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 — Stage 1: Initiating
the Encounter
APRN-Level Question Stem (2–4 sentences)
A 58-year-old man arrives for a new patient visit. He appears
guarded and avoids eye contact; when you introduce yourself
he gives monosyllabic answers about his smoking history and
chronic cough. Using Bates’ recommended approach to
initiating the encounter, what is the best first step to establish
rapport and elicit a more complete history?
,Options
A. Continue with a standard history checklist to save time.
B. Acknowledge his emotion and invite him to tell his story in
his own words.
C. Focus immediately on biomedical questions about cough
duration and sputum.
D. Request a full tobacco exposure history and administer
standardized tobacco screening.
Correct Answer
B
Rationales
Correct Option — B (3–4 sentences)
Bates emphasizes beginning the encounter by establishing
rapport and a patient-centered agenda. Acknowledging the
patient’s affect and inviting an open story reduces
defensiveness and often elicits key contextual information (e.g.,
stressors, barriers) that guide subsequent focused questioning.
This step follows Stage 1 principles to build trust before moving
to data collection.
Incorrect Options
A — Rigid checklist early undermines rapport and may miss
psychosocial cues Bates recommends.
C — Immediate biomedical focus risks missing emotional or
social contributors to symptoms and may reinforce
guardedness.
D — While tobacco history is important, starting with
,standardized screening without rapport may produce
incomplete answers.
Teaching Point
Start encounters with empathy and an open invitation to tell
the story.
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 — Stage 2:
Gathering Information
APRN-Level Question Stem
A 34-year-old woman presents with intermittent palpitations.
You have limited time and concurrent triage demands. Applying
Bates’ guidance on focused versus comprehensive histories,
which approach best balances efficiency and diagnostic
accuracy for this visit?
Options
A. Perform a comprehensive multisystem history because
palpitations may indicate systemic disease.
B. Take a focused history targeted to cardiac, endocrine, and
medication causes, then expand if red flags appear.
, C. Use a rapid checklist to rule out life-threatening causes and
schedule a full history later.
D. Defer history-taking and perform an ECG first to save time.
Correct Answer
B
Rationales
Correct Option — B
Bates recommends tailoring the history to the reason for the
visit: start focused on high-yield systems (cardiac, endocrine,
meds, stimulants), while remaining ready to broaden if atypical
or red-flag features emerge. This approach preserves efficiency
without sacrificing safety.
Incorrect Options
A — A full comprehensive history is unnecessary and inefficient
for an isolated complaint absent red flags.
C — A checklist-only approach risks missing pertinent context
(e.g., recent medication changes).
D — Jumping to tests without an appropriate focused history
violates Bates’ staged diagnostic reasoning.
Teaching Point
Start focused on relevant systems; expand if red flags or atypical
features arise.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
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 — Stage 1: Initiating
the Encounter
APRN-Level Question Stem (2–4 sentences)
A 58-year-old man arrives for a new patient visit. He appears
guarded and avoids eye contact; when you introduce yourself
he gives monosyllabic answers about his smoking history and
chronic cough. Using Bates’ recommended approach to
initiating the encounter, what is the best first step to establish
rapport and elicit a more complete history?
,Options
A. Continue with a standard history checklist to save time.
B. Acknowledge his emotion and invite him to tell his story in
his own words.
C. Focus immediately on biomedical questions about cough
duration and sputum.
D. Request a full tobacco exposure history and administer
standardized tobacco screening.
Correct Answer
B
Rationales
Correct Option — B (3–4 sentences)
Bates emphasizes beginning the encounter by establishing
rapport and a patient-centered agenda. Acknowledging the
patient’s affect and inviting an open story reduces
defensiveness and often elicits key contextual information (e.g.,
stressors, barriers) that guide subsequent focused questioning.
This step follows Stage 1 principles to build trust before moving
to data collection.
Incorrect Options
A — Rigid checklist early undermines rapport and may miss
psychosocial cues Bates recommends.
C — Immediate biomedical focus risks missing emotional or
social contributors to symptoms and may reinforce
guardedness.
D — While tobacco history is important, starting with
,standardized screening without rapport may produce
incomplete answers.
Teaching Point
Start encounters with empathy and an open invitation to tell
the story.
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 — Stage 2:
Gathering Information
APRN-Level Question Stem
A 34-year-old woman presents with intermittent palpitations.
You have limited time and concurrent triage demands. Applying
Bates’ guidance on focused versus comprehensive histories,
which approach best balances efficiency and diagnostic
accuracy for this visit?
Options
A. Perform a comprehensive multisystem history because
palpitations may indicate systemic disease.
B. Take a focused history targeted to cardiac, endocrine, and
medication causes, then expand if red flags appear.
, C. Use a rapid checklist to rule out life-threatening causes and
schedule a full history later.
D. Defer history-taking and perform an ECG first to save time.
Correct Answer
B
Rationales
Correct Option — B
Bates recommends tailoring the history to the reason for the
visit: start focused on high-yield systems (cardiac, endocrine,
meds, stimulants), while remaining ready to broaden if atypical
or red-flag features emerge. This approach preserves efficiency
without sacrificing safety.
Incorrect Options
A — A full comprehensive history is unnecessary and inefficient
for an isolated complaint absent red flags.
C — A checklist-only approach risks missing pertinent context
(e.g., recent medication changes).
D — Jumping to tests without an appropriate focused history
violates Bates’ staged diagnostic reasoning.
Teaching Point
Start focused on relevant systems; expand if red flags or atypical
features arise.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
