BATES' GUIDE TO PHYSICAL
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 58-year-old man with diabetes arrives late to a clinic visit
looking anxious and avoids eye contact. You have 10 minutes
before the next patient; you must begin the encounter. Which
opening approach best aligns with Bates’ recommendations to
establish rapport while prioritizing patient safety and efficient
information gathering?
,Options
A. Start with a rapid, closed-questions review of systems to save
time.
B. Introduce yourself, confirm identity, explain the visit’s
agenda, and invite the patient’s chief concern.
C. Begin immediately with physical exam to quickly assess for
acute problems.
D. Ask family members present to summarize patient's history
before addressing the patient.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter with a
clear introduction, identity confirmation, and agenda setting
while inviting the patient's primary concern. This approach
builds rapport, reduces anxiety, and allows shared prioritization
of issues within time constraints. It is compatible with patient-
centered care and efficient clinical decision-making.
Incorrect (A): Rapid closed questioning may miss the patient’s
most distressing concern and undermines rapport; Bates
recommends open invites before targeted questions.
Incorrect (C): Beginning with the physical exam without an
introduction or agenda can feel abrupt, violates patient
autonomy, and may miss key history needed to guide the exam.
Incorrect (D): Relying on family summary risks missing the
,patient's perspective and may breach privacy; Bates advises
confirming information directly with the patient when possible.
Teaching Point
Agenda setting and patient invitation builds rapport and
clarifies priorities.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 2:
Gathering Information
APRN-Level Question Stem
A 34-year-old woman reports intermittent palpitations and
dizziness. You suspect anxiety but also want to rule out cardiac
causes. Which eliciting technique most effectively applies Bates’
guidance to clarify symptom context and red flags?
Options
A. Ask "Do your palpitations feel like anxiety?" and proceed if
she agrees.
B. Use open-ended questions to explore onset, triggers,
duration, associated symptoms, and alleviating factors.
C. Focus solely on past psychiatric history since anxiety is most
, likely.
D. Order an ECG immediately without further history because
palpitations equal cardiac risk.
Correct Answer
B
Rationales
Correct (B): Bates recommends open-ended exploration of
symptom context (onset, triggers, duration, associated features)
to distinguish benign from urgent etiologies. This clarifies red
flags (syncope, chest pain, dyspnea) that indicate cardiac
evaluation. Detailed history guides appropriate testing and
avoids anchoring bias.
Incorrect (A): Leading questions bias the response and risk
premature diagnostic closure; Bates advises neutral,
exploratory prompts.
Incorrect (C): Ignoring cardiac and other medical causes risks
missed red flags; a broad differential is required.
Incorrect (D): While ECG may be appropriate if red flags
present, immediate testing without focused history is inefficient
and may miss necessary contextual information.
Teaching Point
Use open-ended prompts for onset, triggers, and associated
symptoms to detect red flags.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
EXAMINATION AND HISTORY TAKING
13TH EDITION
• AUTHOR(S)LYNN S. BICKLEY; PETER
G. SZILAGYI; RICHARD M. HOFFMAN;
RAINIER P. SORIANO
TEST BANK
1
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 1: Initiating
the Encounter
APRN-Level Question Stem
A 58-year-old man with diabetes arrives late to a clinic visit
looking anxious and avoids eye contact. You have 10 minutes
before the next patient; you must begin the encounter. Which
opening approach best aligns with Bates’ recommendations to
establish rapport while prioritizing patient safety and efficient
information gathering?
,Options
A. Start with a rapid, closed-questions review of systems to save
time.
B. Introduce yourself, confirm identity, explain the visit’s
agenda, and invite the patient’s chief concern.
C. Begin immediately with physical exam to quickly assess for
acute problems.
D. Ask family members present to summarize patient's history
before addressing the patient.
Correct Answer
B
Rationales
Correct (B): Bates emphasizes initiating the encounter with a
clear introduction, identity confirmation, and agenda setting
while inviting the patient's primary concern. This approach
builds rapport, reduces anxiety, and allows shared prioritization
of issues within time constraints. It is compatible with patient-
centered care and efficient clinical decision-making.
Incorrect (A): Rapid closed questioning may miss the patient’s
most distressing concern and undermines rapport; Bates
recommends open invites before targeted questions.
Incorrect (C): Beginning with the physical exam without an
introduction or agenda can feel abrupt, violates patient
autonomy, and may miss key history needed to guide the exam.
Incorrect (D): Relying on family summary risks missing the
,patient's perspective and may breach privacy; Bates advises
confirming information directly with the patient when possible.
Teaching Point
Agenda setting and patient invitation builds rapport and
clarifies priorities.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
(2021). Bates’ Guide to Physical Examination & History Taking
(13th Ed.). Ch. 1.
2
Reference
Ch. 1 — Approach to the Clinical Encounter — Stage 2:
Gathering Information
APRN-Level Question Stem
A 34-year-old woman reports intermittent palpitations and
dizziness. You suspect anxiety but also want to rule out cardiac
causes. Which eliciting technique most effectively applies Bates’
guidance to clarify symptom context and red flags?
Options
A. Ask "Do your palpitations feel like anxiety?" and proceed if
she agrees.
B. Use open-ended questions to explore onset, triggers,
duration, associated symptoms, and alleviating factors.
C. Focus solely on past psychiatric history since anxiety is most
, likely.
D. Order an ECG immediately without further history because
palpitations equal cardiac risk.
Correct Answer
B
Rationales
Correct (B): Bates recommends open-ended exploration of
symptom context (onset, triggers, duration, associated features)
to distinguish benign from urgent etiologies. This clarifies red
flags (syncope, chest pain, dyspnea) that indicate cardiac
evaluation. Detailed history guides appropriate testing and
avoids anchoring bias.
Incorrect (A): Leading questions bias the response and risk
premature diagnostic closure; Bates advises neutral,
exploratory prompts.
Incorrect (C): Ignoring cardiac and other medical causes risks
missed red flags; a broad differential is required.
Incorrect (D): While ECG may be appropriate if red flags
present, immediate testing without focused history is inefficient
and may miss necessary contextual information.
Teaching Point
Use open-ended prompts for onset, triggers, and associated
symptoms to detect red flags.
Citation
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P.
