Clinical History-Taking & Examination Flashcards

When taking a history from a patient presenting with chest pain, which mnemonic is most useful for characterising the pain?

Answer: SOCRATES

SOCRATES (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity) is the standard mnemonic for characterising pain in clinical history-taking.

Which finding on auscultation is most consistent with a pleural effusion?

Answer: Stony dull percussion with reduced breath sounds

A pleural effusion produces stony dull percussion note and reduced or absent breath sounds over the effusion due to fluid accumulation in the pleural space.

A 45-year-old presents with gradual onset dyspnoea and bilateral pitting oedema to the knees. Which examination finding would most support a diagnosis of congestive heart failure?

Answer: Elevated JVP with S3 gallop

Elevated JVP and S3 gallop are classic signs of congestive heart failure, reflecting increased venous pressure and a dilated, poorly compliant ventricle.

When examining the abdomen, what is the correct order of examination steps?

Answer: Inspection, auscultation, percussion, palpation

The abdomen is examined in the order: inspection, auscultation, percussion, then palpation. Auscultation precedes percussion and palpation to avoid artificially altering bowel sounds.

Which of the following best describes the 'shifting dullness' sign in abdominal examination?

Answer: Dullness that moves to the dependent side when the patient is rolled

Shifting dullness is elicited by percussing the flanks and then rolling the patient; if ascites is present, the dull area shifts to the dependent side as fluid moves with gravity.

A patient describes waking at night with arm pain and paraesthesia that is relieved by shaking the hand. Which nerve is most likely affected?

Answer: Median nerve

Nocturnal paraesthesia relieved by shaking (the 'flick sign') is characteristic of carpal tunnel syndrome, which involves compression of the median nerve at the wrist.