BATES' GUIDE TO PHYSICAL
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — FOUNDATIONAL
SKILLS ESSENTIAL TO THE CLINICAL ENCOUNTER
APRN-Level Question Stem
A 62-year-old male with COPD presents for routine follow-up.
He is anxious, speaks rapidly, and repeatedly interrupts. You
note his wife provides majority of answers. Which approach
best aligns with Bates’ foundational interview skills to get
accurate history while respecting patient autonomy?
Options
A. Continue allowing the wife to answer; defer to the caregiver
,for history accuracy.
B. Interrupt the wife, ask the patient open-ended questions,
and request direct responses from him.
C. Privately ask the wife to step out for part of the interview and
use focused, open-ended questions with the patient.
D. Rely on the medical record and minimize direct questioning
to reduce patient anxiety.
Correct Answer
C
Rationales
Correct (C): Bates emphasizes patient-centered interviewing
and ensuring the patient’s voice; asking the caregiver to step
out and using open-ended questions reduces proxy bias and
supports autonomy while preserving accuracy. Patient privacy
and direct engagement improve diagnostic clarity and rapport.
Incorrect (A): Deferring exclusively to the caregiver risks missing
the patient’s subjective symptoms and violates Bates’ emphasis
on direct patient engagement.
Incorrect (B): Abruptly interrupting may escalate anxiety and
harm rapport; Bates recommends gentle redirection and
creating private space for direct responses.
Incorrect (D): Overreliance on records omits current subjective
data; Bates advises active elicitation of up-to-date history.
Teaching Point
Privately engage the patient with open-ended questions to
ensure patient-centered history.
,Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Approach to the Clinical Encounter — STRUCTURE AND
SEQUENCE OF THE CLINICAL ENCOUNTER
APRN-Level Question Stem
You evaluate a 28-year-old woman with intermittent syncope. In
planning the visit, how should you sequence the encounter per
Bates to maximize diagnostic yield for a potentially serious
symptom?
Options
A. Complete full social history first, then perform a rapid
focused physical exam, leaving detailed HPI later.
B. Start with a focused history of present illness, perform
targeted physical exam for syncope, then expand to relevant
systems.
C. Begin with a complete head-to-toe physical exam to rule out
all causes before any history.
D. Collect family history and lifestyle factors first, delaying
targeted orthostatic and cardiac exam.
, Correct Answer
B
Rationales
Correct (B): Bates recommends tailoring structure and
sequence: for urgent or focal complaints begin with focused HPI
and targeted exam to address immediate safety and likely
etiologies, then broaden as needed. This prioritizes time-
sensitive assessment.
Incorrect (A): Social history first delays critical focused
assessment for syncope and may miss transient cues.
Incorrect (C): Doing a full exam before history is inefficient and
risks missing immediate red flags highlighted in the HPI.
Incorrect (D): Delaying focused cardiac/orthostatic assessment
risks missing treatable causes; Bates prioritizes focused
evaluation for acute symptoms.
Teaching Point
For focal, potentially urgent complaints, prioritize focused HPI
and targeted exam first.
Citation
Bickley et al., (2021). Bates’ Guide Ch. 1.
3
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — FOUNDATIONAL
SKILLS ESSENTIAL TO THE CLINICAL ENCOUNTER
APRN-Level Question Stem
A 62-year-old male with COPD presents for routine follow-up.
He is anxious, speaks rapidly, and repeatedly interrupts. You
note his wife provides majority of answers. Which approach
best aligns with Bates’ foundational interview skills to get
accurate history while respecting patient autonomy?
Options
A. Continue allowing the wife to answer; defer to the caregiver
,for history accuracy.
B. Interrupt the wife, ask the patient open-ended questions,
and request direct responses from him.
C. Privately ask the wife to step out for part of the interview and
use focused, open-ended questions with the patient.
D. Rely on the medical record and minimize direct questioning
to reduce patient anxiety.
Correct Answer
C
Rationales
Correct (C): Bates emphasizes patient-centered interviewing
and ensuring the patient’s voice; asking the caregiver to step
out and using open-ended questions reduces proxy bias and
supports autonomy while preserving accuracy. Patient privacy
and direct engagement improve diagnostic clarity and rapport.
Incorrect (A): Deferring exclusively to the caregiver risks missing
the patient’s subjective symptoms and violates Bates’ emphasis
on direct patient engagement.
Incorrect (B): Abruptly interrupting may escalate anxiety and
harm rapport; Bates recommends gentle redirection and
creating private space for direct responses.
Incorrect (D): Overreliance on records omits current subjective
data; Bates advises active elicitation of up-to-date history.
Teaching Point
Privately engage the patient with open-ended questions to
ensure patient-centered history.
,Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Approach to the Clinical Encounter — STRUCTURE AND
SEQUENCE OF THE CLINICAL ENCOUNTER
APRN-Level Question Stem
You evaluate a 28-year-old woman with intermittent syncope. In
planning the visit, how should you sequence the encounter per
Bates to maximize diagnostic yield for a potentially serious
symptom?
Options
A. Complete full social history first, then perform a rapid
focused physical exam, leaving detailed HPI later.
B. Start with a focused history of present illness, perform
targeted physical exam for syncope, then expand to relevant
systems.
C. Begin with a complete head-to-toe physical exam to rule out
all causes before any history.
D. Collect family history and lifestyle factors first, delaying
targeted orthostatic and cardiac exam.
, Correct Answer
B
Rationales
Correct (B): Bates recommends tailoring structure and
sequence: for urgent or focal complaints begin with focused HPI
and targeted exam to address immediate safety and likely
etiologies, then broaden as needed. This prioritizes time-
sensitive assessment.
Incorrect (A): Social history first delays critical focused
assessment for syncope and may miss transient cues.
Incorrect (C): Doing a full exam before history is inefficient and
risks missing immediate red flags highlighted in the HPI.
Incorrect (D): Delaying focused cardiac/orthostatic assessment
risks missing treatable causes; Bates prioritizes focused
evaluation for acute symptoms.
Teaching Point
For focal, potentially urgent complaints, prioritize focused HPI
and targeted exam first.
Citation
Bickley et al., (2021). Bates’ Guide Ch. 1.
3
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
