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 woman presents for preconception counseling. Her
mother had early-onset breast cancer at age 42; the patient
reports no current symptoms. Family history reveals breast
cancer in two maternal relatives across two generations. On
exam, BMI 24, no palpable masses. Which is the most
appropriate next step?
Page 1 of 987
,Options
A. Reassure and recommend routine prenatal vitamins when
pregnant.
B. Offer referral for genetic counseling and discussion of BRCA
testing.
C. Order diagnostic breast MRI now despite normal exam.
D. Recommend annual mammography starting immediately.
Correct answer
B
Rationale — Correct
Jarvis emphasizes collecting a detailed three-generation family
history to identify hereditary cancer syndromes. Multiple first-
and second-degree relatives with early-onset breast cancer
suggests high hereditary risk; genetic counseling (not
immediate testing without counseling) is the evidence-based
next step to discuss testing, implications, and cascade
screening. This approach prioritizes informed consent and
family risk management.
Rationale — Incorrect
A. Reassurance alone misses a possible hereditary cancer
syndrome; not evidence-based given significant family history.
C. Diagnostic MRI is for suspicious findings or known high-risk
patients after counseling; ordering it without counseling or
testing is premature.
D. Immediate mammography at 28 is not guideline-based for
Page 2 of 987
,asymptomatic young women; management depends on risk
assessment and counseling.
Teaching point
Three-generation pedigree → refer to genetic counseling when
early-onset familial cancers appear.
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-month-old infant is brought in for well visit. Mother reports
pica and the baby’s sibling was recently diagnosed with lead
poisoning. The infant appears pale and has delayed milestones
on screening. Capillary hemoglobin is 9.5 g/dL. What is the
priority action?
Options
A. Start oral iron supplementation immediately and recheck in 4
weeks.
B. Perform venous blood lead level testing and home
environmental assessment.
C. Assume iron deficiency from poor diet; advise iron-fortified
Page 3 of 987
, cereal.
D. Order a head CT to evaluate for central nervous system lead
effects.
Correct answer
B
Rationale — Correct
Jarvis stresses environment as a determinant of child health
and recommends targeted screening when exposure risk exists.
Given family/sibling lead poisoning, low hemoglobin, and
developmental delay, confirm exposure with venous blood lead
level and initiate an environmental/home assessment to
remove source. This addresses both diagnosis and prevention—
critical for child safety.
Rationale — Incorrect
A. Iron may be needed but starting without addressing
potential lead exposure delays urgent environmental
remediation and lead testing.
C. Assuming dietary cause misses toxic exposure risk—contrary
to environmental assessment priorities.
D. Head CT is not first-line for lead exposure; neuroimaging is
reserved for focal neurologic signs.
Teaching point
Suspected lead exposure → venous lead level + environmental
remediation urgently.
Page 4 of 987
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 woman presents for preconception counseling. Her
mother had early-onset breast cancer at age 42; the patient
reports no current symptoms. Family history reveals breast
cancer in two maternal relatives across two generations. On
exam, BMI 24, no palpable masses. Which is the most
appropriate next step?
Page 1 of 987
,Options
A. Reassure and recommend routine prenatal vitamins when
pregnant.
B. Offer referral for genetic counseling and discussion of BRCA
testing.
C. Order diagnostic breast MRI now despite normal exam.
D. Recommend annual mammography starting immediately.
Correct answer
B
Rationale — Correct
Jarvis emphasizes collecting a detailed three-generation family
history to identify hereditary cancer syndromes. Multiple first-
and second-degree relatives with early-onset breast cancer
suggests high hereditary risk; genetic counseling (not
immediate testing without counseling) is the evidence-based
next step to discuss testing, implications, and cascade
screening. This approach prioritizes informed consent and
family risk management.
Rationale — Incorrect
A. Reassurance alone misses a possible hereditary cancer
syndrome; not evidence-based given significant family history.
C. Diagnostic MRI is for suspicious findings or known high-risk
patients after counseling; ordering it without counseling or
testing is premature.
D. Immediate mammography at 28 is not guideline-based for
Page 2 of 987
,asymptomatic young women; management depends on risk
assessment and counseling.
Teaching point
Three-generation pedigree → refer to genetic counseling when
early-onset familial cancers appear.
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-month-old infant is brought in for well visit. Mother reports
pica and the baby’s sibling was recently diagnosed with lead
poisoning. The infant appears pale and has delayed milestones
on screening. Capillary hemoglobin is 9.5 g/dL. What is the
priority action?
Options
A. Start oral iron supplementation immediately and recheck in 4
weeks.
B. Perform venous blood lead level testing and home
environmental assessment.
C. Assume iron deficiency from poor diet; advise iron-fortified
Page 3 of 987
, cereal.
D. Order a head CT to evaluate for central nervous system lead
effects.
Correct answer
B
Rationale — Correct
Jarvis stresses environment as a determinant of child health
and recommends targeted screening when exposure risk exists.
Given family/sibling lead poisoning, low hemoglobin, and
developmental delay, confirm exposure with venous blood lead
level and initiate an environmental/home assessment to
remove source. This addresses both diagnosis and prevention—
critical for child safety.
Rationale — Incorrect
A. Iron may be needed but starting without addressing
potential lead exposure delays urgent environmental
remediation and lead testing.
C. Assuming dietary cause misses toxic exposure risk—contrary
to environmental assessment priorities.
D. Head CT is not first-line for lead exposure; neuroimaging is
reserved for focal neurologic signs.
Teaching point
Suspected lead exposure → venous lead level + environmental
remediation urgently.
Page 4 of 987
