PHYSICAL EXAMINATION AND HEALTH
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 32-year-old woman comes for a preconception visit. She
reports her mother had early-onset Alzheimer’s disease and her
brother died of colorectal cancer at 45. Her BMI is 32 kg/m² and
she works in a garment factory with solvent exposures. Family
history reveals two first-degree relatives with cancer. Which of
the following is the best initial clinical interpretation and next
step?
Page 1 of 986
,A. Reassure; no specialized genetic referral needed —
encourage weight loss and prenatal vitamins.
B. Document pedigree, calculate familial risk, and refer to
genetic counseling for targeted risk assessment.
C. Order whole-genome sequencing immediately to screen for
all possible hereditary cancer and dementia genes.
D. Schedule immediate colonoscopy and brain MRI before
conception due to high risk.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes constructing a pedigree and
assessing familial risk as the first step when family history
suggests possible hereditary disease. This stratifies risk and
guides targeted genetic counseling and testing rather than
broad testing. Referral for genetic counseling is evidence-based
and ensures informed, targeted evaluation.
A (incorrect): While lifestyle modification is appropriate,
dismissing the family history without pedigree analysis risks
missing high-penetrance syndromes. Jarvis recommends risk
stratification before reassurance.
C (incorrect): Whole-genome sequencing is not a first-line
screening tool due to complexity, cost, and interpretation
needs; targeted testing after counseling is recommended.
D (incorrect): Immediate invasive testing (colonoscopy, brain
Page 2 of 986
,MRI) without risk stratification is premature; colonoscopy
timing should be personalized after pedigree and counseling.
Teaching point
Start with a detailed pedigree and genetic counseling referral
when first-degree relatives have early-onset disease.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 58-year-old man reports progressive hearing loss and balance
issues; he also has a history of working in shipyards for 30 years
with intermittent loud noise and lead exposure. His father had
late-onset hearing loss. On exam, Weber lateralizes to the right
and Rinne is AC>BC bilaterally. Which interpretation best
integrates genetics and environment?
A. Findings suggest purely conductive loss from cerumen; treat
conservatively.
B. Pattern suggests sensorineural loss likely multifactorial:
occupational noise exposure plus possible familial
predisposition.
C. Lateralization indicates unilateral cholesteatoma; urgent ENT
Page 3 of 986
, referral.
D. Findings are diagnostic for Meniere’s disease; start salt
restriction and diuretics.
Correct answer
B
Rationales
Correct (B): Jarvis underscores gene-environment interaction:
long occupational noise and toxin exposure produce
sensorineural loss, and family history suggests susceptibility.
Weber/Rinne support sensorineural pattern. Management
includes audiology, hearing conservation, and assessment for
modifiable exposures.
A (incorrect): AC>BC bilaterally (positive Rinne) and Weber
lateralization do not fit conductive loss from cerumen. Jarvis
recommends objective testing prior to conservative
assumptions.
C (incorrect): Weber lateralization and Rinne pattern do not
point to unilateral conductive pathology like cholesteatoma.
Also exam lacks otoscopic findings.
D (incorrect): Meniere’s includes episodic vertigo and unilateral
low-frequency hearing loss; exam findings and occupational
history favor multifactorial sensorineural loss.
Teaching point
Integrate exposure history with family history—noise + genetic
susceptibility often cause progressive sensorineural hearing
loss.
Page 4 of 986
ASSESSMENT
9TH EDITION
• AUTHOR(S)CAROLYN JARVIS; ANN L.
ECKHARDT
TEST BANK
1
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 32-year-old woman comes for a preconception visit. She
reports her mother had early-onset Alzheimer’s disease and her
brother died of colorectal cancer at 45. Her BMI is 32 kg/m² and
she works in a garment factory with solvent exposures. Family
history reveals two first-degree relatives with cancer. Which of
the following is the best initial clinical interpretation and next
step?
Page 1 of 986
,A. Reassure; no specialized genetic referral needed —
encourage weight loss and prenatal vitamins.
B. Document pedigree, calculate familial risk, and refer to
genetic counseling for targeted risk assessment.
C. Order whole-genome sequencing immediately to screen for
all possible hereditary cancer and dementia genes.
D. Schedule immediate colonoscopy and brain MRI before
conception due to high risk.
Correct answer
B
Rationales
Correct (B): Jarvis emphasizes constructing a pedigree and
assessing familial risk as the first step when family history
suggests possible hereditary disease. This stratifies risk and
guides targeted genetic counseling and testing rather than
broad testing. Referral for genetic counseling is evidence-based
and ensures informed, targeted evaluation.
A (incorrect): While lifestyle modification is appropriate,
dismissing the family history without pedigree analysis risks
missing high-penetrance syndromes. Jarvis recommends risk
stratification before reassurance.
C (incorrect): Whole-genome sequencing is not a first-line
screening tool due to complexity, cost, and interpretation
needs; targeted testing after counseling is recommended.
D (incorrect): Immediate invasive testing (colonoscopy, brain
Page 2 of 986
,MRI) without risk stratification is premature; colonoscopy
timing should be personalized after pedigree and counseling.
Teaching point
Start with a detailed pedigree and genetic counseling referral
when first-degree relatives have early-onset disease.
Citation
Jarvis, C., & Eckhardt, A. L. (2023). Physical Examination and
Health Assessment (9th ed.). Ch. 1.
2
Reference
Ch. 1 — Evidence-Based Assessment — Genetics & Environment
Stem
A 58-year-old man reports progressive hearing loss and balance
issues; he also has a history of working in shipyards for 30 years
with intermittent loud noise and lead exposure. His father had
late-onset hearing loss. On exam, Weber lateralizes to the right
and Rinne is AC>BC bilaterally. Which interpretation best
integrates genetics and environment?
A. Findings suggest purely conductive loss from cerumen; treat
conservatively.
B. Pattern suggests sensorineural loss likely multifactorial:
occupational noise exposure plus possible familial
predisposition.
C. Lateralization indicates unilateral cholesteatoma; urgent ENT
Page 3 of 986
, referral.
D. Findings are diagnostic for Meniere’s disease; start salt
restriction and diuretics.
Correct answer
B
Rationales
Correct (B): Jarvis underscores gene-environment interaction:
long occupational noise and toxin exposure produce
sensorineural loss, and family history suggests susceptibility.
Weber/Rinne support sensorineural pattern. Management
includes audiology, hearing conservation, and assessment for
modifiable exposures.
A (incorrect): AC>BC bilaterally (positive Rinne) and Weber
lateralization do not fit conductive loss from cerumen. Jarvis
recommends objective testing prior to conservative
assumptions.
C (incorrect): Weber lateralization and Rinne pattern do not
point to unilateral conductive pathology like cholesteatoma.
Also exam lacks otoscopic findings.
D (incorrect): Meniere’s includes episodic vertigo and unilateral
low-frequency hearing loss; exam findings and occupational
history favor multifactorial sensorineural loss.
Teaching point
Integrate exposure history with family history—noise + genetic
susceptibility often cause progressive sensorineural hearing
loss.
Page 4 of 986
