Bate's Self-Assessment: Chapters 1, 2,
3, 8 Questions and Answers 2025-2026
Updated.
A 34-year-old male with a history of complex social and medical needs (including current
substance abuse) presents to a primary care teaching clinic. The patient has experienced a
number of adversarial relationships with prior clinicians, including voluntarily leaving two
practices within the previous year and being asked to leave care at a third clinic due to
misbehavior. The attending physician desires to utilize the approaches to this patient that are
most likely lead to comprehensive care and patient compliance. Which of the following is the
most appropriate interview style for the attending physician to use?
A. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic
information
B. Taking a symptom-focused approach to reduce the involvement of the patient's emotional
difficulties
C. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete
details - Answer D. Following the patient's lead to understand their thoughts, ideas,
concerns, and requests
Rationale:
Following the patient's lead is the key concept of patient-centered medical care. This approach
helps to identify the personal context and address concerns as well as concrete maladies.
Current evidence suggests that this technique is not only very satisfying to the patient and the
clinician, but also leads to optimal outcomes. Focusing on the need for immediate diagnostic
certainty over personal connection and taking charge of the interaction to meet the clinician's
desire to acquire diagnostic information are incorrect because diagnostic certainty may be
required in emergent conditions, whereas establishing personal connection with patients first
may lead to improved long-term care. Ignoring the personal connection with patients can lead
to alienation and missed diagnoses as the patient is less likely to engage in care. Deferring
respect, empathy, humility, and sensitivity in favor of the acquisition of concrete details about
the patient's condition is incorrect because deferring respect for the patient in favor of concrete
details is unlikely to engage the patient in his or her care. Taking a symptom-focused approach
to reduce the involvement of the patient's emotional difficulties is incorrect because emotional
issues may be at the forefront of a patient's issues (such as a diabetic who is unmotivated to
control his diabetes due to concurrent depression), and sidelining the emotional needs may
sabotage progress on medical issues.Reference: Bickley, Lynn S.Bates'Guide to Physical
Examination and History Taking, 13th ed., Philadelphia: Wolters Kluwer, Chapter 1: Approach to
the Clinical Encounter.
,to feel ill, and, in explanation for her lack of adherence to the prescribed treatment, she simply
says, "I don't like it." At this initial visit with her third rheumatology provider, the clinician elects
to explore the issues behind her noncompliance before engaging in diagnostics and treatment
using the FIFE model. Which of the following best defines the elements of the FIFE model?
A. Facts, intelligence, fortuity, and eventuality
B. Facts, intensity, focus, and evidence
C. Focus, intensity, function, and evaluation
D. Feelings, ideas, function, and expec - Answer D. Feelings, ideas, function, and
expectations
Rationale:
This model captures the patient's emotional landscape, intellectual landscape, current situation
(function), and thoughts about future conditions. This breadth is important as aspects of a
patient's illness experience may be missed without a wide exploration. For example, a clinician
may deeply engage with a patient's emotional experience, but the lack of attention to a
patient's ideas surrounding their care and treatment may be perceived as condescending—
especially to a very well-educated patient. Focus, intensity, function, and evaluation and facts,
intensity, focus, and evidence are incorrect because these elements are very concrete in nature
and may miss the emotional aspects of the patient's illness. Feelings, impression, fantasy, and
emotion is incorrect because, in contrary to the above two answers, these elements are almost
entirely rooted in the emotional landscape with little attention paid to the intellectual side of a
patient's experience. Facts, intelligence, fortuity, and eventuality are incorrect because this
group of elements (especially the latter two) does not clearly specify the topics that the clinician
should explore.Reference: Bickley, Lynn S.Bates'Guide to Physical Examination and History
Taking,13th ed., Philadelphia: Wolters Kluwer, Chapter 1: Approach to the Clinical Encounter.
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother,
who convinced the patient to attend the clinic after he disclosed that he prefers homosexual
partners but is afraid that his last partner may have given him an infection. The patient
expresses to the intake nurse that he is unashamed of his sexual orientation and will not stay
through the visit if he feels that he is dismissed or discriminated against because of it. The nurse
practitioner receives this communication prior to entering the examination room and decides to
employ active listening to best connect with the patient at this critical juncture in his care with
the clinic. Which of the following is an example of an active listening technique?
A. Paring down the patient's concerns to concrete medical needs
B. Setting aside the patient's emotional state to focus on his medical needs
C. Considering a differential di - Answer E. Using nonverbal communication to encourage the
, Active listening is the core of the interview technique and demands such skills as setting aside
diagnostic priorities in favor of open discussion; using verbal and non-verbal skills to encourage
the patient to engage fully with their own narrative, and being aware of the patient's emotional
state. Ignoring visual cues to focus on the patient's exact words is incorrect because focusing on
the patient's words is important, and other cues to concerns and discomforts may be gleaned
from nonverbal cues such as posture and facial expression. Setting aside the patient's emotional
state to focus on his medical needs is incorrect because except in emergent circumstances,
laying a foundation of trust and emotional connection is critical prior to engaging in specific
medical needs. Paring down the patient's concerns to concrete medical needs is incorrect
because addressing the concrete medical needs at hand is a vital part of medical visits, without
a greater understanding of the patient's concerns, fears, and anxieties, the patient is unlikely to
feel satisfied on the end of the visit. Considering a differential diagnosis while the patient is
speaking to maximize the patient's time with the provider is incorrect because this may save
time for the provider, but it is unlikely to serve the patient best if the provider is distracted with
complex thoughts and conjectures.Reference: Bickley, Lynn S.Bates'Guide to Physical
Examination and History Taking, 13th ed., Philadelphia: Wolters Kluwer, Chapter 1: Approach to
the Clinical Encounter.
A 23-year-old physician assistant (PA) student found that she felt nervous when called upon to
examine men in her age group. On one occasion, she encountered a young male patient who
appeared embarrassed to see her walk into the room. What should the PA do to minimize their
mutual discomfort?
A. Adjust lighting so it is tangential to the patient's body.
B. Explain that she is a PA student.
C. Ask the patient where he comes from.
D. Provide ongoing interpretation of findings.
E. Explain how the examination will proceed. - Answer E. Explain how the examination will
proceed.
Rationale:
Patient comfort is a primary concern in setting the stage for the examination, and, if patients
know how the exam will proceed, they are likely to feel more relaxed. In addition, explaining a
routine may help remind the PA student of the routine she will follow. Adjusting lighting so that
it is tangential to the patient's body is important for accurate visualization of body structures
but does not necessarily reduce the patient's embarrassment. Asking the patient where he
comes from would move the situation away from the professional to the personal, which could
enhance discomfort. Explaining that she is a PA student may reduce the PA's own anxiety but
will not necessarily calm the patient. Providing ongoing interpretation of findings is not
advisable for beginners, who are not primary caregivers and may make errors.Reference:
3, 8 Questions and Answers 2025-2026
Updated.
A 34-year-old male with a history of complex social and medical needs (including current
substance abuse) presents to a primary care teaching clinic. The patient has experienced a
number of adversarial relationships with prior clinicians, including voluntarily leaving two
practices within the previous year and being asked to leave care at a third clinic due to
misbehavior. The attending physician desires to utilize the approaches to this patient that are
most likely lead to comprehensive care and patient compliance. Which of the following is the
most appropriate interview style for the attending physician to use?
A. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic
information
B. Taking a symptom-focused approach to reduce the involvement of the patient's emotional
difficulties
C. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete
details - Answer D. Following the patient's lead to understand their thoughts, ideas,
concerns, and requests
Rationale:
Following the patient's lead is the key concept of patient-centered medical care. This approach
helps to identify the personal context and address concerns as well as concrete maladies.
Current evidence suggests that this technique is not only very satisfying to the patient and the
clinician, but also leads to optimal outcomes. Focusing on the need for immediate diagnostic
certainty over personal connection and taking charge of the interaction to meet the clinician's
desire to acquire diagnostic information are incorrect because diagnostic certainty may be
required in emergent conditions, whereas establishing personal connection with patients first
may lead to improved long-term care. Ignoring the personal connection with patients can lead
to alienation and missed diagnoses as the patient is less likely to engage in care. Deferring
respect, empathy, humility, and sensitivity in favor of the acquisition of concrete details about
the patient's condition is incorrect because deferring respect for the patient in favor of concrete
details is unlikely to engage the patient in his or her care. Taking a symptom-focused approach
to reduce the involvement of the patient's emotional difficulties is incorrect because emotional
issues may be at the forefront of a patient's issues (such as a diabetic who is unmotivated to
control his diabetes due to concurrent depression), and sidelining the emotional needs may
sabotage progress on medical issues.Reference: Bickley, Lynn S.Bates'Guide to Physical
Examination and History Taking, 13th ed., Philadelphia: Wolters Kluwer, Chapter 1: Approach to
the Clinical Encounter.
,to feel ill, and, in explanation for her lack of adherence to the prescribed treatment, she simply
says, "I don't like it." At this initial visit with her third rheumatology provider, the clinician elects
to explore the issues behind her noncompliance before engaging in diagnostics and treatment
using the FIFE model. Which of the following best defines the elements of the FIFE model?
A. Facts, intelligence, fortuity, and eventuality
B. Facts, intensity, focus, and evidence
C. Focus, intensity, function, and evaluation
D. Feelings, ideas, function, and expec - Answer D. Feelings, ideas, function, and
expectations
Rationale:
This model captures the patient's emotional landscape, intellectual landscape, current situation
(function), and thoughts about future conditions. This breadth is important as aspects of a
patient's illness experience may be missed without a wide exploration. For example, a clinician
may deeply engage with a patient's emotional experience, but the lack of attention to a
patient's ideas surrounding their care and treatment may be perceived as condescending—
especially to a very well-educated patient. Focus, intensity, function, and evaluation and facts,
intensity, focus, and evidence are incorrect because these elements are very concrete in nature
and may miss the emotional aspects of the patient's illness. Feelings, impression, fantasy, and
emotion is incorrect because, in contrary to the above two answers, these elements are almost
entirely rooted in the emotional landscape with little attention paid to the intellectual side of a
patient's experience. Facts, intelligence, fortuity, and eventuality are incorrect because this
group of elements (especially the latter two) does not clearly specify the topics that the clinician
should explore.Reference: Bickley, Lynn S.Bates'Guide to Physical Examination and History
Taking,13th ed., Philadelphia: Wolters Kluwer, Chapter 1: Approach to the Clinical Encounter.
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother,
who convinced the patient to attend the clinic after he disclosed that he prefers homosexual
partners but is afraid that his last partner may have given him an infection. The patient
expresses to the intake nurse that he is unashamed of his sexual orientation and will not stay
through the visit if he feels that he is dismissed or discriminated against because of it. The nurse
practitioner receives this communication prior to entering the examination room and decides to
employ active listening to best connect with the patient at this critical juncture in his care with
the clinic. Which of the following is an example of an active listening technique?
A. Paring down the patient's concerns to concrete medical needs
B. Setting aside the patient's emotional state to focus on his medical needs
C. Considering a differential di - Answer E. Using nonverbal communication to encourage the
, Active listening is the core of the interview technique and demands such skills as setting aside
diagnostic priorities in favor of open discussion; using verbal and non-verbal skills to encourage
the patient to engage fully with their own narrative, and being aware of the patient's emotional
state. Ignoring visual cues to focus on the patient's exact words is incorrect because focusing on
the patient's words is important, and other cues to concerns and discomforts may be gleaned
from nonverbal cues such as posture and facial expression. Setting aside the patient's emotional
state to focus on his medical needs is incorrect because except in emergent circumstances,
laying a foundation of trust and emotional connection is critical prior to engaging in specific
medical needs. Paring down the patient's concerns to concrete medical needs is incorrect
because addressing the concrete medical needs at hand is a vital part of medical visits, without
a greater understanding of the patient's concerns, fears, and anxieties, the patient is unlikely to
feel satisfied on the end of the visit. Considering a differential diagnosis while the patient is
speaking to maximize the patient's time with the provider is incorrect because this may save
time for the provider, but it is unlikely to serve the patient best if the provider is distracted with
complex thoughts and conjectures.Reference: Bickley, Lynn S.Bates'Guide to Physical
Examination and History Taking, 13th ed., Philadelphia: Wolters Kluwer, Chapter 1: Approach to
the Clinical Encounter.
A 23-year-old physician assistant (PA) student found that she felt nervous when called upon to
examine men in her age group. On one occasion, she encountered a young male patient who
appeared embarrassed to see her walk into the room. What should the PA do to minimize their
mutual discomfort?
A. Adjust lighting so it is tangential to the patient's body.
B. Explain that she is a PA student.
C. Ask the patient where he comes from.
D. Provide ongoing interpretation of findings.
E. Explain how the examination will proceed. - Answer E. Explain how the examination will
proceed.
Rationale:
Patient comfort is a primary concern in setting the stage for the examination, and, if patients
know how the exam will proceed, they are likely to feel more relaxed. In addition, explaining a
routine may help remind the PA student of the routine she will follow. Adjusting lighting so that
it is tangential to the patient's body is important for accurate visualization of body structures
but does not necessarily reduce the patient's embarrassment. Asking the patient where he
comes from would move the situation away from the professional to the personal, which could
enhance discomfort. Explaining that she is a PA student may reduce the PA's own anxiety but
will not necessarily calm the patient. Providing ongoing interpretation of findings is not
advisable for beginners, who are not primary caregivers and may make errors.Reference:
