NZREX Clinical History-Taking & Examination 4 β Questions and Answers
Question 1: Which of the following best describes a 'collateral history' and when it is most important?
- History obtained from a third party; most important when the patient cannot reliably self-report (Correct answer)
- History of previous hospital admissions obtained from notes
- History focused solely on medications from the pharmacy
- A second history taken after initial management
Correct answer: History obtained from a third party; most important when the patient cannot reliably self-report
A collateral history is obtained from someone who knows the patient (family, carer, witnesses) and is critical when the patient has impaired cognition, is unconscious, or has psychiatric conditions affecting insight.
Question 2: When examining peripheral pulses, which pulse site is most appropriate for assessing perfusion in a shocked patient?
- Carotid pulse (Correct answer)
- Radial pulse
- Dorsalis pedis pulse
- Femoral pulse
Correct answer: Carotid pulse
In severe shock, peripheral pulses (radial, pedal) may be absent. The carotid pulse is a central pulse that persists until cardiac arrest is imminent, making it the most reliable for assessing perfusion in shock.
Question 3: A patient has asymmetric reflexes with brisk reflexes on the right and absent reflexes on the left arm. Which type of lesion would cause absent reflexes?
- Lower motor neurone lesion (Correct answer)
- Upper motor neurone lesion
- Cerebellar lesion
- Basal ganglia lesion
Correct answer: Lower motor neurone lesion
Absent or reduced reflexes indicate a lower motor neurone lesion affecting the reflex arc (anterior horn cell, nerve root, peripheral nerve, neuromuscular junction, or muscle). UMN lesions cause brisk/exaggerated reflexes.
Question 4: In a patient with suspected deep vein thrombosis (DVT), which clinical scoring system is used to estimate pre-test probability?
- Wells score (Correct answer)
- CURB-65 score
- CHADS2 score
- Glasgow Coma Scale
Correct answer: Wells score
The Wells DVT score estimates pre-test probability of DVT based on clinical features such as calf swelling, tenderness, immobilisation, and active cancer, guiding the decision to request D-dimer or duplex ultrasound.
Question 5: Which auscultatory finding is characteristic of aortic stenosis?
- Ejection systolic murmur loudest at the right upper sternal border radiating to the carotids (Correct answer)
- Pan-systolic murmur loudest at the apex radiating to the axilla
- Mid-diastolic murmur loudest at the apex with the patient in the left lateral position
- Early diastolic murmur at the left lower sternal border
Correct answer: Ejection systolic murmur loudest at the right upper sternal border radiating to the carotids
Aortic stenosis produces an ejection systolic (crescendo-decrescendo) murmur heard best at the right upper sternal border (aortic area) that radiates to the carotid arteries due to turbulent flow across the stenotic valve.
Question 6: When documenting a skin lesion, which descriptor refers to a solid raised lesion less than 1 cm in diameter?
- Papule (Correct answer)
- Macule
- Vesicle
- Plaque
Correct answer: Papule
A papule is a solid, raised skin lesion less than 1 cm in diameter. A macule is flat, a vesicle is fluid-filled, and a plaque is a raised flat-topped lesion greater than 1 cm.
NZREX Clinical History-Taking & Examination 4
Which of the following best describes a 'collateral history' and when it is most important?