosocial framework to uncover contributors
before organ-specific testing.
