Clinical History-Taking & Examination Flashcards

Which of the following is the most appropriate first step when approaching a systemically unwell patient?

Answer: ABCDE assessment

The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is the internationally recognised framework for assessing and managing the acutely unwell patient in a structured, prioritised manner.

A patient reports productive cough, fever, and right-sided pleuritic chest pain. On examination there is dullness to percussion and bronchial breathing at the right base. What is the most likely diagnosis?

Answer: Right lower lobe pneumonia

Dullness to percussion with bronchial breathing indicates consolidation, consistent with lobar pneumonia. A pleural effusion would cause absent (not bronchial) breath sounds and stony dullness.

Which clinical sign is used to assess for hepatomegaly during abdominal examination?

Answer: Begin percussion in the right iliac fossa and move superiorly until dullness is detected

Hepatomegaly is assessed by starting percussion in the right iliac fossa (where the liver is absent) and moving upward to detect the superior border of liver dullness, then palpating to confirm the inferior border.

What is the primary purpose of the 'systems review' component of a clinical history?

Answer: To identify symptoms not covered in the presenting complaint that may be relevant

The systems review (or review of systems) systematically screens for symptoms in each organ system that the patient may not have volunteered, ensuring no relevant information is missed.

When examining cranial nerve VII (facial nerve), which movement tests the upper motor neurone versus lower motor neurone?

Answer: Forehead sparing (UMN) versus forehead involvement (LMN)

In upper motor neurone facial palsy (e.g., stroke), the forehead is spared due to bilateral cortical representation. In lower motor neurone palsy (e.g., Bell's palsy), the entire ipsilateral face including the forehead is affected.

A 70-year-old patient presents with confusion. Which validated tool is most appropriate for brief cognitive assessment in the acute setting?

Answer: Abbreviated Mental Test Score (AMTS)

The AMTS (10 questions, score 0–10) is rapid and validated for use in acute settings to screen for cognitive impairment. The MMSE and MoCA are more detailed and better suited to outpatient cognitive assessment.