NZREX Clinical Assessment Skills 2 — Questions and Answers
Question 1: In the NZREX, when examining a patient with suspected peripheral vascular disease, what clinical test assesses arterial insufficiency in the lower limbs?
- Buerger's test — elevate the leg to 45 degrees and observe for pallor, then hang the leg over the bed and observe for reactive hyperaemia (Correct answer)
- Trendelenburg test only
- Straight leg raise test
- McMurray's test
Correct answer: Buerger's test — elevate the leg to 45 degrees and observe for pallor, then hang the leg over the bed and observe for reactive hyperaemia
Buerger's test assesses arterial insufficiency: the leg is elevated to 45 degrees (pallor indicates poor arterial supply), then hung over the bed edge (delayed reactive hyperaemia — a dusky red colour — confirms arterial insufficiency).
Question 2: During a NZREX cranial nerve examination, which cranial nerves are tested when you ask the patient to smile and raise their eyebrows?
- Cranial nerve VII (facial nerve) — assessing both upper and lower motor neuron function (Correct answer)
- Cranial nerve V (trigeminal nerve)
- Cranial nerve XII (hypoglossal nerve)
- Cranial nerve X (vagus nerve)
Correct answer: Cranial nerve VII (facial nerve) — assessing both upper and lower motor neuron function
Asking a patient to smile and raise their eyebrows tests cranial nerve VII (facial nerve). The ability to raise eyebrows helps distinguish between upper motor neuron (forehead spared) and lower motor neuron (forehead affected) lesions.
Question 3: When examining a knee joint in the NZREX, what does a positive anterior drawer test indicate?
- Anterior cruciate ligament (ACL) injury (Correct answer)
- Posterior cruciate ligament (PCL) injury
- Medial meniscus tear
- Lateral collateral ligament injury
Correct answer: Anterior cruciate ligament (ACL) injury
A positive anterior drawer test (the tibia slides forward on the femur when the examiner pulls it anteriorly with the knee at 90 degrees) indicates an anterior cruciate ligament (ACL) injury.
Question 4: In the NZREX clinical exam, what is the correct method to assess for ascites using the shifting dullness technique?
- Percuss from the midline laterally until dullness is detected, then ask the patient to roll towards you and wait 30 seconds before re-percussing (Correct answer)
- Simply inspect the abdomen for distension
- Use deep palpation only
- Auscultate for bowel sounds in all four quadrants
Correct answer: Percuss from the midline laterally until dullness is detected, then ask the patient to roll towards you and wait 30 seconds before re-percussing
To test for shifting dullness: percuss from the midline (resonant over air-filled bowel) laterally until dullness is found (fluid). Mark this point, ask the patient to roll towards you, wait 30 seconds for fluid to shift, then re-percuss. If the previously dull area is now resonant, ascites is present.
Question 5: During a NZREX dermatological assessment, what systematic approach should be used to describe a skin lesion?
- Site, size, shape, surface, surrounding skin, colour, consistency, and distribution (Correct answer)
- Name the diagnosis first, then describe the lesion
- Note only whether the lesion is raised or flat
- Describe only the colour and size
Correct answer: Site, size, shape, surface, surrounding skin, colour, consistency, and distribution
A systematic approach to skin lesion description includes: site (location), size (measured), shape (round, irregular), surface (smooth, scaly), surrounding skin, colour, consistency (firm, soft), and distribution (localised, generalised, dermatomal).
Question 6: In the NZREX, what clinical findings differentiate an upper motor neuron (UMN) from a lower motor neuron (LMN) lesion?
- UMN: increased tone, hyperreflexia, upgoing plantar response, no fasciculations; LMN: decreased tone, hyporeflexia, downgoing plantar response, fasciculations and wasting (Correct answer)
- UMN: wasting and fasciculations; LMN: increased tone and hyperreflexia
- There is no clinical difference between UMN and LMN lesions
- UMN always affects only the legs; LMN only affects the arms
Correct answer: UMN: increased tone, hyperreflexia, upgoing plantar response, no fasciculations; LMN: decreased tone, hyporeflexia, downgoing plantar response, fasciculations and wasting
UMN lesions cause increased tone (spasticity), hyperreflexia, extensor plantar response (Babinski positive), and no fasciculations. LMN lesions cause decreased tone (flaccidity), hyporeflexia, flexor plantar response, and fasciculations with muscle wasting.
NZREX Clinical Assessment Skills 2
In the NZREX, when examining a patient with suspected peripheral vascular disease, what clinical test assesses arterial insufficiency in the lower limbs?