NZREX Clinical History-Taking & Examination 2 β Questions and Answers
Question 1: Which examination finding is most specific for meningism?
- Kernig's sign (Correct answer)
- Romberg's sign
- Babinski's sign
- Lhermitte's sign
Correct answer: Kernig's sign
Kernig's sign (inability to extend the knee when the hip is flexed to 90Β°) is a specific sign of meningeal irritation, seen in meningitis and subarachnoid haemorrhage.
Question 2: When performing a focused musculoskeletal examination of the knee, which test specifically assesses the anterior cruciate ligament?
- Lachman test (Correct answer)
- McMurray test
- Valgus stress test
- Patellar tap
Correct answer: Lachman test
The Lachman test assesses anterior cruciate ligament (ACL) integrity by applying an anterior force to the tibia with the knee at 20β30Β° flexion. It is more sensitive than the anterior drawer test.
Question 3: A patient presents with a tremor. Which feature best distinguishes an essential tremor from a Parkinsonian tremor?
- Essential tremor occurs with action; Parkinsonian tremor is a resting tremor (Correct answer)
- Essential tremor is unilateral; Parkinsonian tremor is bilateral
- Essential tremor affects the legs; Parkinsonian tremor affects the hands only
- Essential tremor is faster in frequency than Parkinsonian tremor
Correct answer: Essential tremor occurs with action; Parkinsonian tremor is a resting tremor
Essential tremor is an action/postural tremor that worsens with movement, whereas Parkinsonian tremor is a resting tremor (pill-rolling) that improves with voluntary movement.
Question 4: When eliciting the history of presenting illness, what does the 'ICE' framework stand for?
- Ideas, Concerns, Expectations (Correct answer)
- Information, Communication, Examination
- Investigation, Clinical findings, Evidence
- Illness, Cause, Experience
Correct answer: Ideas, Concerns, Expectations
ICE stands for Ideas (what the patient thinks is wrong), Concerns (what worries them most), and Expectations (what they hope the consultation will achieve). It ensures patient-centred history-taking.
Question 5: On fundoscopy, which finding is most characteristic of hypertensive retinopathy grade III?
- Flame haemorrhages and cotton wool spots (Correct answer)
- Arteriovenous nipping only
- Papilloedema with no haemorrhages
- Silver wiring with no other changes
Correct answer: Flame haemorrhages and cotton wool spots
Grade III hypertensive retinopathy includes flame-shaped haemorrhages and cotton wool spots (soft exudates), reflecting retinal ischaemia. Grade IV adds papilloedema.
Question 6: A patient presents with ptosis, miosis, and anhidrosis on the right side of the face. Which syndrome does this describe?
- Horner syndrome (Correct answer)
- Argyll Robertson syndrome
- Holmes-Adie syndrome
- Marcus Gunn phenomenon
Correct answer: Horner syndrome
Horner syndrome results from disruption of the sympathetic pathway and presents with ipsilateral ptosis, miosis (pupil constriction), and anhidrosis (loss of sweating) on the affected side.
NZREX Clinical History-Taking & Examination 2
Which examination finding is most specific for meningism?