NZREX Clinical History-Taking & Examination 2

Question 1

Which examination finding is most specific for meningism?

Accepted Answer

Kernig's sign

Answer

Kernig's sign (inability to extend the knee when the hip is flexed to 90°) 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?

Accepted Answer

Lachman test

Answer

The Lachman test assesses anterior cruciate ligament (ACL) integrity by applying an anterior force to the tibia with the knee at 20–30° 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?

Accepted Answer

Essential tremor occurs with action; Parkinsonian tremor is a resting tremor

Answer

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?

Accepted Answer

Ideas, Concerns, Expectations

Answer

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?

Accepted Answer

Flame haemorrhages and cotton wool spots

Answer

Grade III hypertensive retinopathy includes flame-shaped haemorrhages and cotton wool spots (soft exudates), reflecting retinal ischaemia. Grade IV adds papilloedema.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical History-Taking & Examination 2