PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 28-year woman comes for a preconception visit. She reports a
family history of cystic fibrosis in a first cousin and says she and
her partner are healthy with no known genetic disorders. Her
partner’s ancestry is Ashkenazi Jewish. On exam she is well,
vitals normal. You must decide next steps to estimate
reproductive risk.
Page 1 of 987
,Options
A. Reassure the couple — no further testing indicated given
cousin affected and no immediate family history.
B. Offer carrier screening for both partners based on family
history and partner ancestry.
C. Order prenatal ultrasound only if pregnancy confirmed;
carrier screening is unnecessary preconception.
D. Recommend immediate referral for in-vitro fertilization with
preimplantation genetic diagnosis.
Correct answer
B
Rationale — Correct (3–4 sentences)
Jarvis emphasizes targeted genetic risk assessment using family
history and ancestry. Ashkenazi Jewish ancestry increases
carrier frequencies for several conditions, and a relative with
cystic fibrosis raises potential carrier risk — carrier screening for
both partners is evidence-based preconception care. Screening
informs reproductive options and is a safety-focused next step.
Rationale — Incorrect
A. Cousin affected still increases population risk; reassuring
without screening ignores ancestry risk.
C. Waiting until pregnancy misses opportunity for informed
reproductive planning and preconception interventions.
D. IVF with PGD is premature and invasive; counseling and
screening should precede referral.
Page 2 of 987
,Teaching point (≤20 words)
Preconception carrier screening guided by family history and
ancestry identifies reproductive risk and options.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 45-year man presents because his father died of colon cancer
at age 48. He is asymptomatic. You palpate no masses and vitals
are normal. Which approach best applies Jarvis’ framework for
genetic-environment risk assessment?
Options
A. Schedule colonoscopy at the standard population age (50)
since he’s asymptomatic.
B. Take a three-generation family history, assess
environmental/lifestyle risks, and recommend earlier screening.
C. Order CT abdomen/pelvis now to screen for occult
malignancy.
D. Advise only lifestyle modification and repeat routine care at
standard intervals.
Page 3 of 987
, Correct answer
B
Rationale — Correct (3–4 sentences)
Jarvis stresses the three-generation pedigree and integrating
genetic with modifiable environmental risks. A first-degree
relative with early-onset colon cancer increases personal risk
and typically warrants earlier screening and tailored prevention.
This approach balances genetic risk recognition with actionable
screening.
Rationale — Incorrect
A. Waiting until age 50 ignores increased familial risk and
deviates from evidence-based earlier screening.
C. CT is not standard screening and exposes to radiation
without indication.
D. Lifestyle advice is helpful but insufficient alone for high
genetic risk.
Teaching point (≤20 words)
Early family history triggers tailored surveillance — gather three
generations and adjust screening age accordingly.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
3
Page 4 of 987
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 28-year woman comes for a preconception visit. She reports a
family history of cystic fibrosis in a first cousin and says she and
her partner are healthy with no known genetic disorders. Her
partner’s ancestry is Ashkenazi Jewish. On exam she is well,
vitals normal. You must decide next steps to estimate
reproductive risk.
Page 1 of 987
,Options
A. Reassure the couple — no further testing indicated given
cousin affected and no immediate family history.
B. Offer carrier screening for both partners based on family
history and partner ancestry.
C. Order prenatal ultrasound only if pregnancy confirmed;
carrier screening is unnecessary preconception.
D. Recommend immediate referral for in-vitro fertilization with
preimplantation genetic diagnosis.
Correct answer
B
Rationale — Correct (3–4 sentences)
Jarvis emphasizes targeted genetic risk assessment using family
history and ancestry. Ashkenazi Jewish ancestry increases
carrier frequencies for several conditions, and a relative with
cystic fibrosis raises potential carrier risk — carrier screening for
both partners is evidence-based preconception care. Screening
informs reproductive options and is a safety-focused next step.
Rationale — Incorrect
A. Cousin affected still increases population risk; reassuring
without screening ignores ancestry risk.
C. Waiting until pregnancy misses opportunity for informed
reproductive planning and preconception interventions.
D. IVF with PGD is premature and invasive; counseling and
screening should precede referral.
Page 2 of 987
,Teaching point (≤20 words)
Preconception carrier screening guided by family history and
ancestry identifies reproductive risk and options.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 45-year man presents because his father died of colon cancer
at age 48. He is asymptomatic. You palpate no masses and vitals
are normal. Which approach best applies Jarvis’ framework for
genetic-environment risk assessment?
Options
A. Schedule colonoscopy at the standard population age (50)
since he’s asymptomatic.
B. Take a three-generation family history, assess
environmental/lifestyle risks, and recommend earlier screening.
C. Order CT abdomen/pelvis now to screen for occult
malignancy.
D. Advise only lifestyle modification and repeat routine care at
standard intervals.
Page 3 of 987
, Correct answer
B
Rationale — Correct (3–4 sentences)
Jarvis stresses the three-generation pedigree and integrating
genetic with modifiable environmental risks. A first-degree
relative with early-onset colon cancer increases personal risk
and typically warrants earlier screening and tailored prevention.
This approach balances genetic risk recognition with actionable
screening.
Rationale — Incorrect
A. Waiting until age 50 ignores increased familial risk and
deviates from evidence-based earlier screening.
C. CT is not standard screening and exposes to radiation
without indication.
D. Lifestyle advice is helpful but insufficient alone for high
genetic risk.
Teaching point (≤20 words)
Early family history triggers tailored surveillance — gather three
generations and adjust screening age accordingly.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
3
Page 4 of 987
