NZREX Clinical History-Taking & Examination 4

Question 1

Which of the following best describes a 'collateral history' and when it is most important?

Accepted Answer

History obtained from a third party; most important when the patient cannot reliably self-report

Answer

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?

Accepted Answer

Carotid pulse

Answer

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?

Accepted Answer

Lower motor neurone lesion

Answer

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?

Accepted Answer

Wells score

Answer

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?

Accepted Answer

Ejection systolic murmur loudest at the right upper sternal border radiating to the carotids

Answer

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.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical History-Taking & Examination 4