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 — Structure and
Sequence of the Clinical Encounter: Stage 1 — Initiating the
Encounter
APRN-Level Question Stem
A 56-year-old Spanish-speaking man arrives for a new-patient
visit and looks anxious. You have a 20-minute slot and a clinic
interpreter is available by phone. The patient begins telling a
long backstory; you need to establish priorities, rapport, and
efficient information flow while respecting language needs.
,Which initial approach best balances efficiency, patient-
centeredness, and Bates' recommended sequence?
Options
A. Continue listening uninterrupted until the patient finishes,
then summarize and proceed with focused history.
B. Interrupt to ask the interpreter to summarize key concerns
every 3–4 minutes to keep time.
C. Use a brief, open-ended prompt (“What brings you today?”),
allow 1–2 minutes of uninterrupted narrative, then set an
agenda with the interpreter.
D. Tell the patient you need to ask specific questions and begin
a directed checklist without further narrative.
Correct Answer
C
Rationales
Correct (C): Bates emphasizes initiating the encounter with
open-ended prompts to build rapport, then collaboratively
setting an agenda. Allowing a brief uninterrupted narrative
respects the patient's story and cultural factors while the
interpreter and clinician then prioritize concerns to use time
effectively. This approach integrates patient-centeredness with
structure.
Incorrect (A): Letting an unrestricted narrative consumes
limited appointment time and may miss urgent issues; Bates
recommends early agenda-setting.
Incorrect (B): Frequent interpreter summaries fragment rapport
,and burden the interpreter; Bates favors patient-centered
listening followed by negotiated agenda.
Incorrect (D): Abruptly shifting to a checklist reduces rapport
and may miss patient priorities or psychosocial issues noted in
Bates' model.
Teaching Point
Start with an open prompt, allow brief narrative, then negotiate
a focused agenda.
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 28-year-old woman presents with intermittent palpitations
and fatigue. Her vitals are normal; ECG from triage shows sinus
tachycardia at 110 bpm. During history gathering she discloses
occasional panic attacks and recent caffeine increase. According
to Bates' approach to gathering information, which next step
most effectively integrates history and exam to refine
differential diagnosis?
, Options
A. Order thyroid function tests immediately because
palpitations and tachycardia suggest hyperthyroidism.
B. Explore temporal pattern, triggers, substance use, and
associated symptoms while performing focused cardiovascular
and mental-status exams.
C. Reassure the patient and attribute symptoms to anxiety,
schedule counseling referral without further testing.
D. Begin empiric beta-blocker therapy to control heart rate
before further evaluation.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes gathering a focused history that
integrates symptom timing, triggers, substances, and associated
findings plus targeted exam maneuvers to narrow causes. This
approach refines the differential (cardiac, endocrine,
psychiatric, substance-related) before ordering tests or
treatment.
Incorrect (A): Jumping to immediate TFTs is premature without
focused history/exam; Bates recommends hypothesis-
generating questions first.
Incorrect (C): Attributing to anxiety without targeted
assessment risks missing medical causes; Bates warns against
premature closure.
Incorrect (D): Starting empiric therapy before clarifying etiology
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 — Structure and
Sequence of the Clinical Encounter: Stage 1 — Initiating the
Encounter
APRN-Level Question Stem
A 56-year-old Spanish-speaking man arrives for a new-patient
visit and looks anxious. You have a 20-minute slot and a clinic
interpreter is available by phone. The patient begins telling a
long backstory; you need to establish priorities, rapport, and
efficient information flow while respecting language needs.
,Which initial approach best balances efficiency, patient-
centeredness, and Bates' recommended sequence?
Options
A. Continue listening uninterrupted until the patient finishes,
then summarize and proceed with focused history.
B. Interrupt to ask the interpreter to summarize key concerns
every 3–4 minutes to keep time.
C. Use a brief, open-ended prompt (“What brings you today?”),
allow 1–2 minutes of uninterrupted narrative, then set an
agenda with the interpreter.
D. Tell the patient you need to ask specific questions and begin
a directed checklist without further narrative.
Correct Answer
C
Rationales
Correct (C): Bates emphasizes initiating the encounter with
open-ended prompts to build rapport, then collaboratively
setting an agenda. Allowing a brief uninterrupted narrative
respects the patient's story and cultural factors while the
interpreter and clinician then prioritize concerns to use time
effectively. This approach integrates patient-centeredness with
structure.
Incorrect (A): Letting an unrestricted narrative consumes
limited appointment time and may miss urgent issues; Bates
recommends early agenda-setting.
Incorrect (B): Frequent interpreter summaries fragment rapport
,and burden the interpreter; Bates favors patient-centered
listening followed by negotiated agenda.
Incorrect (D): Abruptly shifting to a checklist reduces rapport
and may miss patient priorities or psychosocial issues noted in
Bates' model.
Teaching Point
Start with an open prompt, allow brief narrative, then negotiate
a focused agenda.
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 28-year-old woman presents with intermittent palpitations
and fatigue. Her vitals are normal; ECG from triage shows sinus
tachycardia at 110 bpm. During history gathering she discloses
occasional panic attacks and recent caffeine increase. According
to Bates' approach to gathering information, which next step
most effectively integrates history and exam to refine
differential diagnosis?
, Options
A. Order thyroid function tests immediately because
palpitations and tachycardia suggest hyperthyroidism.
B. Explore temporal pattern, triggers, substance use, and
associated symptoms while performing focused cardiovascular
and mental-status exams.
C. Reassure the patient and attribute symptoms to anxiety,
schedule counseling referral without further testing.
D. Begin empiric beta-blocker therapy to control heart rate
before further evaluation.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes gathering a focused history that
integrates symptom timing, triggers, substances, and associated
findings plus targeted exam maneuvers to narrow causes. This
approach refines the differential (cardiac, endocrine,
psychiatric, substance-related) before ordering tests or
treatment.
Incorrect (A): Jumping to immediate TFTs is premature without
focused history/exam; Bates recommends hypothesis-
generating questions first.
Incorrect (C): Attributing to anxiety without targeted
assessment risks missing medical causes; Bates warns against
premature closure.
Incorrect (D): Starting empiric therapy before clarifying etiology
