NZREX Clinical Assessment Skills β Questions and Answers
Question 1: During a NZREX clinical examination, you are assessing a patient with acute abdominal pain. What is the correct sequence for abdominal examination?
- Inspection, auscultation, percussion, palpation (Correct answer)
- Palpation, percussion, auscultation, inspection
- Inspection, palpation, percussion, auscultation
- Auscultation, inspection, palpation, percussion
Correct answer: Inspection, auscultation, percussion, palpation
The correct sequence for abdominal examination is inspection, auscultation, percussion, then palpation. Auscultation comes before palpation and percussion because palpation can alter bowel sounds, leading to inaccurate findings.
Question 2: In the NZREX exam, what is the essential first step when approaching any clinical station?
- Introduce yourself, confirm the patient's identity, explain what you intend to do, and obtain consent (Correct answer)
- Begin the physical examination immediately to save time
- Read the patient's notes before speaking to them
- Ask the examiner for additional information
Correct answer: Introduce yourself, confirm the patient's identity, explain what you intend to do, and obtain consent
In NZREX (and NZ clinical practice), you must always introduce yourself, verify the patient's identity, explain the examination or procedure, and obtain informed consent before proceeding. This reflects NZ consumer rights standards.
Question 3: When performing a cardiovascular examination in the NZREX, what clinical signs should you specifically check in the hands?
- Clubbing, splinter haemorrhages, Janeway lesions, Osler's nodes, and peripheral cyanosis (Correct answer)
- Grip strength and finger dexterity only
- Temperature of the skin only
- Capillary refill time only
Correct answer: Clubbing, splinter haemorrhages, Janeway lesions, Osler's nodes, and peripheral cyanosis
In a cardiovascular examination, the hands may reveal important signs: clubbing (cyanotic heart disease), splinter haemorrhages (endocarditis), Janeway lesions (painless, endocarditis), Osler's nodes (painful, endocarditis), and peripheral cyanosis.
Question 4: During a respiratory examination in the NZREX, what does increased tactile vocal fremitus on one side suggest?
- Consolidation (such as pneumonia) on that side (Correct answer)
- Pleural effusion on that side
- Pneumothorax on that side
- Normal finding β no pathology
Correct answer: Consolidation (such as pneumonia) on that side
Increased tactile vocal fremitus occurs when sound is transmitted more efficiently through consolidated (solid) lung tissue, as in pneumonia. Decreased fremitus would suggest pleural effusion or pneumothorax, which block sound transmission.
Question 5: In the NZREX clinical exam, how should you assess for cerebellar dysfunction?
- Test for dysmetria (finger-nose test), dysdiadochokinesia (rapid alternating movements), intention tremor, gait ataxia, and nystagmus (Correct answer)
- Only check for Romberg's sign
- Test deep tendon reflexes only
- Perform a Mini Mental State Examination
Correct answer: Test for dysmetria (finger-nose test), dysdiadochokinesia (rapid alternating movements), intention tremor, gait ataxia, and nystagmus
Cerebellar examination includes testing for dysmetria (finger-nose and heel-shin tests), dysdiadochokinesia (inability to perform rapid alternating movements), intention tremor, gait ataxia (broad-based, unsteady gait), and nystagmus.
Question 6: When examining a patient's thyroid in the NZREX, what is the correct technique?
- Stand behind the patient, ask them to swallow water, and palpate the thyroid as it moves with swallowing (Correct answer)
- Stand in front of the patient and press firmly on the neck
- Use a stethoscope to listen to the thyroid only
- Examine the thyroid with the patient lying flat
Correct answer: Stand behind the patient, ask them to swallow water, and palpate the thyroid as it moves with swallowing
The thyroid should be examined from behind the patient, using both hands to palpate the gland. Asking the patient to swallow water helps identify the thyroid as it moves upward with the larynx during swallowing.
NZREX Clinical Assessment Skills
During a NZREX clinical examination, you are assessing a patient with acute abdominal pain.
What is the correct sequence for abdominal examination?