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Bates’ Guide to Physical Examination and History Taking,10th Edition by Lynn S. Bickley – Test Bank 

 

 

 

Chapter 1: Overview: Physical Examination and History Taking

 

 

 

 

Multiple Choice

 

 

 

 

  1. For which of the following patients would a comprehensive health history be appropriate?
  2. A) A new patient with the chief complaint of “I sprained my ankle”
  3. B) An established patient with the chief complaint of “I have an upper respiratory infection”
  4. C) A new patient with the chief complaint of “I am here to establish care”
  5. D) A new patient with the chief complaint of “I cut my hand”

 

 

 

 

 

  1. The components of the health history include all of the following except which one?
  2. A) Review of systems
  3. B) Thorax and lungs
  4. C) Present illness
  5. D) Personal and social items

 

 

 

  1. Is the following information subjective or objective?

Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest.

  1. A) Subjective
  2. B) Objective

 

  1. Is the following information subjective or objective?

Mr. M. has a respiratory rate of 32 and a pulse rate of 120.

  1. A) Subjective
  2. B) Objective

 

 

 

 

  1. The following information is recorded in the health history: “The patient has had abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric area.”

Which of these categories does it belong to?

  1. A) Chief complaint
  2. B) Present illness
  3. C) Personal and social history
  4. D) Review of systems

 

 

 

  1. The following information is recorded in the health history: “The patient completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week.”

Which category does it belong to?

  1. A) Chief complaint
  2. B) Present illness
  3. C) Personal and social history
  4. D) Review of systems

 

 

 

  1. The following information is recorded in the health history: “I feel really tired.”

Which category does it belong to?

  1. A) Chief complaint
  2. B) Present illness
  3. C) Personal and social history
  4. D) Review of systems

 

 

  1. The following information is recorded in the health history: “Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea.”

Which category does it belong to?

  1. A) Chief complaint
  2. B) Present illness
  3. C) Personal and social history
  4. D) Review of systems

 

 

  1. The following information is best placed in which category?

“The patient has had three cesarean sections.”

  1. A) Adult illnesses
  2. B) Surgeries
  3. C) Obstetrics/gynecology
  4. D) Psychiatric

 

 

  1. The following information is best placed in which category?

“The patient had a stent placed in the left anterior descending artery (LAD) in 1999.”

  1. A) Adult illnesses
  2. B) Surgeries
  3. C) Obstetrics/gynecology
  4. D) Psychiatric

 

 

  1. The following information is best placed in which category?

“The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated.”

  1. A) Adult illnesses
  2. B) Surgeries
  3. C) Obstetrics/gynecology
  4. D) Psychiatric

 

 

 

 

Bates’ Guide to Physical Examination and History Taking, 10th Edition

 

 

Chapter 2: Clinical Reasoning, Assessment, and Recording Your Findings

 

 

 

 

Multiple Choice

 

 

 

 

  1. A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to?
  2. A) Musculoskeletal
  3. B) Reproductive
  4. C) Urinary
  5. D) Endocrine

 

 

 

  1. A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom?
  2. A) Reproductive
  3. B) Urinary
  4. C) Cardiac
  5. D) Hematologic

 

 

 

  1. A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough?
  2. A) Ophthalmologic
  3. B) Auditory
  4. C) Cardiac
  5. D) Endocrine

 

 

 

 

  1. A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct?
  2. A) Infectious
  3. B) Inflammatory
  4. C) Hematologic
  5. D) Traumatic

 

 

 

 

  1. A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven’t worked as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort.  The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process?
  2. A) Infectious
  3. B) Neoplastic
  4. C) Degenerative
  5. D) Traumatic

 

 

 

 

 

  1. A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process?
  2. A) Infection
  3. B) Inflammation
  4. C) Allergic
  5. D) Vascular

 

 

 

  1. A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn’t been. Which of the following physical examination descriptions is most consistent with meningitis?
  2. A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion
  3. B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right
  4. C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion
  5. D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion

 

 

 

 

  1. A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
  2. A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
  3. B) Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
  4. C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
  5. D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.

 

 

  1. A 55-year-old data entry operator comes to the clinic to establish care. She has the following symptoms: headache, neck pain, sinus congestion, sore throat, ringing in ears, sharp brief chest pains at rest, burning abdominal pain with spicy foods, constipation, urinary frequency that is worse with coughing and sneezing, and swelling in legs. This cluster of symptoms is explained by:
  2. A) One disease process
  3. B) More than one disease process

 

 

 

 

  1. A 62-year-old teacher presents to the clinic for evaluation of the following symptoms: fever, headache, sinus congestion, sore throat, green nasal discharge, and cough. This cluster of symptoms is best explained by:
  2. A) One disease process
  3. B) More than one disease process

 

 

 

  1. Steve has just seen a 5-year-old girl who wheezes when exposed to cats. The patient’s family history is positive for asthma.  You think the child most likely has asthma. What have you just accomplished?
  2. A) You have tested your hypothesis.
  3. B) You have developed a plan.
  4. C) You have established a working diagnosis.
  5. D) You have created a hypothesis.

 

 

 

  1. Ms. Washington is a 67-year-old who had a heart attack last month. Now she  complains of shortness of breath and not being able to sleep in a flat position (orthopnea).  On examination you note increased jugular venous pressure, an S3 gallop, crackles low in the lung fields, and swollen ankles (edema).  This is an example of a:
  2. A) Pathophysiologic problem
  3. B) Psychopathologic problem

 

 

 

 

  1. On the way to see your next patient, you glance at the calendar and make a mental note to buy a Mother’s Day card. Your patient is Ms. Hernandez, a 76-year-old widow who lost her husband in May, two years ago. She comes in today with a headaches, abdominal pain, and general malaise.  This happened once before, about a year ago, according to your detailed office notes.  You have done a thorough evaluation but are unable to arrive at a consistent picture to tie these symptoms together.  This is an example of a:
  2. A) Pathophysiologic problem
  3. B) Psychopathologic problem

 

 

 

  1. Mr. Larson is a 42-year-old widowed father of two children, ages 4 and 11. He works in a sales office to support his family.   Recently he has injured his back and you are thinking he would benefit from physical therapy, three times a week, for an hour per session.  What would be your next step?
  2. A) Write the physical therapy prescription.
  3. B) Have your office staff explain directions to the physical therapy center.
  4. C) Discuss the plan with Mr. Larson.
  5. D) Tell Mr. Larson that he will be going to physical therapy three times a week.

 

 

 

  1. You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches.  Today he complains of these pains, as well as dull chest pain under his sternum.  What would the order of priority be for your problem list?
  2. A) Arthritis, war injury pain, headaches, chest pain
  3. B) War injury pain, arthritis, headaches, chest pain
  4. C) Headaches, arthritis, war injury pain, chest pain
  5. D) Chest pain, headaches, arthritis, war injury pain

 

 

 

 

  1. You are excited about a positive test finding you have just noticed on physical examination of your patient. You go on to do more examination, laboratory work, and diagnostic tests, only to find that there is no sign of the disease you thought would correlate with the finding.  This same experience happens several times.  What should you conclude?
  2. A) Consider not doing this test routinely.
  3. B) Use this test when you have a higher suspicion for a certain correlating condition.
  4. C) Continue using the test, perhaps doing less laboratory work and diagnostics.
  5. D) Omit this test from future examinations.

 

 

  1. You are growing fatigued of performing a maneuver on examination because you have never found a positive and are usually pressed for time. How should you next approach this maneuver?
  2. A) Use this test when you have a higher suspicion for a certain correlating condition.
  3. B) Omit this test from future examinations.
  4. C) Continue doing the test, but rely more heavily on laboratory work and diagnostics.
  5. D) Continue performing it on all future examinations.

 

 

 

 

  1. You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your “routine” when examining patients in the midwestern United States.  You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana.  How should you next approach these questions and maneuvers?
  2. A) Continue asking these questions in a more selective way.
  3. B) Stop asking these questions, because they are low yield.
  4. C) Question the validity of the questions.
  5. D) Ask these questions of all your patients.

 

 

 

 

Bates’ Guide to Physical Examination and History Taking, 10th Edition

 

 

Chapter 3: Interviewing and the Health History

 

 

 

 

Multiple Choice

 

 

 

 

  1. You are running late after your quarterly quality improvement meeting at the hospital and have just gotten paged from the nurses’ station because a family member of one of your patients wants to talk with you about that patient’s care. You have clinic this afternoon and are double-booked for the first appointment time; three other patients also have arrived and are sitting in the waiting room. Which of the following demeanors is a behavior consistent with skilled interviewing when you walk into the examination room to speak with your first clinic patient?
  2. A) Irritability
  3. B) Impatience
  4. C) Boredom
  5. D) Calm

 

 

 

 

  1. Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient–provider interview?
  2. A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient’s story.
  3. B) Invite the patient’s story, negotiate a plan, establish the agenda, and establish rapport.
  4. C) Greet the patient, establish rapport, invite the patient’s story, establish the agenda, expand and clarify the patient’s story, and negotiate a plan.
  5. D) Negotiate a plan, establish an agenda, invite the patient’s story, and establish rapport.

 

 

 

  1. Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted?
  2. A) Setting in which the symptom occurs
  3. B) Associated manifestations
  4. C) Quality
  5. D) Timing

 

 

 

  1. Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea.

Which of the following symptom attributes was not addressed in this description?

  1. A) Severity
  2. B) Setting in which the symptom occurs
  3. C) Timing
  4. D) Associated manifestations

 

  1. You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning?
  2. A) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer
  3. B) Reassuring the patient that the urinary symptoms are benign and that she doesn’t need to worry about it being a sign of cancer
  4. C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing
  5. D) Asking her to tell you exactly what she means when she states that she has a urinary tract infection

 

  1. Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say “Go on,” and later, “Mm-hmmm.” This is an example of which of the following skilled interviewing techniques?
  2. A) Echoing
  3. B) Nonverbal communication
  4. C) Facilitation
  5. D) Empathic response

 

 

  1. Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn’t say anything in response to your question. This is an example of which type of challenging patient?
  2. A) Talkative patient
  3. B) Angry patient
  4. C) Silent patient
  5. D) Hearing-impaired patient

 

 

  1. Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?
  2. A) Allow the patient to speak uninterrupted for the duration of the appointment.
  3. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
  4. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.
  5. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end.