ORIGINAL, COMPLETE & VERIFIED
✅ Bates’ Guide to Physical Examination and History Taking, 13th
Edition
,Unit I: Foundations of Health Assessment
Chapter 1. Approach to the Clinical Encounter
Theme: Building rapport, ethics, and the patient-centered approach
Each question includes a ✅ Correct Answer and a deep rationale.
1. A 54-year-old patient arrives for a follow-up visit and begins
describing a new, unrelated concern. What is the most appropriate
patient-centered response?
A. "Let's first finish reviewing your lab results before addressing new
concerns."
B. "We'll have to reschedule to discuss that issue in a different visit."
C. "Tell me more about this new concern. We’ll figure out how to
prioritize everything."
D. "You should have mentioned that earlier so we could prepare."
✅ Correct Answer: C
Rationale: This approach reflects the patient-centered model, which
values shared decision-making and prioritization based on the patient's
concerns. It fosters rapport and trust while ensuring time is used
efficiently.
2. During the initial greeting, a clinician smiles, shakes hands, and
addresses the patient by name. Which best describes the purpose of
this approach?
A. To complete required social norms
B. To establish professional authority
C. To foster a therapeutic alliance
D. To avoid potential legal issues
✅ Correct Answer: C
Rationale: Building rapport from the first moment is essential to
,developing a therapeutic alliance, which is foundational for effective
clinical encounters and encourages open communication.
3. A medical student begins taking a history by asking, "You're not
experiencing any chest pain, are you?" This is an example of:
A. An open-ended question
B. A leading question
C. A reflective technique
D. A closed and neutral question
✅ Correct Answer: B
Rationale: Leading questions may influence the patient’s answer and
reduce the accuracy of information obtained. Neutral, open-ended
formats are more appropriate in early encounters.
4. Which of the following most accurately reflects the ethical
principle of autonomy in a clinical encounter?
A. Telling the patient which treatment to choose based on guidelines
B. Providing balanced options and supporting the patient's informed
choice
C. Refusing to discuss unproven therapies
D. Prioritizing clinician judgment over patient preferences
✅ Correct Answer: B
Rationale: Autonomy involves respecting the patient’s right to make
decisions about their health after receiving all necessary information.
Shared decision-making is key.
5. A patient with limited English proficiency nods affirmatively to
every question. What should the clinician consider next?
,A. Proceeding with the exam since the patient appears to understand
B. Asking yes/no questions to simplify communication
C. Confirming understanding using teach-back with a professional
interpreter
D. Relying on a family member for translation
✅ Correct Answer: C
Rationale: Nodding may not reflect comprehension. The teach-back
method ensures patient understanding, and professional interpreters
prevent miscommunication and bias.
6. Which behavior best demonstrates cultural humility during a
clinical encounter?
A. Relying on one's medical knowledge rather than asking about culture
B. Adapting care based on cultural assumptions
C. Asking the patient to explain what health and illness mean to them
D. Avoiding cultural topics to remain neutral
✅ Correct Answer: C
Rationale: Cultural humility emphasizes curiosity and active learning
from patients’ perspectives rather than assumptions or stereotypes.
7. When is the most appropriate time to discuss confidentiality with
an adolescent patient?
A. At the end of the visit
B. Only if the patient brings up sensitive topics
C. Before starting the interview
D. During physical examination
✅ Correct Answer: C
Rationale: Discussing confidentiality early builds trust and sets
expectations, especially with adolescents who may hesitate to disclose
sensitive issues.
,8. A clinician notices a patient avoiding eye contact and crossing
their arms. What is the best interpretation?
A. The patient is disinterested
B. The patient is deceptive
C. The patient may feel uncomfortable or defensive
D. The patient is culturally disrespectful
✅ Correct Answer: C
Rationale: Non-verbal cues may suggest discomfort or emotional
distress. Interpreting these signs with cultural sensitivity is crucial in
patient-centered encounters.
9. What ethical principle is violated if a clinician fails to provide the
patient with all treatment options, including risks and benefits?
A. Justice
B. Nonmaleficence
C. Fidelity
D. Autonomy
✅ Correct Answer: D
Rationale: Patients can only exercise autonomy when fully informed.
Withholding information undermines their ability to participate in
decision-making.
10. A patient says, “I don’t think my doctor listens to me.” What is
the best initial response?
A. "Why do you feel that way?"
B. "Doctors are very busy sometimes."
C. "That must be frustrating. Can you tell me more?"
, D. "Did something specific happen?"
✅ Correct Answer: C
Rationale: Validating emotion first helps establish rapport and
encourages further disclosure. Reflective listening is essential to patient-
centered care.
11. Which component of the patient-centered approach is best
supported by open-ended questioning?
A. Efficient documentation
B. Biomedical diagnosis
C. Eliciting the patient’s narrative
D. Assessing insurance coverage
✅ Correct Answer: C
Rationale: Open-ended questions invite the patient’s story, central to
understanding their experience of illness beyond just symptoms.
12. What is the best response when a patient hesitates before
answering a personal question?
A. Move on to a different topic
B. Ask the question again more firmly
C. Acknowledge their hesitation and offer reassurance
D. Remind them that you are the healthcare professional
✅ Correct Answer: C
Rationale: Addressing hesitation with empathy promotes trust and
shows respect for the patient’s boundaries and readiness.
13. A clinician asks, “How has your condition affected your daily
life?” This type of question is designed to:
✅ Bates’ Guide to Physical Examination and History Taking, 13th
Edition
,Unit I: Foundations of Health Assessment
Chapter 1. Approach to the Clinical Encounter
Theme: Building rapport, ethics, and the patient-centered approach
Each question includes a ✅ Correct Answer and a deep rationale.
1. A 54-year-old patient arrives for a follow-up visit and begins
describing a new, unrelated concern. What is the most appropriate
patient-centered response?
A. "Let's first finish reviewing your lab results before addressing new
concerns."
B. "We'll have to reschedule to discuss that issue in a different visit."
C. "Tell me more about this new concern. We’ll figure out how to
prioritize everything."
D. "You should have mentioned that earlier so we could prepare."
✅ Correct Answer: C
Rationale: This approach reflects the patient-centered model, which
values shared decision-making and prioritization based on the patient's
concerns. It fosters rapport and trust while ensuring time is used
efficiently.
2. During the initial greeting, a clinician smiles, shakes hands, and
addresses the patient by name. Which best describes the purpose of
this approach?
A. To complete required social norms
B. To establish professional authority
C. To foster a therapeutic alliance
D. To avoid potential legal issues
✅ Correct Answer: C
Rationale: Building rapport from the first moment is essential to
,developing a therapeutic alliance, which is foundational for effective
clinical encounters and encourages open communication.
3. A medical student begins taking a history by asking, "You're not
experiencing any chest pain, are you?" This is an example of:
A. An open-ended question
B. A leading question
C. A reflective technique
D. A closed and neutral question
✅ Correct Answer: B
Rationale: Leading questions may influence the patient’s answer and
reduce the accuracy of information obtained. Neutral, open-ended
formats are more appropriate in early encounters.
4. Which of the following most accurately reflects the ethical
principle of autonomy in a clinical encounter?
A. Telling the patient which treatment to choose based on guidelines
B. Providing balanced options and supporting the patient's informed
choice
C. Refusing to discuss unproven therapies
D. Prioritizing clinician judgment over patient preferences
✅ Correct Answer: B
Rationale: Autonomy involves respecting the patient’s right to make
decisions about their health after receiving all necessary information.
Shared decision-making is key.
5. A patient with limited English proficiency nods affirmatively to
every question. What should the clinician consider next?
,A. Proceeding with the exam since the patient appears to understand
B. Asking yes/no questions to simplify communication
C. Confirming understanding using teach-back with a professional
interpreter
D. Relying on a family member for translation
✅ Correct Answer: C
Rationale: Nodding may not reflect comprehension. The teach-back
method ensures patient understanding, and professional interpreters
prevent miscommunication and bias.
6. Which behavior best demonstrates cultural humility during a
clinical encounter?
A. Relying on one's medical knowledge rather than asking about culture
B. Adapting care based on cultural assumptions
C. Asking the patient to explain what health and illness mean to them
D. Avoiding cultural topics to remain neutral
✅ Correct Answer: C
Rationale: Cultural humility emphasizes curiosity and active learning
from patients’ perspectives rather than assumptions or stereotypes.
7. When is the most appropriate time to discuss confidentiality with
an adolescent patient?
A. At the end of the visit
B. Only if the patient brings up sensitive topics
C. Before starting the interview
D. During physical examination
✅ Correct Answer: C
Rationale: Discussing confidentiality early builds trust and sets
expectations, especially with adolescents who may hesitate to disclose
sensitive issues.
,8. A clinician notices a patient avoiding eye contact and crossing
their arms. What is the best interpretation?
A. The patient is disinterested
B. The patient is deceptive
C. The patient may feel uncomfortable or defensive
D. The patient is culturally disrespectful
✅ Correct Answer: C
Rationale: Non-verbal cues may suggest discomfort or emotional
distress. Interpreting these signs with cultural sensitivity is crucial in
patient-centered encounters.
9. What ethical principle is violated if a clinician fails to provide the
patient with all treatment options, including risks and benefits?
A. Justice
B. Nonmaleficence
C. Fidelity
D. Autonomy
✅ Correct Answer: D
Rationale: Patients can only exercise autonomy when fully informed.
Withholding information undermines their ability to participate in
decision-making.
10. A patient says, “I don’t think my doctor listens to me.” What is
the best initial response?
A. "Why do you feel that way?"
B. "Doctors are very busy sometimes."
C. "That must be frustrating. Can you tell me more?"
, D. "Did something specific happen?"
✅ Correct Answer: C
Rationale: Validating emotion first helps establish rapport and
encourages further disclosure. Reflective listening is essential to patient-
centered care.
11. Which component of the patient-centered approach is best
supported by open-ended questioning?
A. Efficient documentation
B. Biomedical diagnosis
C. Eliciting the patient’s narrative
D. Assessing insurance coverage
✅ Correct Answer: C
Rationale: Open-ended questions invite the patient’s story, central to
understanding their experience of illness beyond just symptoms.
12. What is the best response when a patient hesitates before
answering a personal question?
A. Move on to a different topic
B. Ask the question again more firmly
C. Acknowledge their hesitation and offer reassurance
D. Remind them that you are the healthcare professional
✅ Correct Answer: C
Rationale: Addressing hesitation with empathy promotes trust and
shows respect for the patient’s boundaries and readiness.
13. A clinician asks, “How has your condition affected your daily
life?” This type of question is designed to:
