Clinical History-Taking & Examination Flashcards

When taking a psychiatric history, which component specifically explores the patient's understanding of their illness?

Answer: Insight

Insight in psychiatric assessment refers to the patient's awareness and understanding that they have a mental illness and that their experiences may be symptoms of that illness. It informs treatment planning and capacity assessment.

Which clinical sign is elicited by asking the patient to hold their arms outstretched with wrists dorsiflexed, and is associated with hepatic encephalopathy?

Answer: Asterixis (flapping tremor)

Asterixis (flapping tremor or liver flap) is elicited with arms outstretched and wrists extended. It represents inability to maintain posture due to brief lapses in muscle contraction, classically seen in hepatic encephalopathy.

A 28-year-old woman presents with amenorrhoea for 10 weeks. On examination the uterus is palpable at the umbilicus. What gestational age does this most likely correspond to?

Answer: 20 weeks

The fundal height in centimetres approximately equals gestational age in weeks from 20 weeks onward. At 20 weeks, the fundus reaches the umbilicus. At 10 weeks the uterus is not yet abdominally palpable.

Which of the following is the most appropriate technique for auscultating the mitral valve?

Answer: Bell of the stethoscope at the apex with the patient in the left lateral decubitus position

The mitral area is the apex of the heart. The bell (low-frequency sounds) in the left lateral position brings the apex closer to the chest wall, enhancing detection of the low-pitched mitral stenosis murmur.

When assessing a patient's gait, which pattern is characterised by the foot being lifted high and slapping down due to foot drop?

Answer: Steppage gait

Steppage gait results from foot drop (weakness of ankle dorsiflexion), causing the patient to lift the knee excessively to clear the foot, which then slaps down. It indicates a common peroneal nerve or L4/L5 lesion.

Which symptom in a patient with haematuria most increases concern for bladder cancer?

Answer: Painless macroscopic haematuria

Painless macroscopic (visible) haematuria in adults is a red flag symptom for urothelial malignancy (bladder or kidney cancer) until proven otherwise, and requires urgent investigation with urine cytology and cystoscopy.