PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 29-year-old woman presents for a preconception visit. She
reports her mother died at 52 from “heart problems,” and a
maternal uncle had a stroke at 48. Her blood pressure today is
132/84 mm Hg; BMI 31 kg/m². She asks whether she and her
future child are at increased risk. Which interpretation and next
step best reflect evidence-based assessment?
Page 1 of 988
,Options
A. Reassure her family history is non-specific; no further
screening indicated.
B. Obtain a three-generation pedigree and assess modifiable
risk factors; consider early lipid and BP screening.
C. Order genetic testing for a single gene for cardiomyopathy
immediately.
D. Recommend elective prenatal genetic testing once pregnant
without further family history workup.
Correct Answer
B
Rationale — Correct (3–4 sentences)
Jarvis emphasizes building a three-generation pedigree to
quantify familial clustering and identify early-onset
cardiovascular disease patterns. Her family history of relatives
with cardiovascular events before age 55 suggests increased
familial risk; combining pedigree with assessment of modifiable
factors (BP, BMI, lipids) guides targeted screening. This
approach aligns with evidence-based assessment and prioritizes
actionable interventions for maternal and future child health.
Incorrect Options
A. Dismissive — ignores early-onset family events and missed
opportunity for risk stratification.
C. Premature — single-gene testing is not first-line without a
clear familial monogenic pattern.
Page 2 of 988
,D. Incomplete — prenatal testing without pedigree/screening
neglects current maternal risk optimization.
Teaching Point
Use a three-generation pedigree plus modifiable-risk screening
for early-onset familial disease.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 45-year-old male factory worker reports chronic cough and
increasing dyspnea with exertion. He has a 20-pack-year
smoking history and worked with silica for 12 years. On exam,
inspiratory crackles at lung bases and reduced chest expansion
are noted. Which interpretation best integrates genetic and
environmental risk?
Options
A. Findings are classic COPD from smoking; silica exposure is
irrelevant.
B. The combination of occupational silica exposure and smoking
increases risk for accelerated pulmonary fibrosis; pursue
targeted pulmonary testing.
Page 3 of 988
, C. Inspiratory crackles indicate heart failure; refer for
echocardiogram only.
D. Normal variant — advise symptomatic treatment and repeat
exam in 6 months.
Correct Answer
B
Rationale — Correct (3–4 sentences)
Jarvis highlights integrating environmental exposures with
personal risk to identify high-risk patterns. Silica exposure plus
smoking potentiates fibrotic lung disease and accelerates
decline—crackles and restricted expansion suggest interstitial
involvement rather than simple obstructive disease. Evidence-
based next steps include pulmonary function testing and
imaging (chest radiograph or HRCT) to confirm fibrosis and
guide management.
Incorrect Options
A. Incorrect — silica is a significant occupational risk that
modifies phenotype and prognosis.
C. Misinterprets crackles as only cardiac; pulmonary causes
must be considered given exposure history.
D. Unsafe — delaying evaluation risks progression of potentially
irreversible disease.
Teaching Point
Always combine occupational exposures with personal risk
when lung crackles appear.
Page 4 of 988
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 29-year-old woman presents for a preconception visit. She
reports her mother died at 52 from “heart problems,” and a
maternal uncle had a stroke at 48. Her blood pressure today is
132/84 mm Hg; BMI 31 kg/m². She asks whether she and her
future child are at increased risk. Which interpretation and next
step best reflect evidence-based assessment?
Page 1 of 988
,Options
A. Reassure her family history is non-specific; no further
screening indicated.
B. Obtain a three-generation pedigree and assess modifiable
risk factors; consider early lipid and BP screening.
C. Order genetic testing for a single gene for cardiomyopathy
immediately.
D. Recommend elective prenatal genetic testing once pregnant
without further family history workup.
Correct Answer
B
Rationale — Correct (3–4 sentences)
Jarvis emphasizes building a three-generation pedigree to
quantify familial clustering and identify early-onset
cardiovascular disease patterns. Her family history of relatives
with cardiovascular events before age 55 suggests increased
familial risk; combining pedigree with assessment of modifiable
factors (BP, BMI, lipids) guides targeted screening. This
approach aligns with evidence-based assessment and prioritizes
actionable interventions for maternal and future child health.
Incorrect Options
A. Dismissive — ignores early-onset family events and missed
opportunity for risk stratification.
C. Premature — single-gene testing is not first-line without a
clear familial monogenic pattern.
Page 2 of 988
,D. Incomplete — prenatal testing without pedigree/screening
neglects current maternal risk optimization.
Teaching Point
Use a three-generation pedigree plus modifiable-risk screening
for early-onset familial disease.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 45-year-old male factory worker reports chronic cough and
increasing dyspnea with exertion. He has a 20-pack-year
smoking history and worked with silica for 12 years. On exam,
inspiratory crackles at lung bases and reduced chest expansion
are noted. Which interpretation best integrates genetic and
environmental risk?
Options
A. Findings are classic COPD from smoking; silica exposure is
irrelevant.
B. The combination of occupational silica exposure and smoking
increases risk for accelerated pulmonary fibrosis; pursue
targeted pulmonary testing.
Page 3 of 988
, C. Inspiratory crackles indicate heart failure; refer for
echocardiogram only.
D. Normal variant — advise symptomatic treatment and repeat
exam in 6 months.
Correct Answer
B
Rationale — Correct (3–4 sentences)
Jarvis highlights integrating environmental exposures with
personal risk to identify high-risk patterns. Silica exposure plus
smoking potentiates fibrotic lung disease and accelerates
decline—crackles and restricted expansion suggest interstitial
involvement rather than simple obstructive disease. Evidence-
based next steps include pulmonary function testing and
imaging (chest radiograph or HRCT) to confirm fibrosis and
guide management.
Incorrect Options
A. Incorrect — silica is a significant occupational risk that
modifies phenotype and prognosis.
C. Misinterprets crackles as only cardiac; pulmonary causes
must be considered given exposure history.
D. Unsafe — delaying evaluation risks progression of potentially
irreversible disease.
Teaching Point
Always combine occupational exposures with personal risk
when lung crackles appear.
Page 4 of 988
