Clinical History-Taking & Examination Flashcards

A patient with type 2 diabetes presents with a 3-month history of tingling and numbness in both feet in a 'glove and stocking' distribution. Which type of neuropathy does this suggest?

Answer: Distal symmetrical sensory polyneuropathy

Distal symmetrical sensory polyneuropathy is the most common form of diabetic neuropathy, presenting with 'glove and stocking' distribution of sensory symptoms due to length-dependent axonal damage.

When performing a respiratory examination, which finding indicates tracheal deviation and what does it signify?

Answer: Trachea displaced away from the affected side in tension pneumothorax; toward the affected side in collapse

In tension pneumothorax, mediastinal structures including the trachea are pushed away from the affected side. In lung collapse (atelectasis), the trachea is pulled toward the affected side due to reduced lung volume.

Which of the following best describes Trousseau's sign in hypocalcaemia?

Answer: Carpal spasm induced by inflating a blood pressure cuff above systolic pressure for 3 minutes

Trousseau's sign is carpal spasm (main d'accoucheur position) induced by occluding arterial flow with a blood pressure cuff above systolic for 3 minutes, indicating latent tetany due to hypocalcaemia.

A patient presents with sudden severe 'thunderclap' headache. What is the most important diagnosis to exclude?

Answer: Subarachnoid haemorrhage

A thunderclap headache (sudden onset, maximal at onset, 'worst headache of my life') must be investigated urgently to exclude subarachnoid haemorrhage (SAH), as delayed diagnosis significantly worsens outcomes.

When taking a sexual health history, which approach is most appropriate in the context of the NZREX consultation?

Answer: Use open, non-judgmental language and normalise questions by explaining they are routine

A non-judgmental, normalising approach (e.g., 'I ask all my patients these questions') is essential for sexual health history-taking, enabling accurate disclosure and appropriate testing, including STI screening.

Which of the following is the correct technique for assessing capillary refill time?

Answer: Apply pressure to a fingernail for 5 seconds, release, and count seconds until colour returns; normal is under 2 seconds

Capillary refill time (CRT) is measured by applying firm pressure to a fingernail for 5 seconds at heart level, then counting seconds until normal colour returns. Normal CRT is less than 2 seconds; prolonged CRT suggests poor perfusion.