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Chapter 01: The History and Interviewing Process
Ball: Seidel’s Guide to Physical Examination, 9th Edition
MULTIPLE CHOICE
; Which question would be considered a “leading question?”
| a. | “Please describe any associated symptoms with your headaches?” |
| b. | “You don’t get headaches often, do you?” |
| c. | “What activities affect the severity of your headaches?” |
| d. | “What times of the day are your headaches the most severe?” |
| e. | “What worries you most about your headache?” |
ANS: B
This question would limit the information in the patient’s answer. The other choices allow the patient more discretion about the extent of an answer.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient’s language?
| a. | Ask a person unfamiliar with the patient to translate. |
| b. | Have a friend of the patient translate. |
| c. | Ask simple leading questions that the patient may understand. |
| d. | Use a neighbor as translator. |
| e. | Involve the family with the translation. |
ANS: A
When you do not speak the patient’s language, family members or friends may pose a communication barrier and may have issues of confidentiality; a stranger as an interpreter is less biased.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Periods of silence during the interview can serve important purposes, such as:
| a. | allowing the clinician to catch up on documentation. |
| b. | giving you a clue that you should speed up the interview. |
| c. | providing time for reflection. |
| d. | increasing the length of the visit. |
| e. | promoting a calm environment. |
ANS: C
Silence is a useful tool during interviews for the purposes of reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Which technique is most likely to result in the patient’s understanding of questions?
| a. | Use phrases that are commonly used by other patients in the area. |
| b. | Use the patient’s own terms if possible. |
| c. | Use language that keeps the patient from being expansive in his or her answer. |
| d. | Use proper medical and technical terminology. |
| e. | Use the simplest language possible. |
ANS: B
To ensure that your questions have been correctly understood, be clear, and explicit while using the patient’s idiom and level of understanding.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; A patient becomes restless during the history and says, “I don’t have time for all of this conversation. I’ve got to get back to ; Your most appropriate response would be to:
| a. | stop using open-ended questions and become more direct. |
| b. | ask another open-ended question and insist on an answer. |
| c. | ask questions about his anger and move closer to him. |
| d. | acknowledge his anger and proceed with the history and examination. |
| e. | ignore his displeasure and become more assertive about getting answers. |
ANS: D
This is the only answer that resists the tendency for patient manipulation, pursues the information, and confronts the patient’s anger.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; When questioning a patient regarding alcohol intake, she tells you that she is “only a social ; Which initial response is appropriate?
| a. | “I’m glad that you are a responsible ; |
| b. | “Many people who are really alcoholic say they are social ; |
| c. | “What amount and what kind of alcohol do you drink in a week?” |
| d. | “If you only drink socially, you won’t need to worry about always having a designated ; |
| e. | “Do the other people in your household consume alcohol?” |
ANS: C
This answer clarifies the patient’s own term without asking a leading question or being judgmental.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate?
| a. | “Can you describe the pain?” |
| b. | “The pain doesn’t radiate to your arm, does it?” |
| c. | “Have you been treated for anxiety before?” |
| d. | “Does your father have heart disease?” |
| e. | “Are the pains worse after you eat?” |
ANS: A
Initially, an open-ended question is a more appropriate response. “Can you describe the pain?” is an open-ended question that offers clues to the chief concern.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Ms. A. states, “My life is just too painful. It isn’t worth ; She appears depressed. Which one of the following statements is the most appropriate caregiver response?
| a. | “Try to think about the good things in ; |
| b. | “You shouldn’t feel that way; look at all the good things in your ; |
| c. | “You can’t mean what you’re ; |
| d. | “If you think about it, nothing is worth getting this upset ; |
| e. | “What in life is causing you such pain?” |
ANS: E
Specific yet open-ended questions are best used when the patient has feelings of loss of self-worth and depression. The other responses hurry the patient and offer superficial assurance.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; During an interview, you have the impression that a patient may be considering suicide. Which action is essential?
| a. | Immediately begin proceedings for an involuntary commitment. |
| b. | Ask whether the patient has considered self-harm. |
| c. | Ask whether the patient would like to visit a psychiatrist. |
| d. | Record the impression in the patient’s chart and refer the patient for hospitalization. |
| e. | Avoid directly confronting the patient regarding your impression. |
ANS: B
If you think the patient may be considering suicide, he or she probably is. Mentioning it gives permission to talk about it.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should:
| a. | never be interviewed alone because this may alienate the parent. |
| b. | be mailed a questionnaire in advance to avoid the need for her to talk. |
| c. | be given the opportunity to be interviewed without the parent at some point. |
| d. | be allowed to direct the flow of the interview. |
| e. | be ignored while you address all questions to the parent. |
ANS: C
An older child should be given the opportunity to give information directly. This enhances the probability that the child will follow your advice.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; When communicating with older children and teenagers, you should be sensitive to their:
| a. | parent’s needs. |
| b. | natural urge to communicate. |
| c. | need for verbal instructions. |
| d. | typical reluctance to talk. |
| e. | desire for adult companionship. |
ANS: D
Adolescents are usually reluctant to talk; therefore, the provider should clearly communicate a respect for their confidentiality.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should:
| a. | order a neurology consult. |
| b. | stop all of his medications. |
| c. | continue to press the patient for appropriate answers. |
| d. | validate the concern with his family or caregivers. |
| e. | dismiss the finding as a normal age-related change. |
ANS: D
When older adults experience memory loss for recent events, consult other family members to clarify discrepancies or to fill in the gaps.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; To what extent should the patient with a physical disability or emotional disorder be involved in providing health history information to the health professional?
| a. | All information should be obtained from family members. |
| b. | All information should be collected from past records while the patient is in another room. |
| c. | The patient should be involved only when you sense that he or she may feel ignored. |
| d. | The patient should be fully involved to the limit of his or her ability. |
| e. | The patient should be present during information collection but should not be addressed directly. |
ANS: D
Patients with disabilities may not give an effective history, but they must be respected, and the history must be obtained from them to the greatest extent possible. Family members may help provide a more complete history but not at the exclusion of the patient.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; When taking a history, you should:
| a. | ask patients to give you any information they can recall about their health. |
| b. | start the interview with the patient’s family history. |
| c. | use a chronologic and sequential framework. |
| d. | use a holistic and eclectic structure. |
| e. | start the interview with the social history. |
ANS: C
To give structure to the present problem or chief concern, the provider should proceed in a chronologic and sequential framework. Asking patients to give you any information they can recall about their health and using a holistic and eclectic structure do not provide for structure. Starting the interview with the patient’s family history and with the social history are incorrect because gathering data about the chief concern is the initial step.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; When questioning the patient regarding his or her sexual history, which question should be asked initially?
| a. | “Do you have any particular sexual likes or dislikes?” |
| b. | “Do you have any worries or concerns regarding your sex life?” |
| c. | “How often do you have intercourse and with whom?” |
| d. | “Do you have any reason to think you may have been exposed to a sexually transmitted infection?” |
| e. | “What sexually transmitted diseases have you had in the past?” |
ANS: B
When approaching questioning about a sensitive area, it is recommended that the provider first ask open-ended questions that explore the patient’s feelings about the issue.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Direct questioning about intimate partner violence in the home should be:
| a. | a routine component of history taking with female patients. |
| b. | avoided for fear of offending the woman’s partner. |
| c. | conducted only in cases in which there is a history of abuse. |
| d. | used only when the patient is obviously being victimized. |
| e. | used only when bruises are found on physical examination. |
ANS: A
The presence of intimate partner violence should be routinely queried, and the questioning should be direct for all female patients.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:
| a. | Miller Analogies Test. |
| b. | PACE Assessment Instrument. |
| c. | CAGE questionnaire. |
| d. | Glasgow Coma Scale. |
| e. | HITS questionnaire. |
ANS: C
The CAGE questionnaire is a model for approaching a discussion of the use of alcohol.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; When you enter the examination room of a 3-year-old girl, you find her sitting on her father’s lap. She turns away from you when you greet her. Initially, your best response is to:
| a. | screen the child for sexual abuse. |
| b. | ask the child to be seated on the examination table so you can talk to her father. |
| c. | explain to the child that you will not hurt her and that she will have to trust you. |
| d. | ask the father to persuade the child to cooperate with you. |
| e. | leave the child sitting in the father’s lap while you talk to the father. |
ANS: E
Interaction with children must be modified according to age and in a manner that promotes trust.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom’s health?
| a. | Attachment to parents |
| b. | Tendency to give too much information |
| c. | Low peer support needs |
| d. | Propensity for risk taking |
| e. | High self-esteem |
ANS: D
Adolescents tend to experiment with risky behaviors that lead to a high incidence of morbidity and mortality. Adolescents may be reluctant to provide information.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Pain is difficult to assess in older adults because:
| a. | their histories are usually unreliable. |
| b. | sharp pain may be felt as a dull ache. |
| c. | they tend to exaggerate symptoms. |
| d. | their language skills decline. |
| e. | drugs act more rapidly with age. |
ANS: B
Pain is often an unreliable symptom in older adults because they lose pain perception and experience pain in a different manner from those in other age groups.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; A survey of mobility and activities of daily living (ADL) is part of a(n):
| a. | ethnic assessment. |
| b. | functional assessment. |
| c. | genetic examination. |
| d. | social history. |
| e. | sexual history. |
ANS: B
A functional assessment is an assessment of a patient’s mobility, upper extremity movement, household management, activities of daily living, and instrumental activities of daily living.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; Constitutional symptoms in the ROS refer to:
| a. | height, visual acuity, and body mass index. |
| b. | fever, chills, fatigue, and malaise. |
| c. | hearing loss, tinnitus, and diplopia. |
| d. | rashes, skin turgor, and temperature. |
| e. | joint stiffness, redness, and swelling. |
ANS: B
General constitutional symptoms refer to fever, chills, malaise, fatigability, night sweats, sleep patterns, and weight (average, preferred, present, change).
TOP: Discipline: Behavioral Science MSC: Organ System: General
; has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _____ history.
| a. | complete |
| b. | inventory |
| c. | problem or focused |
| d. | interim |
| e. | family |
ANS: C
If the patient is well known or if you have been seeing the patient for the same problem over time, a focused history is appropriate.
TOP: Discipline: Behavioral Science MSC: Organ System: General
; A pedigree diagram is drafted for the purpose of obtaining:
| a. | sexual orientation and history. |
| b. | growth and developmental status. |
| c. | genetic and familial health problems. |
| d. | ethnic and cultural backgrounds. |
| e. | the past medical history. |
ANS: C
Drafting a pedigree diagram, or genogram, is a method to determine consanguinity of health problems.
TOP: Discipline: Behavioral Science MSC: Organ System: General
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