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 28-year-old pregnant woman (12 weeks) reports that her
mother had "a blood clot during pregnancy" and her maternal
aunt had a deep vein thrombosis (DVT) at age 35. She is
otherwise healthy and asks whether she should have genetic
testing. You note she is a smoker (5 cigarettes/day) and the
prenatal chart lists no prior miscarriages. How do you interpret
her family history and next best step?
Page 1 of 988
,Options
A. Recommend immediate thrombophilia genetic testing
because family DVTs indicate a high likelihood of inherited
thrombophilia.
B. Explain that family history suggests possible inherited risk but
first obtain a three-generation pedigree and refer for genetic
counseling before testing.
C. Reassure that isolated family DVTs are irrelevant to
pregnancy risk and no action is needed besides routine prenatal
care.
D. Start prophylactic anticoagulation during pregnancy based
solely on family history to prevent DVT.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes structured history (three-
generation pedigree) and evidence-based risk assessment
before ordering genetic tests. A pedigree clarifies inheritance
patterns and ages of onset; genetic counseling addresses
implications for pregnancy and testing utility. This approach
balances patient safety and avoids unnecessary testing.
Incorrect (A): Ordering immediate testing ignores pretest
probability and counseling—Jarvis warns against indiscriminate
testing without pedigree and counseling.
Incorrect (C): Dismissing family history risks missing heritable
thrombophilia; Jarvis recommends targeted assessment when
Page 2 of 988
,family history suggests possible inherited disease.
Incorrect (D): Starting anticoagulation solely on family history is
unsafe—therapeutic interventions require confirmed risk
stratification and specialist guidance.
Teaching Point
Obtain a three-generation pedigree and genetic counseling
before testing for inherited thrombophilia.
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 6-year-old boy presents with frequent nosebleeds and easy
bruising. Parents report a maternal uncle had "bleeding
problems." On exam you note multiple ecchymoses and
prolonged bleeding from a venipuncture site. Which
interpretation and immediate action best aligns with evidence-
based assessment?
Options
A. Diagnose hemophilia and start factor replacement therapy
immediately.
Page 3 of 988
, B. Obtain a focused three-generation family history, order
targeted coagulation studies (PT, aPTT, platelet count), and
consider urgent hematology referral.
C. Attribute symptoms to physical play common in boys and
schedule routine follow-up.
D. Start empirical vitamin K injections while awaiting additional
history.
Correct Answer
B
Rationales
Correct (B): Jarvis highlights combining focused family history
with objective testing to interpret bleeding patterns. A
maternal-family pattern suggests possible X-linked disorder, so
quick coagulation studies and hematology referral ensure safe,
evidence-based triage.
Incorrect (A): Immediate diagnosis and factor therapy without
confirmatory labs and specialist input risks inappropriate
treatment.
Incorrect (C): Dismissing significant bleeding and a suggestive
family pattern is unsafe and contradicts Jarvis’ emphasis on red
flags.
Incorrect (D): Empiric vitamin K assumes deficiency; it may
delay correct diagnosis and is not indicated without supporting
evidence.
Page 4 of 988
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics and
Environment
Stem
A 28-year-old pregnant woman (12 weeks) reports that her
mother had "a blood clot during pregnancy" and her maternal
aunt had a deep vein thrombosis (DVT) at age 35. She is
otherwise healthy and asks whether she should have genetic
testing. You note she is a smoker (5 cigarettes/day) and the
prenatal chart lists no prior miscarriages. How do you interpret
her family history and next best step?
Page 1 of 988
,Options
A. Recommend immediate thrombophilia genetic testing
because family DVTs indicate a high likelihood of inherited
thrombophilia.
B. Explain that family history suggests possible inherited risk but
first obtain a three-generation pedigree and refer for genetic
counseling before testing.
C. Reassure that isolated family DVTs are irrelevant to
pregnancy risk and no action is needed besides routine prenatal
care.
D. Start prophylactic anticoagulation during pregnancy based
solely on family history to prevent DVT.
Correct Answer
B
Rationales
Correct (B): Jarvis emphasizes structured history (three-
generation pedigree) and evidence-based risk assessment
before ordering genetic tests. A pedigree clarifies inheritance
patterns and ages of onset; genetic counseling addresses
implications for pregnancy and testing utility. This approach
balances patient safety and avoids unnecessary testing.
Incorrect (A): Ordering immediate testing ignores pretest
probability and counseling—Jarvis warns against indiscriminate
testing without pedigree and counseling.
Incorrect (C): Dismissing family history risks missing heritable
thrombophilia; Jarvis recommends targeted assessment when
Page 2 of 988
,family history suggests possible inherited disease.
Incorrect (D): Starting anticoagulation solely on family history is
unsafe—therapeutic interventions require confirmed risk
stratification and specialist guidance.
Teaching Point
Obtain a three-generation pedigree and genetic counseling
before testing for inherited thrombophilia.
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 6-year-old boy presents with frequent nosebleeds and easy
bruising. Parents report a maternal uncle had "bleeding
problems." On exam you note multiple ecchymoses and
prolonged bleeding from a venipuncture site. Which
interpretation and immediate action best aligns with evidence-
based assessment?
Options
A. Diagnose hemophilia and start factor replacement therapy
immediately.
Page 3 of 988
, B. Obtain a focused three-generation family history, order
targeted coagulation studies (PT, aPTT, platelet count), and
consider urgent hematology referral.
C. Attribute symptoms to physical play common in boys and
schedule routine follow-up.
D. Start empirical vitamin K injections while awaiting additional
history.
Correct Answer
B
Rationales
Correct (B): Jarvis highlights combining focused family history
with objective testing to interpret bleeding patterns. A
maternal-family pattern suggests possible X-linked disorder, so
quick coagulation studies and hematology referral ensure safe,
evidence-based triage.
Incorrect (A): Immediate diagnosis and factor therapy without
confirmatory labs and specialist input risks inappropriate
treatment.
Incorrect (C): Dismissing significant bleeding and a suggestive
family pattern is unsafe and contradicts Jarvis’ emphasis on red
flags.
Incorrect (D): Empiric vitamin K assumes deficiency; it may
delay correct diagnosis and is not indicated without supporting
evidence.
Page 4 of 988
