Bates’ Guide to Physical Examination and History Taking, 11th Edition
Chapter 3: Interviewing and the Health History
Multiple Choice
1. You are
... [Show More] 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 doublebooked 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?
A) Irritability
B) Impatience
C) Boredom
D) Calm
Ans: D
Chapter: 03
Page and Header: 58, Getting Ready: The Approach to the Interview
Feedback: The appearance of calmness and patience, even when time is limited, is the hallmark
of a skilled interviewer.
2. 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?
A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story.
B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport.
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.
D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport.
Ans: C
Chapter: 03
Page and Header: 60, Learning About the Patient: The Sequence of the Interview
Feedback: This is the most productive sequence for the interview. Greeting patients and
establishing rapport allows them to feel more comfortable before “inviting” them to relate their
story. After hearing the patient's story, together you establish the agenda regarding the most
important items to expand upon. At the end, together you negotiate the plan of diagnosis and
treatment.
3. 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?
A) Setting in which the symptom occurs
B) Associated manifestations
C) Quality
D) Timing
Ans: B
Chapter: 03
Page and Header: 65, The Seven Attributes of a Symptom
Feedback: The interviewer has not recorded whether or not the pain has been accompanied by
nausea, vomiting, fever, chills, weight loss, and so on. Associated manifestations are additional
symptoms that may accompany the initial chief complaint and that help the examiner to start
refining his or her differential diagnosis.
4. 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?
A) Severity
B) Setting in which the symptom occurs
C) Timing
D) Associated manifestations
Ans: A
Chapter: 03
Page and Header: 65, The Seven Attributes of a Symptom
Feedback: The severity of the symptom was not recorded by the interviewer, so we have no
understanding as to how bad the symptom is for this patient. The patient could have been asked
to rate his pain on a 0 to 10 scale or used one of the other standardized pain scales available.
This allows the comparison of pain intensity before and after an intervention.
5. 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?
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
B) Reassuring the p [Show Less]