NR509 Midterm Review -Bates Guide to Physical
Examination 13th edition Chapters 1-17 (Answered)
Patient and clinician-centered
The approach to a clinical encounter
Echolalia
repetition of the words and phrases of others
Occurs in manic and schizophrenia
Clinicians
Experts have defined patient-centered interviewing as "following the patient's lead to
understand their thoughts, ideas, concerns and requests, without adding additional
information from the ________ perspective."
F-I-F-E
Feelings
Ideas
Functional effect
Expectations
Guided questioning
Moves from open-ended to focused questions
Offers multiple choices for answers
Using echoing
Clarifies what the patient is saying
Asking a series of questions one at a time
What are some types of challenging patients?
Silent, talkative, aggressive, argumentative, discriminatory, flirtatious, nonadherent,
confusing narrative
Comprehensive Assessment
Used for patients you are seeing for the 1st time. Includes all elements.
Focused Assessment
Used for patients you know well returning for routine care, or specific "urgent care"
Components of the health history
ALL SUBJECTIVE"
Initial information (age, gender, source of info), CC, HPI, OLDCART, PMH, FH, SH,
ROS
What should be listed under adult illnesses in health history?
Medical illnesses (DM, HTN, astham etc)
Surgical (dates, indication, type)
OBGYN (menstrual hx, obs hx, contraception)
Psychiatric (dx, hospitalizations, treatments)
Problem list
Summarizes all related problems that support a differential diagnosis.
Most active listed 1st.
,Differential diagnosis with pertinent + and -
social determinants of health
economic stability, education, neighborhood and built environment, health and health
care, social and community context.
Explain how the examination will proceed.
A 23-year-old physician assistant (PA) student found that she felt nervous when called
upon to examine men in her age group. On one occasion, she encountered a young
male patient who appeared embarrassed to see her walk into the room. What should
the PA do to minimize their mutual discomfort?
Follow the patient's lead to understand their thoughts, feeling, and ideas.
A 34-year-old male with a history of complex social and medical needs (including
current substance abuse) presents to a PC clinic. The patient has experienced a
number of adversarial relationships with prior clinicians, including voluntarily leaving two
practices within the previous year and being asked to leave care at a third clinic due to
misbehavior. The attending physician desires to utilize the approaches to this patient
that are most likely lead to comprehensive care and patient compliance. Which of the
following is the most appropriate interview style for the attending physician to use?
Using nonverbal communication to encourage the patient to expand their narrative
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his
brother, who convinced the patient to attend the clinic after he disclosed that he prefers
homosexual partners but is afraid that his last partner may have given him an infection.
The patient expresses to the intake nurse that he is unashamed of his sexual orientation
and will not stay through the visit if he feels that he is dismissed or discriminated against
because of it. The nurse practitioner receives this communication prior to entering the
examination room and decides to employ active listening to best connect with the
patient at this critical juncture in his care with the clinic. Which of the following is an
example of an active listening technique?
Feelings, ideas, function, expectations
A 42-year-old female mathematician presents for follow-up care regarding a new
diagnosis of systemic lupus erythematosus 6 months ago after a lengthy diagnostic
process during which she was debilitated with fatigue and joint pain. Since her
diagnosis, she has been minimally compliant with medications and has switched her
rheumatology provider twice. She continues to feel ill, and, in explanation for her lack of
adherence to the prescribed treatment, she simply says, “I don’t like it.” At this initial visit
with her third rheumatology provider, the clinician elects to explore the issues behind
her noncompliance before engaging in diagnostics and treatment using the FIFE model.
Which of the following best defines the elements of the FIFE model?
The 5 P's of the Social History
Partners
Practices
Protection from STI's
Past history of STI
Pregnancy plans
Review of Systems (ROS)
Constitutional
HEENT
,Neck
Breasts
Respiratory
Cardiovascular
Gastrointestinal
Peripheral Vascular
Genitourinary
Musculoskeletal
Integumentary
Neurological
Psychiatric
Endocrine
Hematological
Allergy/Immunological
Obtain a more complete description of problems.
A 39-year-old nurse who is a well-established patient complains of irregular menstrual
periods and pelvic pain. She says that she is having trouble sleeping and asks whether
she could be given a “sleeping pill.” The patient also says she is thinking of leaving her
job. What is the best “next step” in caring for this patient?
Validating and empathetic with open-ended questions
A 29-year-old female professional athlete presents to a new primary care provider with
chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical fitness
and conditioning. She is seeking a care provider who will explore the issue in more
detail and work with her particular concerns. Which of the following is the description of
the patient-centered care this individual seeks?
Recognizing the patient’s emotions by asking or confirming how she feels about the
event
A 36-year-old female air traffic controller presents to her primary care provider for a
routine visit 3 months after losing her spouse to a lengthy battle with a
neurodegenerative disease. The patient denies any psychiatric symptoms on review of
systems and, in fact, states that she has slept better in the last month than she had in
the previous years. She endorses a healthy support system, including the extended
family of her deceased spouse, with whom she is still close. She becomes wistful and
briefly tearful when speaking of the plans that they had when they first married that were
never fulfilled; she then changes the subject rapidly to whether her Pap smear is due.
Which of the following is an example of an empathetic response to this patient?
Moving from open-ended to focused questions
A 63-year-old male presents to establish care at a new primary care clinic to discuss
issues with pain and fatigue. The clinician conducting the visit begins with general
historical questions but quickly becomes suspicious that the patient is suffering from
decompensated heart failure. When the patient mentions that he has had vague chest
pain since last night, the clinician feels that the focus must be redirected to this
potentially emergent condition. Which of the following interview techniques is the most
appropriate to effectively manage this visit?
Echoing
, A 59-year-old patient presents to his primary care provider with a history of several
episodes of sharp epigastric pain. His father died of pancreatic cancer at age 52 years,
and the patient recalls to the clinician that, “His pain was just like mine is now …” The
patient then pauses several seconds. The clinician replies, “Just like?” after which the
patient restarts his narrative. Which of the following is an example of the interviewing
techniques employed by the clinician?
“That sounds like a frightening experience that you are recovering well from.”
A 14-year-old male presents to a new primary care provider after his family relocates to
a state. The patient underwent treatment for sarcoma when he was age 11 years,
including an above-the-knee amputation. He has learned to successfully navigate with a
prosthetic leg and even engage in competitive athletics at school. He does not like to
speak of his experience with cancer and often makes up humorous stories to tell new
acquaintances about his amputation (such as, “I got bit by a squirrel and they had to
amputate.”). Although he is very well engaged in most of the visit with the new clinician,
when the topic of cancer arises, he demurs to his father, who accompanies him to this
appointment. Which of the following statements is most likely to be helpful in cementing
the patient’s trust in the new provider?
Cut over eye from shaving
A 54-year-old diplomat working at the United Nations reports occasional chest pain and
a sense of tightness in his chest when particularly stressed over work deadlines. The
patient is 6 feet 4 inches tall. He has a temperature of 98.6ºF and blood pressure of
140/78. He has a cut over one eye that he says is “from shaving.” Which of the following
represents subjective information about this patient?
Accelerated heart rate
A 32-year-old office worker reports excessive stress at work and pain in the right lower
quadrant. She states that last night she vomited twice. Her blood pressure is 120/75,
heart rate 93 bpm. The patient looks pale and is sweating lightly. Which of the following
is an objective finding?
Determine the number of pack-years the patient smokes.
A 29-year-old electrician complains of persistent cough and wheezing, particularly when
he exercises. He says he smokes “occasionally” but rarely so much that he needs to
purchase cigarettes: “Mostly, I bum them,” he says, chuckling. Upon hearing this
information, what is the best next step on the part of the clinician?
Obtain a menstrual history for the previous 6 months.
A 47-year-old fitness trainer visits the physician assistant (PA) because of skin dryness,
night sweats, and irregular menstrual periods. It is the PA’s first contact with this patient.
The patient notes that “My sex life has really gone downhill lately” and says that she is
considering divorcing her husband of 20 years, stating that “He’s not a bad guy. I just
think that I can do better.” In which of the following ways should the clinician proceed?
A comprehensive health history
A 26-year-old homeless male presents for a new-patient evaluation at a community
health center. He has a history of intravenous drug use, from which he contracted
hepatitis C. He also suffers from uncontrolled asthma that he has had since childhood,
with treatment including frequent doses of oral steroids when he cannot keep inhalers in
his possession. Two years ago, he was diagnosed with bipolar disorder. On today’s
visit, his main concern is a small abscess in his right antecubital fossa at a heroin
Examination 13th edition Chapters 1-17 (Answered)
Patient and clinician-centered
The approach to a clinical encounter
Echolalia
repetition of the words and phrases of others
Occurs in manic and schizophrenia
Clinicians
Experts have defined patient-centered interviewing as "following the patient's lead to
understand their thoughts, ideas, concerns and requests, without adding additional
information from the ________ perspective."
F-I-F-E
Feelings
Ideas
Functional effect
Expectations
Guided questioning
Moves from open-ended to focused questions
Offers multiple choices for answers
Using echoing
Clarifies what the patient is saying
Asking a series of questions one at a time
What are some types of challenging patients?
Silent, talkative, aggressive, argumentative, discriminatory, flirtatious, nonadherent,
confusing narrative
Comprehensive Assessment
Used for patients you are seeing for the 1st time. Includes all elements.
Focused Assessment
Used for patients you know well returning for routine care, or specific "urgent care"
Components of the health history
ALL SUBJECTIVE"
Initial information (age, gender, source of info), CC, HPI, OLDCART, PMH, FH, SH,
ROS
What should be listed under adult illnesses in health history?
Medical illnesses (DM, HTN, astham etc)
Surgical (dates, indication, type)
OBGYN (menstrual hx, obs hx, contraception)
Psychiatric (dx, hospitalizations, treatments)
Problem list
Summarizes all related problems that support a differential diagnosis.
Most active listed 1st.
,Differential diagnosis with pertinent + and -
social determinants of health
economic stability, education, neighborhood and built environment, health and health
care, social and community context.
Explain how the examination will proceed.
A 23-year-old physician assistant (PA) student found that she felt nervous when called
upon to examine men in her age group. On one occasion, she encountered a young
male patient who appeared embarrassed to see her walk into the room. What should
the PA do to minimize their mutual discomfort?
Follow the patient's lead to understand their thoughts, feeling, and ideas.
A 34-year-old male with a history of complex social and medical needs (including
current substance abuse) presents to a PC clinic. The patient has experienced a
number of adversarial relationships with prior clinicians, including voluntarily leaving two
practices within the previous year and being asked to leave care at a third clinic due to
misbehavior. The attending physician desires to utilize the approaches to this patient
that are most likely lead to comprehensive care and patient compliance. Which of the
following is the most appropriate interview style for the attending physician to use?
Using nonverbal communication to encourage the patient to expand their narrative
A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his
brother, who convinced the patient to attend the clinic after he disclosed that he prefers
homosexual partners but is afraid that his last partner may have given him an infection.
The patient expresses to the intake nurse that he is unashamed of his sexual orientation
and will not stay through the visit if he feels that he is dismissed or discriminated against
because of it. The nurse practitioner receives this communication prior to entering the
examination room and decides to employ active listening to best connect with the
patient at this critical juncture in his care with the clinic. Which of the following is an
example of an active listening technique?
Feelings, ideas, function, expectations
A 42-year-old female mathematician presents for follow-up care regarding a new
diagnosis of systemic lupus erythematosus 6 months ago after a lengthy diagnostic
process during which she was debilitated with fatigue and joint pain. Since her
diagnosis, she has been minimally compliant with medications and has switched her
rheumatology provider twice. She continues to feel ill, and, in explanation for her lack of
adherence to the prescribed treatment, she simply says, “I don’t like it.” At this initial visit
with her third rheumatology provider, the clinician elects to explore the issues behind
her noncompliance before engaging in diagnostics and treatment using the FIFE model.
Which of the following best defines the elements of the FIFE model?
The 5 P's of the Social History
Partners
Practices
Protection from STI's
Past history of STI
Pregnancy plans
Review of Systems (ROS)
Constitutional
HEENT
,Neck
Breasts
Respiratory
Cardiovascular
Gastrointestinal
Peripheral Vascular
Genitourinary
Musculoskeletal
Integumentary
Neurological
Psychiatric
Endocrine
Hematological
Allergy/Immunological
Obtain a more complete description of problems.
A 39-year-old nurse who is a well-established patient complains of irregular menstrual
periods and pelvic pain. She says that she is having trouble sleeping and asks whether
she could be given a “sleeping pill.” The patient also says she is thinking of leaving her
job. What is the best “next step” in caring for this patient?
Validating and empathetic with open-ended questions
A 29-year-old female professional athlete presents to a new primary care provider with
chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has
experienced a dismissal of her complaints because of her high level of physical fitness
and conditioning. She is seeking a care provider who will explore the issue in more
detail and work with her particular concerns. Which of the following is the description of
the patient-centered care this individual seeks?
Recognizing the patient’s emotions by asking or confirming how she feels about the
event
A 36-year-old female air traffic controller presents to her primary care provider for a
routine visit 3 months after losing her spouse to a lengthy battle with a
neurodegenerative disease. The patient denies any psychiatric symptoms on review of
systems and, in fact, states that she has slept better in the last month than she had in
the previous years. She endorses a healthy support system, including the extended
family of her deceased spouse, with whom she is still close. She becomes wistful and
briefly tearful when speaking of the plans that they had when they first married that were
never fulfilled; she then changes the subject rapidly to whether her Pap smear is due.
Which of the following is an example of an empathetic response to this patient?
Moving from open-ended to focused questions
A 63-year-old male presents to establish care at a new primary care clinic to discuss
issues with pain and fatigue. The clinician conducting the visit begins with general
historical questions but quickly becomes suspicious that the patient is suffering from
decompensated heart failure. When the patient mentions that he has had vague chest
pain since last night, the clinician feels that the focus must be redirected to this
potentially emergent condition. Which of the following interview techniques is the most
appropriate to effectively manage this visit?
Echoing
, A 59-year-old patient presents to his primary care provider with a history of several
episodes of sharp epigastric pain. His father died of pancreatic cancer at age 52 years,
and the patient recalls to the clinician that, “His pain was just like mine is now …” The
patient then pauses several seconds. The clinician replies, “Just like?” after which the
patient restarts his narrative. Which of the following is an example of the interviewing
techniques employed by the clinician?
“That sounds like a frightening experience that you are recovering well from.”
A 14-year-old male presents to a new primary care provider after his family relocates to
a state. The patient underwent treatment for sarcoma when he was age 11 years,
including an above-the-knee amputation. He has learned to successfully navigate with a
prosthetic leg and even engage in competitive athletics at school. He does not like to
speak of his experience with cancer and often makes up humorous stories to tell new
acquaintances about his amputation (such as, “I got bit by a squirrel and they had to
amputate.”). Although he is very well engaged in most of the visit with the new clinician,
when the topic of cancer arises, he demurs to his father, who accompanies him to this
appointment. Which of the following statements is most likely to be helpful in cementing
the patient’s trust in the new provider?
Cut over eye from shaving
A 54-year-old diplomat working at the United Nations reports occasional chest pain and
a sense of tightness in his chest when particularly stressed over work deadlines. The
patient is 6 feet 4 inches tall. He has a temperature of 98.6ºF and blood pressure of
140/78. He has a cut over one eye that he says is “from shaving.” Which of the following
represents subjective information about this patient?
Accelerated heart rate
A 32-year-old office worker reports excessive stress at work and pain in the right lower
quadrant. She states that last night she vomited twice. Her blood pressure is 120/75,
heart rate 93 bpm. The patient looks pale and is sweating lightly. Which of the following
is an objective finding?
Determine the number of pack-years the patient smokes.
A 29-year-old electrician complains of persistent cough and wheezing, particularly when
he exercises. He says he smokes “occasionally” but rarely so much that he needs to
purchase cigarettes: “Mostly, I bum them,” he says, chuckling. Upon hearing this
information, what is the best next step on the part of the clinician?
Obtain a menstrual history for the previous 6 months.
A 47-year-old fitness trainer visits the physician assistant (PA) because of skin dryness,
night sweats, and irregular menstrual periods. It is the PA’s first contact with this patient.
The patient notes that “My sex life has really gone downhill lately” and says that she is
considering divorcing her husband of 20 years, stating that “He’s not a bad guy. I just
think that I can do better.” In which of the following ways should the clinician proceed?
A comprehensive health history
A 26-year-old homeless male presents for a new-patient evaluation at a community
health center. He has a history of intravenous drug use, from which he contracted
hepatitis C. He also suffers from uncontrolled asthma that he has had since childhood,
with treatment including frequent doses of oral steroids when he cannot keep inhalers in
his possession. Two years ago, he was diagnosed with bipolar disorder. On today’s
visit, his main concern is a small abscess in his right antecubital fossa at a heroin
