NZREX Clinical History-Taking & Examination 1 β Questions and Answers
Question 1: When taking a history from a patient presenting with chest pain, which mnemonic is most useful for characterising the pain?
- SOCRATES (Correct answer)
- ABCDE
- SAMPLE
- OLDCARTS
Correct answer: SOCRATES
SOCRATES (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity) is the standard mnemonic for characterising pain in clinical history-taking.
Question 2: Which finding on auscultation is most consistent with a pleural effusion?
- Stony dull percussion with reduced breath sounds (Correct answer)
- Hyper-resonance with absent breath sounds
- Bronchial breathing with coarse crackles
- Wheeze with prolonged expiration
Correct answer: Stony dull percussion with reduced breath sounds
A pleural effusion produces stony dull percussion note and reduced or absent breath sounds over the effusion due to fluid accumulation in the pleural space.
Question 3: A 45-year-old presents with gradual onset dyspnoea and bilateral pitting oedema to the knees. Which examination finding would most support a diagnosis of congestive heart failure?
- Elevated JVP with S3 gallop (Correct answer)
- Tracheal deviation to the right
- Barrel chest with pursed-lip breathing
- Dullness at the right base only
Correct answer: Elevated JVP with S3 gallop
Elevated JVP and S3 gallop are classic signs of congestive heart failure, reflecting increased venous pressure and a dilated, poorly compliant ventricle.
Question 4: When examining the abdomen, what is the correct order of examination steps?
- Inspection, auscultation, percussion, palpation (Correct answer)
- Inspection, percussion, palpation, auscultation
- Palpation, percussion, auscultation, inspection
- Auscultation, inspection, palpation, percussion
Correct answer: Inspection, auscultation, percussion, palpation
The abdomen is examined in the order: inspection, auscultation, percussion, then palpation. Auscultation precedes percussion and palpation to avoid artificially altering bowel sounds.
Question 5: Which of the following best describes the 'shifting dullness' sign in abdominal examination?
- Dullness that moves to the dependent side when the patient is rolled (Correct answer)
- Fixed dullness in the flanks regardless of position
- Dullness in the epigastrium that shifts to the left
- Tympany that becomes dull after percussion of the right iliac fossa
Correct answer: Dullness that moves to the dependent side when the patient is rolled
Shifting dullness is elicited by percussing the flanks and then rolling the patient; if ascites is present, the dull area shifts to the dependent side as fluid moves with gravity.
Question 6: A patient describes waking at night with arm pain and paraesthesia that is relieved by shaking the hand. Which nerve is most likely affected?
- Median nerve (Correct answer)
- Ulnar nerve
- Radial nerve
- Musculocutaneous nerve
Correct answer: Median nerve
Nocturnal paraesthesia relieved by shaking (the 'flick sign') is characteristic of carpal tunnel syndrome, which involves compression of the median nerve at the wrist.
NZREX Clinical History-Taking & Examination 1
When taking a history from a patient presenting with chest pain, which mnemonic is most useful for characterising the pain?