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
Stem: A 54-year-old man arrives for a new-patient visit after
referral for poorly controlled hypertension. He appears anxious,
repeatedly glances at his phone, and hesitates before answering
questions. During the opening, which communication strategy
best aligns with Bates’ guidance to build rapport and elicit
concerns while minimizing bias?
Options:
A. Begin with an open invitation: “Tell me what brings you in
,today,” then allow silence to encourage disclosure.
B. Start with reviewing referral notes and immediately ask
targeted medication-adherence questions.
C. Offer a family-centered question: “How is your family
coping?” to establish social context before medical questions.
D. Provide a quick apology for time constraints and ask the
patient to list the top complaint within 30 seconds.
Correct Answer: A
Rationales — Correct: Bates emphasizes starting with an open,
nonleading invitation to elicit the patient's chief concerns and
build rapport; silence can permit disclosure of priorities and
reduce clinician-driven agendas. This approach reduces early
bias and allows agenda setting consistent with Stage 1.
Rationales — Incorrect:
B. Jumping into notes and targeted medication queries may
close off the patient’s priorities and impose clinician bias.
C. Family questions can be useful but premature family-
centered questions may distract from the patient’s primary
concern; Bates recommends first eliciting chief complaint.
D. Apologizing and rushing the patient prioritizes clinician time,
risks missed information, and undermines trust.
Teaching Point: Start with an open invitation; let patients state
priorities before targeted questioning.
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
Stem: A 28-year-old woman presents with episodic palpitations.
You obtain a focused history but notice inconsistent
descriptions of onset and context. According to Bates’
recommended history-taking techniques, what next-step
approach best refines the diagnostic problem?
Options:
A. Use focused closed questions to standardize onset, duration,
and triggers.
B. Transition immediately to physical exam and defer
clarification until vital signs are available.
C. Rephrase the patient’s narrative and ask for specific examples
of the most recent episode.
D. Refer for ambulatory ECG without further history to avoid
biasing symptom recall.
Correct Answer: C
Rationales — Correct: Bates encourages clinicians to reframe
and clarify the patient’s story (echoing/rephrasing) to resolve
inconsistencies, elicit salient details, and improve diagnostic
specificity. Asking for recent examples anchors the description
and supports pattern recognition.
Rationales — Incorrect:
A. Closed questions are useful but overuse risks fragmenting
the narrative and missing context; rephrasing maintains patient-
centeredness while clarifying.
, B. Deferring clarification risks missing critical history that could
guide exam maneuvers and immediate safety assessment.
D. Immediate testing without clarifying the history may produce
low-yield investigations and misses targeted evaluation.
Teaching Point: Rephrase the narrative and request a concrete
recent example to clarify ambiguous symptom descriptions.
Citation: Bickley et al. (2021). Ch. 1.
3
Reference: Ch. 1 — Approach to the Clinical Encounter — Stage
3: Performing the Physical Examination
Stem: During a cardiovascular exam, a patient with dyspnea is
unable to lie flat comfortably. Bates’ sequence flexibility
supports which immediate modification to the physical exam to
preserve test validity?
Options:
A. Proceed with supine auscultation regardless of comfort to
standardize comparison.
B. Perform the exam in the patient’s comfortable position
(semi-recumbent) and document positional change.
C. Defer the cardiac exam and proceed with a focused lung
exam only.
D. Ask the patient to lie supine for five minutes then re-evaluate
tolerance.
Correct Answer: B
Rationales — Correct: Bates highlights adapting exam sequence
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
Stem: A 54-year-old man arrives for a new-patient visit after
referral for poorly controlled hypertension. He appears anxious,
repeatedly glances at his phone, and hesitates before answering
questions. During the opening, which communication strategy
best aligns with Bates’ guidance to build rapport and elicit
concerns while minimizing bias?
Options:
A. Begin with an open invitation: “Tell me what brings you in
,today,” then allow silence to encourage disclosure.
B. Start with reviewing referral notes and immediately ask
targeted medication-adherence questions.
C. Offer a family-centered question: “How is your family
coping?” to establish social context before medical questions.
D. Provide a quick apology for time constraints and ask the
patient to list the top complaint within 30 seconds.
Correct Answer: A
Rationales — Correct: Bates emphasizes starting with an open,
nonleading invitation to elicit the patient's chief concerns and
build rapport; silence can permit disclosure of priorities and
reduce clinician-driven agendas. This approach reduces early
bias and allows agenda setting consistent with Stage 1.
Rationales — Incorrect:
B. Jumping into notes and targeted medication queries may
close off the patient’s priorities and impose clinician bias.
C. Family questions can be useful but premature family-
centered questions may distract from the patient’s primary
concern; Bates recommends first eliciting chief complaint.
D. Apologizing and rushing the patient prioritizes clinician time,
risks missed information, and undermines trust.
Teaching Point: Start with an open invitation; let patients state
priorities before targeted questioning.
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
Stem: A 28-year-old woman presents with episodic palpitations.
You obtain a focused history but notice inconsistent
descriptions of onset and context. According to Bates’
recommended history-taking techniques, what next-step
approach best refines the diagnostic problem?
Options:
A. Use focused closed questions to standardize onset, duration,
and triggers.
B. Transition immediately to physical exam and defer
clarification until vital signs are available.
C. Rephrase the patient’s narrative and ask for specific examples
of the most recent episode.
D. Refer for ambulatory ECG without further history to avoid
biasing symptom recall.
Correct Answer: C
Rationales — Correct: Bates encourages clinicians to reframe
and clarify the patient’s story (echoing/rephrasing) to resolve
inconsistencies, elicit salient details, and improve diagnostic
specificity. Asking for recent examples anchors the description
and supports pattern recognition.
Rationales — Incorrect:
A. Closed questions are useful but overuse risks fragmenting
the narrative and missing context; rephrasing maintains patient-
centeredness while clarifying.
, B. Deferring clarification risks missing critical history that could
guide exam maneuvers and immediate safety assessment.
D. Immediate testing without clarifying the history may produce
low-yield investigations and misses targeted evaluation.
Teaching Point: Rephrase the narrative and request a concrete
recent example to clarify ambiguous symptom descriptions.
Citation: Bickley et al. (2021). Ch. 1.
3
Reference: Ch. 1 — Approach to the Clinical Encounter — Stage
3: Performing the Physical Examination
Stem: During a cardiovascular exam, a patient with dyspnea is
unable to lie flat comfortably. Bates’ sequence flexibility
supports which immediate modification to the physical exam to
preserve test validity?
Options:
A. Proceed with supine auscultation regardless of comfort to
standardize comparison.
B. Perform the exam in the patient’s comfortable position
(semi-recumbent) and document positional change.
C. Defer the cardiac exam and proceed with a focused lung
exam only.
D. Ask the patient to lie supine for five minutes then re-evaluate
tolerance.
Correct Answer: B
Rationales — Correct: Bates highlights adapting exam sequence
