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 38-year-old woman tells you her mother was diagnosed
with breast cancer at age 43 and an aunt had ovarian cancer at
52. She has no current breast complaints. On exam you note a
firm, mobile 1.5-cm lump in the upper outer quadrant of the
right breast. Vitals normal. How should you prioritize next
steps?
A. Reassure and schedule routine annual mammography at age
40.
Page 1 of 984
,B. Arrange diagnostic imaging (diagnostic mammogram ±
ultrasound) and referral for genetic counseling.
C. Start empiric empiric hormonal therapy and monitor lump
for 3 months.
D. Order CA-125 and BRCA gene sequencing immediately in
primary care and start surveillance if positive.
Correct Answer: B
Rationale — Correct (B): Jarvis emphasizes integrating family
history (early-onset breast and ovarian cancer in first-
degree/second-degree relatives) with current abnormal
findings. The palpable breast mass warrants diagnostic imaging
(diagnostic mammogram and targeted ultrasound) and family
history meets criteria for genetic counseling/referral for
possible BRCA testing. This approach addresses immediate
diagnostic needs and genetic risk evaluation for patient and
family — a safe, evidence-based priority.
Rationale — Incorrect (A): Routine screening only would delay
evaluation of a palpable mass and ignores significant family
history; Jarvis highlights acting on abnormal findings.
Rationale — Incorrect (C): Empiric therapy without diagnosis is
unsafe; pharmacologic treatment for presumed hormonally
responsive lesion is premature.
Rationale — Incorrect (D): Ordering BRCA testing without
counseling and before diagnostic imaging bypasses appropriate
sequencing — genetic testing should follow counseling and
confirmatory diagnostics.
Page 2 of 984
,Teaching Point: Palpable breast mass + early family cancer =
immediate diagnostic imaging and genetic counseling referral.
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 7-year-old boy is brought for school absenteeism and
learning difficulties. Mother reports lead exposure from peeling
paint in an older rental home. Physical exam shows decreased
attention, distractibility, and slight pallor. Hemoglobin 11.2 g/dL.
What is the most appropriate next action?
A. Provide tutoring resources and reassess in 6 months.
B. Obtain a capillary or venous blood lead level and notify local
public health if elevated.
C. Start iron supplementation and developmental therapy
without lead testing.
D. Reassure mother that school problems are behavioral and
refer to counseling only.
Correct Answer: B
Rationale — Correct (B): Jarvis stresses environmental
exposures as key contributors to developmental and behavioral
problems. Reported exposure to peeling paint in an older home
Page 3 of 984
, is a red flag for lead; the immediate next step is measuring
blood lead level (venous preferred) and reporting to public
health if elevated. This targets the environmental cause and
prevents further neurodevelopmental harm.
Rationale — Incorrect (A): Tutoring alone misses a potentially
reversible toxic exposure; deferral is unsafe.
Rationale — Incorrect (C): Iron alone may help if deficiency
exists, but treating without confirming lead exposure misses the
primary toxin and public health obligations.
Rationale — Incorrect (D): Dismissing as behavioral ignores
environmental etiology and delays necessary testing and
remediation.
Teaching Point: Suspected lead exposure → obtain venous
blood lead level and involve public health promptly.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 29-year-old man with resistant hypertension despite
three medications mentions his father had premature coronary
artery disease. You note mild gynecomastia and a BMI 31.0.
Which next step best integrates genetic and environmental
considerations?
Page 4 of 984
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 38-year-old woman tells you her mother was diagnosed
with breast cancer at age 43 and an aunt had ovarian cancer at
52. She has no current breast complaints. On exam you note a
firm, mobile 1.5-cm lump in the upper outer quadrant of the
right breast. Vitals normal. How should you prioritize next
steps?
A. Reassure and schedule routine annual mammography at age
40.
Page 1 of 984
,B. Arrange diagnostic imaging (diagnostic mammogram ±
ultrasound) and referral for genetic counseling.
C. Start empiric empiric hormonal therapy and monitor lump
for 3 months.
D. Order CA-125 and BRCA gene sequencing immediately in
primary care and start surveillance if positive.
Correct Answer: B
Rationale — Correct (B): Jarvis emphasizes integrating family
history (early-onset breast and ovarian cancer in first-
degree/second-degree relatives) with current abnormal
findings. The palpable breast mass warrants diagnostic imaging
(diagnostic mammogram and targeted ultrasound) and family
history meets criteria for genetic counseling/referral for
possible BRCA testing. This approach addresses immediate
diagnostic needs and genetic risk evaluation for patient and
family — a safe, evidence-based priority.
Rationale — Incorrect (A): Routine screening only would delay
evaluation of a palpable mass and ignores significant family
history; Jarvis highlights acting on abnormal findings.
Rationale — Incorrect (C): Empiric therapy without diagnosis is
unsafe; pharmacologic treatment for presumed hormonally
responsive lesion is premature.
Rationale — Incorrect (D): Ordering BRCA testing without
counseling and before diagnostic imaging bypasses appropriate
sequencing — genetic testing should follow counseling and
confirmatory diagnostics.
Page 2 of 984
,Teaching Point: Palpable breast mass + early family cancer =
immediate diagnostic imaging and genetic counseling referral.
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 7-year-old boy is brought for school absenteeism and
learning difficulties. Mother reports lead exposure from peeling
paint in an older rental home. Physical exam shows decreased
attention, distractibility, and slight pallor. Hemoglobin 11.2 g/dL.
What is the most appropriate next action?
A. Provide tutoring resources and reassess in 6 months.
B. Obtain a capillary or venous blood lead level and notify local
public health if elevated.
C. Start iron supplementation and developmental therapy
without lead testing.
D. Reassure mother that school problems are behavioral and
refer to counseling only.
Correct Answer: B
Rationale — Correct (B): Jarvis stresses environmental
exposures as key contributors to developmental and behavioral
problems. Reported exposure to peeling paint in an older home
Page 3 of 984
, is a red flag for lead; the immediate next step is measuring
blood lead level (venous preferred) and reporting to public
health if elevated. This targets the environmental cause and
prevents further neurodevelopmental harm.
Rationale — Incorrect (A): Tutoring alone misses a potentially
reversible toxic exposure; deferral is unsafe.
Rationale — Incorrect (C): Iron alone may help if deficiency
exists, but treating without confirming lead exposure misses the
primary toxin and public health obligations.
Rationale — Incorrect (D): Dismissing as behavioral ignores
environmental etiology and delays necessary testing and
remediation.
Teaching Point: Suspected lead exposure → obtain venous
blood lead level and involve public health promptly.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3
Reference: Ch. 1 — Evidence-Based Assessment — Genetics
and Environment
Stem: A 29-year-old man with resistant hypertension despite
three medications mentions his father had premature coronary
artery disease. You note mild gynecomastia and a BMI 31.0.
Which next step best integrates genetic and environmental
considerations?
Page 4 of 984
