PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1)
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 42-year-old woman reports her mother was diagnosed with
breast cancer at 46 and her maternal aunt had ovarian cancer
at 50. She has no personal symptoms and her clinical breast
exam today is normal. Family history shows two first-degree or
close relatives with breast/ovarian cancer. What is the best next
step in management?
Page 1 of 986
,Options
A. Reassure the patient and schedule routine screening per
population guidelines.
B. Offer referral to a genetic counselor for risk assessment and
discussion of BRCA testing.
C. Order bilateral diagnostic mammography today.
D. Start empirical chemoprevention (tamoxifen) given family
history.
Correct answer
B
Rationales
Correct (B): Multiple close relatives with breast/ovarian cancer,
including early age at onset (<50), raises hereditary risk. Jarvis
emphasizes pedigree evaluation and referral for formal genetic
risk assessment before genetic testing or high-risk
interventions. This supports safe, evidence-based counseling
and informed decision-making.
Incorrect (A): Routine screening alone underestimates
hereditary risk and misses opportunities for targeted
prevention. Jarvis recommends expanded evaluation when
family history suggests inherited cancer syndromes.
Incorrect (C): Diagnostic mammography is for abnormal
exam/imaging or symptoms; a normal exam and asymptomatic
status make immediate diagnostic imaging less appropriate
than risk stratification.
Incorrect (D): Chemoprevention is considered after careful risk
Page 2 of 986
,estimation and counseling; starting empirically without
specialist input risks harm and violates shared decision
principles.
Teaching point
Two or more close relatives with early breast/ovarian cancer →
genetic counselor referral.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2)
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 7-year-old boy presents with recurrent learning difficulties
and short stature. The mother reports several male relatives on
the maternal side had intellectual disability. On exam you note
small testes and hyperextensible joints. Which pattern best
explains the family history and physical findings?
Options
A. Autosomal dominant inheritance with variable expressivity.
B. X-linked recessive inheritance.
C. Mitochondrial inheritance.
D. Multifactorial inheritance from environmental exposures.
Page 3 of 986
, Correct answer
B
Rationales
Correct (B): A pattern of affected males through maternal
lineage with maternal relatives as carriers is classic for X-linked
recessive disorders. Jarvis highlights using pedigree patterns
plus phenotype to infer inheritance and guide referral. Small
testes and intellectual disability fit X-linked conditions (e.g.,
fragile X).
Incorrect (A): Autosomal dominant typically affects successive
generations of both sexes; male predominance in maternal line
is less consistent.
Incorrect (C): Mitochondrial inheritance transmits through
affected mothers to all children, not male-to-male transmission
patterns.
Incorrect (D): Multifactorial causes usually show no clear sex-
linked pattern and often involve both genetic and
environmental contributors; family male clustering is more
suggestive of X-linked genetics.
Teaching point
Male-limited disease across maternal relatives suggests X-linked
recessive inheritance.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Page 4 of 986
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1)
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 42-year-old woman reports her mother was diagnosed with
breast cancer at 46 and her maternal aunt had ovarian cancer
at 50. She has no personal symptoms and her clinical breast
exam today is normal. Family history shows two first-degree or
close relatives with breast/ovarian cancer. What is the best next
step in management?
Page 1 of 986
,Options
A. Reassure the patient and schedule routine screening per
population guidelines.
B. Offer referral to a genetic counselor for risk assessment and
discussion of BRCA testing.
C. Order bilateral diagnostic mammography today.
D. Start empirical chemoprevention (tamoxifen) given family
history.
Correct answer
B
Rationales
Correct (B): Multiple close relatives with breast/ovarian cancer,
including early age at onset (<50), raises hereditary risk. Jarvis
emphasizes pedigree evaluation and referral for formal genetic
risk assessment before genetic testing or high-risk
interventions. This supports safe, evidence-based counseling
and informed decision-making.
Incorrect (A): Routine screening alone underestimates
hereditary risk and misses opportunities for targeted
prevention. Jarvis recommends expanded evaluation when
family history suggests inherited cancer syndromes.
Incorrect (C): Diagnostic mammography is for abnormal
exam/imaging or symptoms; a normal exam and asymptomatic
status make immediate diagnostic imaging less appropriate
than risk stratification.
Incorrect (D): Chemoprevention is considered after careful risk
Page 2 of 986
,estimation and counseling; starting empirically without
specialist input risks harm and violates shared decision
principles.
Teaching point
Two or more close relatives with early breast/ovarian cancer →
genetic counselor referral.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2)
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 7-year-old boy presents with recurrent learning difficulties
and short stature. The mother reports several male relatives on
the maternal side had intellectual disability. On exam you note
small testes and hyperextensible joints. Which pattern best
explains the family history and physical findings?
Options
A. Autosomal dominant inheritance with variable expressivity.
B. X-linked recessive inheritance.
C. Mitochondrial inheritance.
D. Multifactorial inheritance from environmental exposures.
Page 3 of 986
, Correct answer
B
Rationales
Correct (B): A pattern of affected males through maternal
lineage with maternal relatives as carriers is classic for X-linked
recessive disorders. Jarvis highlights using pedigree patterns
plus phenotype to infer inheritance and guide referral. Small
testes and intellectual disability fit X-linked conditions (e.g.,
fragile X).
Incorrect (A): Autosomal dominant typically affects successive
generations of both sexes; male predominance in maternal line
is less consistent.
Incorrect (C): Mitochondrial inheritance transmits through
affected mothers to all children, not male-to-male transmission
patterns.
Incorrect (D): Multifactorial causes usually show no clear sex-
linked pattern and often involve both genetic and
environmental contributors; family male clustering is more
suggestive of X-linked genetics.
Teaching point
Male-limited disease across maternal relatives suggests X-linked
recessive inheritance.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
Page 4 of 986
