PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
Reference: Ch. 1 — Evidence-Based Assessment — Genetic Risk
& Family History
Stem: A 36-year-old woman comes for a preconception visit.
She reports her mother had early-onset coronary artery disease
at 48 and her maternal aunt had a stroke at 52. Her blood
pressure today is 142/88 mmHg and BMI is 32. How should you
integrate the family history and current findings when planning
risk reduction?
Options:
A. Reassure the patient that family history is nonmodifiable,
focus only on lifestyle counseling.
B. Prioritize referral for genetic testing for a single gene disorder
Page 1 of 981
,causing premature cardiovascular disease.
C. Counsel on aggressive risk-factor modification now and
consider earlier lipid and glucose screening due to family
clustering.
D. Delay interventions until pregnancy is confirmed to avoid
unnecessary preconception testing.
Correct answer: C
Rationales:
Correct (C): Family clustering of premature cardiovascular
events plus the patient’s elevated BP and obesity suggests
multifactorial inherited risk. Jarvis emphasizes combining family
history with current findings to stratify risk and advance
screening and preventive measures now. Early lipid and glucose
screening and aggressive lifestyle/medical risk-reduction fit
evidence-based preventative practice.
A: Incorrect — although family history is nonmodifiable, it
meaningfully raises risk and requires active intervention, per
Jarvis’ risk assessment approach.
B: Incorrect — premature CAD is usually multifactorial; single-
gene testing isn’t the immediate priority without suggestive
syndromic features.
D: Incorrect — delaying risk reduction until pregnancy risks
maternal harm; preconception optimization is recommended.
Teaching point: Combine family history + current vitals to
advance earlier screening and risk reduction.
Page 2 of 981
,Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2.
Reference: Ch. 1 — Evidence-Based Assessment — Constructing
a Pedigree
Stem: During a routine visit a 28-year-old asks why you’re taking
a three-generation family history. She says “Isn’t that overkill?”
You note her brother had unexplained recurrent seizures in
childhood and a paternal uncle died of colon cancer at 45.
Which explanation best reflects evidence-based reasons for a
pedigree?
Options:
A. A three-generation pedigree only matters when the patient
requests genetic testing.
B. It identifies patterns of inheritance and clustering that
change screening and referral decisions.
C. Pedigrees are primarily useful for research and rarely affect
individual clinical care.
D. A three-generation history is only required for pediatric or
reproductive specialists.
Correct answer: B
Rationales:
Correct (B): Jarvis underscores the pedigree’s role in pattern
recognition (autosomal dominant, recessive, multifactorial) and
Page 3 of 981
, how clustering influences screening, surveillance, and referral.
This is practical and alters clinical management.
A: Incorrect — pedigree informs risk independently of patient
request and can prompt proactive care.
C: Incorrect — pedigrees frequently inform individual clinical
decision-making, not just research.
D: Incorrect — pedigrees have broad primary care relevance,
not only specialist settings.
Teaching point: A three-generation pedigree reveals inheritance
patterns that alter screening/referral.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3.
Reference: Ch. 1 — Evidence-Based Assessment — Risk
Stratification
Stem: A 45-year-old man with a 20-pack-year smoking history
reports his father had emphysema and his sister has alpha-1
antitrypsin deficiency. His spirometry shows mild airflow
limitation (FEV1/FVC 0.68; FEV1 78% predicted). Which is the
best next step integrating genetics and environment?
Options:
A. Attribute pathology solely to smoking; recommend smoking
cessation only.
B. Order alpha-1 antitrypsin (AAT) level and phenotype testing
Page 4 of 981
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
Reference: Ch. 1 — Evidence-Based Assessment — Genetic Risk
& Family History
Stem: A 36-year-old woman comes for a preconception visit.
She reports her mother had early-onset coronary artery disease
at 48 and her maternal aunt had a stroke at 52. Her blood
pressure today is 142/88 mmHg and BMI is 32. How should you
integrate the family history and current findings when planning
risk reduction?
Options:
A. Reassure the patient that family history is nonmodifiable,
focus only on lifestyle counseling.
B. Prioritize referral for genetic testing for a single gene disorder
Page 1 of 981
,causing premature cardiovascular disease.
C. Counsel on aggressive risk-factor modification now and
consider earlier lipid and glucose screening due to family
clustering.
D. Delay interventions until pregnancy is confirmed to avoid
unnecessary preconception testing.
Correct answer: C
Rationales:
Correct (C): Family clustering of premature cardiovascular
events plus the patient’s elevated BP and obesity suggests
multifactorial inherited risk. Jarvis emphasizes combining family
history with current findings to stratify risk and advance
screening and preventive measures now. Early lipid and glucose
screening and aggressive lifestyle/medical risk-reduction fit
evidence-based preventative practice.
A: Incorrect — although family history is nonmodifiable, it
meaningfully raises risk and requires active intervention, per
Jarvis’ risk assessment approach.
B: Incorrect — premature CAD is usually multifactorial; single-
gene testing isn’t the immediate priority without suggestive
syndromic features.
D: Incorrect — delaying risk reduction until pregnancy risks
maternal harm; preconception optimization is recommended.
Teaching point: Combine family history + current vitals to
advance earlier screening and risk reduction.
Page 2 of 981
,Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
2.
Reference: Ch. 1 — Evidence-Based Assessment — Constructing
a Pedigree
Stem: During a routine visit a 28-year-old asks why you’re taking
a three-generation family history. She says “Isn’t that overkill?”
You note her brother had unexplained recurrent seizures in
childhood and a paternal uncle died of colon cancer at 45.
Which explanation best reflects evidence-based reasons for a
pedigree?
Options:
A. A three-generation pedigree only matters when the patient
requests genetic testing.
B. It identifies patterns of inheritance and clustering that
change screening and referral decisions.
C. Pedigrees are primarily useful for research and rarely affect
individual clinical care.
D. A three-generation history is only required for pediatric or
reproductive specialists.
Correct answer: B
Rationales:
Correct (B): Jarvis underscores the pedigree’s role in pattern
recognition (autosomal dominant, recessive, multifactorial) and
Page 3 of 981
, how clustering influences screening, surveillance, and referral.
This is practical and alters clinical management.
A: Incorrect — pedigree informs risk independently of patient
request and can prompt proactive care.
C: Incorrect — pedigrees frequently inform individual clinical
decision-making, not just research.
D: Incorrect — pedigrees have broad primary care relevance,
not only specialist settings.
Teaching point: A three-generation pedigree reveals inheritance
patterns that alter screening/referral.
Citation: Jarvis, C., & Eckhardt, A. L. (2023). Physical
Examination and Health Assessment (9th ed.). Ch. 1.
3.
Reference: Ch. 1 — Evidence-Based Assessment — Risk
Stratification
Stem: A 45-year-old man with a 20-pack-year smoking history
reports his father had emphysema and his sister has alpha-1
antitrypsin deficiency. His spirometry shows mild airflow
limitation (FEV1/FVC 0.68; FEV1 78% predicted). Which is the
best next step integrating genetics and environment?
Options:
A. Attribute pathology solely to smoking; recommend smoking
cessation only.
B. Order alpha-1 antitrypsin (AAT) level and phenotype testing
Page 4 of 981
