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
Reference
Ch. 1 — Approach to the Clinical Encounter — Foundational
Skills Essential to the Clinical Encounter
Stem
A 58-year-old man arrives for a new-patient visit. He appears
anxious and keeps glancing at his phone. During the opening,
he answers questions tersely. You must establish rapport and
gather an accurate history. Which initial clinician approach best
balances efficiency and patient-centered rapport to reduce
missed information and bias?
,Options
A. Start with a closed, symptom-focused checklist to expedite
triage and then move to the physical exam.
B. Use a brief open-ended question about his chief concern,
allow uninterrupted narrative, then summarize and ask focused
questions.
C. Prioritize objective vitals and a structured ROS before eliciting
the patient's story to avoid extraneous details.
D. Begin with family and social history first to screen for social
determinants before discussing the chief complaint.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter with
open-ended questions to allow the patient's narrative, followed
by summarization and focused queries; this elicits salient
history, reduces framing bias, and builds rapport. The
uninterrupted narrative often reveals priorities and contextual
details essential for diagnostic reasoning.
A: A closed checklist first risks truncating the patient's story,
increasing information loss and anchoring bias—contrary to
Bates’ recommended patient-centered opening.
C: Collecting vitals/ROS before the patient's narrative can
impede rapport and misses contextual clues; vitals are
important but not the first step in the encounter per Bates.
D: Social determinants are important but are best explored
,after the chief concern and some rapport; starting with them
can feel intrusive and may distract from immediate concerns.
Teaching Point
Open-ended first, then summarize and focus to avoid anchoring
and elicit priorities.
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
Stem
During a busy clinic afternoon you have only 15 minutes for a
follow-up visit for a patient with poorly controlled diabetes.
According to Bates’ recommended structure, which sequence
best preserves clinical reasoning while respecting time
constraints?
Options
A. Rapid review of systems → focused problem list → full
physical exam → negotiate plan.
B. Patient narrative about changes since last visit → focused
problem-directed history → targeted exam → shared plan.
, C. Full complete history including childhood illnesses → full
head-to-toe exam → long-term goals and health maintenance.
D. Immediate medication refill decision based on chart review,
postpone history and exam to another visit.
Correct Answer
B
Rationales
Correct (B): Bates supports tailoring the sequence to visit type:
eliciting the patient's updates, then focused history and
targeted exam, enabling high-yield assessment and shared
planning in limited time. This preserves diagnostic reasoning.
A: A rapid ROS then full physical is inefficient; ROS is lower yield
than focused history in follow-up visits per Bates.
C: A comprehensive approach is unnecessary for problem-
focused follow-up and wastes limited time.
D: Deferring history/exam risks missing important changes and
undermines clinical judgment; revisits may not be possible.
Teaching Point
Tailor encounter sequence—focused history plus targeted exam
preserves reasoning in time-limited visits.
Citation
Bickley et al. (2021). Ch. 1.
3
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
Reference
Ch. 1 — Approach to the Clinical Encounter — Foundational
Skills Essential to the Clinical Encounter
Stem
A 58-year-old man arrives for a new-patient visit. He appears
anxious and keeps glancing at his phone. During the opening,
he answers questions tersely. You must establish rapport and
gather an accurate history. Which initial clinician approach best
balances efficiency and patient-centered rapport to reduce
missed information and bias?
,Options
A. Start with a closed, symptom-focused checklist to expedite
triage and then move to the physical exam.
B. Use a brief open-ended question about his chief concern,
allow uninterrupted narrative, then summarize and ask focused
questions.
C. Prioritize objective vitals and a structured ROS before eliciting
the patient's story to avoid extraneous details.
D. Begin with family and social history first to screen for social
determinants before discussing the chief complaint.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter with
open-ended questions to allow the patient's narrative, followed
by summarization and focused queries; this elicits salient
history, reduces framing bias, and builds rapport. The
uninterrupted narrative often reveals priorities and contextual
details essential for diagnostic reasoning.
A: A closed checklist first risks truncating the patient's story,
increasing information loss and anchoring bias—contrary to
Bates’ recommended patient-centered opening.
C: Collecting vitals/ROS before the patient's narrative can
impede rapport and misses contextual clues; vitals are
important but not the first step in the encounter per Bates.
D: Social determinants are important but are best explored
,after the chief concern and some rapport; starting with them
can feel intrusive and may distract from immediate concerns.
Teaching Point
Open-ended first, then summarize and focus to avoid anchoring
and elicit priorities.
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
Stem
During a busy clinic afternoon you have only 15 minutes for a
follow-up visit for a patient with poorly controlled diabetes.
According to Bates’ recommended structure, which sequence
best preserves clinical reasoning while respecting time
constraints?
Options
A. Rapid review of systems → focused problem list → full
physical exam → negotiate plan.
B. Patient narrative about changes since last visit → focused
problem-directed history → targeted exam → shared plan.
, C. Full complete history including childhood illnesses → full
head-to-toe exam → long-term goals and health maintenance.
D. Immediate medication refill decision based on chart review,
postpone history and exam to another visit.
Correct Answer
B
Rationales
Correct (B): Bates supports tailoring the sequence to visit type:
eliciting the patient's updates, then focused history and
targeted exam, enabling high-yield assessment and shared
planning in limited time. This preserves diagnostic reasoning.
A: A rapid ROS then full physical is inefficient; ROS is lower yield
than focused history in follow-up visits per Bates.
C: A comprehensive approach is unnecessary for problem-
focused follow-up and wastes limited time.
D: Deferring history/exam risks missing important changes and
undermines clinical judgment; revisits may not be possible.
Teaching Point
Tailor encounter sequence—focused history plus targeted exam
preserves reasoning in time-limited visits.
Citation
Bickley et al. (2021). Ch. 1.
3
