NZREX Clinical History-Taking & Examination 3

Question 1

Which of the following is the most appropriate first step when approaching a systemically unwell patient?

Accepted Answer

ABCDE assessment

Answer

The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is the internationally recognised framework for assessing and managing the acutely unwell patient in a structured, prioritised manner.

Question 2

A patient reports productive cough, fever, and right-sided pleuritic chest pain. On examination there is dullness to percussion and bronchial breathing at the right base. What is the most likely diagnosis?

Accepted Answer

Right lower lobe pneumonia

Answer

Dullness to percussion with bronchial breathing indicates consolidation, consistent with lobar pneumonia. A pleural effusion would cause absent (not bronchial) breath sounds and stony dullness.

Question 3

Which clinical sign is used to assess for hepatomegaly during abdominal examination?

Accepted Answer

Begin percussion in the right iliac fossa and move superiorly until dullness is detected

Answer

Hepatomegaly is assessed by starting percussion in the right iliac fossa (where the liver is absent) and moving upward to detect the superior border of liver dullness, then palpating to confirm the inferior border.

Question 4

What is the primary purpose of the 'systems review' component of a clinical history?

Accepted Answer

To identify symptoms not covered in the presenting complaint that may be relevant

Answer

The systems review (or review of systems) systematically screens for symptoms in each organ system that the patient may not have volunteered, ensuring no relevant information is missed.

Question 5

When examining cranial nerve VII (facial nerve), which movement tests the upper motor neurone versus lower motor neurone?

Accepted Answer

Forehead sparing (UMN) versus forehead involvement (LMN)

Answer

In upper motor neurone facial palsy (e.g., stroke), the forehead is spared due to bilateral cortical representation. In lower motor neurone palsy (e.g., Bell's palsy), the entire ipsilateral face including the forehead is affected.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical History-Taking & Examination 3