PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Family History &
Genetic Risk
Stem
A 28-year-old woman presents for a preconception visit. She
reports her mother died of ovarian cancer at 47 and a maternal
aunt had breast cancer at 42. Her current exam is unremarkable
and she has no symptoms. Which action best addresses her
genetic risk and immediate clinical needs?
Page 1 of 983
,A. Recommend routine prenatal vitamins and schedule a
standard prenatal ultrasound when pregnant.
B. Arrange BRCA1/BRCA2 genetic testing and immediate referral
to oncology.
C. Obtain a three-generation pedigree, discuss genetic
counseling, and consider targeted genetic testing.
D. Reassure that family history alone is insufficient and advise
standard age-based cancer screening only.
Correct answer: C
Rationales
Correct (C): Jarvis emphasizes the value of a thorough family
pedigree to quantify hereditary risk before ordering genetic
tests. A three-generation pedigree plus genetic counseling
allows informed decision-making and targeted testing if criteria
are met, balancing benefit, cost, and psychosocial impact. This
is the safest, evidence-based next step for a patient with early-
onset female relatives.
A: Prenatal vitamins are reasonable for conception planning but
do not address significant familial cancer risk or cancer
prevention.
B: Immediate BRCA testing without prior counseling and
pedigree assessment risks misinterpretation and unnecessary
anxiety; oncology referral is premature.
D: Dismissing the strong maternal history contradicts risk-
stratification principles in Jarvis and may miss actionable
prevention steps.
Page 2 of 983
,Teaching point: Always start with a three-generation pedigree
and genetic counseling before testing.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Environmental
Exposures & Reproductive Health
Stem
A 34-year-old male factory worker reports intermittent
headaches and decreased libido for 3 months. He notes
frequent handling of solvents at work and that several
coworkers developed similar symptoms. Vitals and basic neuro
exam are normal. What is the most appropriate immediate
assessment step?
A. Counsel to reduce alcohol and obtain morning testosterone
level.
B. Perform focused occupational exposure history and arrange
environmental/industrial hygiene evaluation.
C. Order brain MRI to exclude central nervous system
pathology.
D. Start empiric antidepressant therapy for possible major
depressive disorder.
Correct answer: B
Page 3 of 983
, Rationales
Correct (B): Jarvis highlights targeted history taking for
environmental exposures when multiple workers share
symptoms. An occupational exposure history and coordination
with industrial hygiene can identify toxicants (e.g., solvents) and
prevent further harm — a priority for safety and public health.
A: Alcohol and testosterone testing may be relevant later but
ignore the cluster occupational pattern suggesting
environmental etiology.
C: Brain MRI is low-yield in this setting and delays addressing a
probable toxic exposure affecting multiple people.
D: Empiric antidepressant therapy risks missing an
environmental toxin causing reversible systemic effects.
Teaching point: Clustered workplace symptoms require an
exposure history and industrial hygiene assessment.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference
Ch. 1 — Evidence-Based Assessment — Epigenetics & Lifespan
Risk
Stem
A 56-year-old woman with lifelong cigarette exposure in
childhood (parents smoked at home) asks whether her
Page 4 of 983
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Family History &
Genetic Risk
Stem
A 28-year-old woman presents for a preconception visit. She
reports her mother died of ovarian cancer at 47 and a maternal
aunt had breast cancer at 42. Her current exam is unremarkable
and she has no symptoms. Which action best addresses her
genetic risk and immediate clinical needs?
Page 1 of 983
,A. Recommend routine prenatal vitamins and schedule a
standard prenatal ultrasound when pregnant.
B. Arrange BRCA1/BRCA2 genetic testing and immediate referral
to oncology.
C. Obtain a three-generation pedigree, discuss genetic
counseling, and consider targeted genetic testing.
D. Reassure that family history alone is insufficient and advise
standard age-based cancer screening only.
Correct answer: C
Rationales
Correct (C): Jarvis emphasizes the value of a thorough family
pedigree to quantify hereditary risk before ordering genetic
tests. A three-generation pedigree plus genetic counseling
allows informed decision-making and targeted testing if criteria
are met, balancing benefit, cost, and psychosocial impact. This
is the safest, evidence-based next step for a patient with early-
onset female relatives.
A: Prenatal vitamins are reasonable for conception planning but
do not address significant familial cancer risk or cancer
prevention.
B: Immediate BRCA testing without prior counseling and
pedigree assessment risks misinterpretation and unnecessary
anxiety; oncology referral is premature.
D: Dismissing the strong maternal history contradicts risk-
stratification principles in Jarvis and may miss actionable
prevention steps.
Page 2 of 983
,Teaching point: Always start with a three-generation pedigree
and genetic counseling before testing.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Environmental
Exposures & Reproductive Health
Stem
A 34-year-old male factory worker reports intermittent
headaches and decreased libido for 3 months. He notes
frequent handling of solvents at work and that several
coworkers developed similar symptoms. Vitals and basic neuro
exam are normal. What is the most appropriate immediate
assessment step?
A. Counsel to reduce alcohol and obtain morning testosterone
level.
B. Perform focused occupational exposure history and arrange
environmental/industrial hygiene evaluation.
C. Order brain MRI to exclude central nervous system
pathology.
D. Start empiric antidepressant therapy for possible major
depressive disorder.
Correct answer: B
Page 3 of 983
, Rationales
Correct (B): Jarvis highlights targeted history taking for
environmental exposures when multiple workers share
symptoms. An occupational exposure history and coordination
with industrial hygiene can identify toxicants (e.g., solvents) and
prevent further harm — a priority for safety and public health.
A: Alcohol and testosterone testing may be relevant later but
ignore the cluster occupational pattern suggesting
environmental etiology.
C: Brain MRI is low-yield in this setting and delays addressing a
probable toxic exposure affecting multiple people.
D: Empiric antidepressant therapy risks missing an
environmental toxin causing reversible systemic effects.
Teaching point: Clustered workplace symptoms require an
exposure history and industrial hygiene assessment.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference
Ch. 1 — Evidence-Based Assessment — Epigenetics & Lifespan
Risk
Stem
A 56-year-old woman with lifelong cigarette exposure in
childhood (parents smoked at home) asks whether her
Page 4 of 983
