Chapter 1: Approach to the Clinical Encounter
1. 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?
a. Adjust lighting so it is tangential to the patient’s body.
b. Explain how the examination will proceed.
c. Ask the patient where he comes from.
d. Explain that she is a PA student.
e. Provide ongoing interpretation of findings.
2. A 34-year-old male with a history of complex social and medical needs (including current substance abuse) presents to
a primary care teaching 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?
a. Focusing on the need for immediate diagnostic certainty over personal connection
b. Taking charge of the interaction to meet the clinician’s desire to acquire diagnostic information
c. Following the patient’s lead to understand their thoughts, ideas, concerns, and requests
d. Deferring respect, empathy, humility, and sensitivity in favor of the acquisition of concrete details about the patient’s
condition
e. Taking a symptom-focused approach to reduce the involvement of the patient’s emotional difficulties
3. 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?
a. Ignoring visual cues to focus on the patient’s exact words
b. Setting aside the patient’s emotional state to focus on his medical needs
c. Paring down the patient’s concerns to concrete medical needs
d. Using nonverbal communication to encourage the patient to expand their narrative
e. Considering a differential diagnosis while the patient is speaking to maximize the patient’s time with the provider
4. 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?
a. Focus, intensity, function, and evaluation
b. Facts, intensity, focus, and evidence
c. Feelings, ideas, function, and expectations
d. Feelings, impression, fantasy, and emotion
e. Facts, intelligence, fortuity, and eventuality
