Clinical Skills Questions And Answers Cmt Nta 4

 


  1. Mention six (6) pulses which can be palpated during physical examination
    (a) Radial pulse
    (b) Brachial pulse
    (c) Carotid pulse
    (d) Femoral pulse
    (e) Dorsalis pedis pulse
    (f) Posterior tibia pulse
  2. Mention four (4) most important parameter to assess during inspection in respiratory
    examination.
    (a) Skin of the chest e.g.; scars, tradition marks, tattoo etc.
    (b) Shape of the chest wall and the spine
    (c) Chest movement
    (d) Respiratory rate and pattern
  3. Where considerable splenomegaly is present, mention six (6) of its typical characteristics
    (a) A firm swelling appearing beneath the left subcostal margin in the left upper quadrant of
    the abdomen
    (b) It is dull to percussion
    (c) Moves downwards on inspiration
    (d) It is not bimanually palpable
    (e) Its upper border cannot be felt (i.e. one cannot “get above it”),
    (f) A notch can often be felt in the lower medial border.
  4. Mention five (5) signs of Respiratory Distress that can be Inspected
    (a) Cyanosis i.e. centrally or peripherally
    (b) Chest wall in-drawing
    (c) Accessory muscle use
    (d) Abnormal respiratory rate and rhythm example apnea, gasping
    (e) Diaphragmatic Paradox e.g. flail chest
    (f) Nasal flaring
    (g) Head nodding with every breath
  5. Mention six (6) causes of elevated jugular venous pressure
    (a) Congestive heart failure
    (b) Cor pulmonale
    (c) Pulmonary embolism
    (d) Right ventricular infarction
    (e) Tricuspid valve disease
    (f) Cardiac Tamponade
    (g) Constrictive pericarditis
  6. What are the four (4) systematically arranged cardinal techniques of physical examination?
    (a) Inspection
    (b) Palpation
    (c) Percussion
    (d) Auscultation
  7. Mention six (6) common symptoms of the Respiratory System
    (a) Chest pain
    (b) Shortness of breath (dyspnoea)
    (c) Wheezing
    (d) Cough
    (e) Sputum
    (f) Blood streak sputum (haemoptysis)
  8. Auscultation of the abdomen detect three (3) important thing, which are;
    (a) Bowel sounds
    (b) Bruits
    (c) Succusion splash
  9. Mention four (4) main groups of lymph nodes which can be palpable during physical
    examination
    (a) Cervical lymphnodes
    (b) Supraclavicular lymphnodes
    (c) Axillary lymphnodes
    (d) Inguinal lymphnodes
  10. Mention four (4) signs which can be palpable during respiratory examination
    (a) Locate the mediastinal position by locating the position of the trachea
    (b) Palpate any part of the chest and identify pathological defect
    (c) Palpate for pain and tenderness
    (d) Identify apex beat
    (e) Examine chest expansion
    (f) Perform tactile vocal fremitus (TVF)
  11. Mention five (5) preparations before doing physical examination to a patient
    (a) Take some time to prepare for the task ahead.
    (b) Reflect your approach to the patient e.g. stay calm
    (c) Prepare the environment e.g. Set the bed for patients comfort during examination
    (d) Prepare and check your equipment
    (e) Make the patient comfortable
  12. Mention six (6) components of motor system in Central nervous system examination
    (a) Muscle bulkiness
    (b) Muscle tone
    (c) Muscle power
    (d) Reflexes
    (e) Cordination
    (f) Involuntary movement
  13. Mention six (6) deep reflexes which can be examined during central nervous system
    examination
    (a) Triceps jerk
    (b) Biceps jerk
    (c) Supinator jerk
    (d) Jaw jerk
    (e) Knee jerk
    (f) Ankle jerk
    (g) Clonus
  14. Mention any six (6) clinical features which can be elicited when a mass/ swelling is noted
    during abdominal examination
    (a) Site
    (b) Size
    (c) Shape
    (d) Consistence (faeces may indented by pressure)
    (e) Smoothness
    (f) Surroundings
    (g) Whether you can get above it
    (h) Movement with respiration (liver or spleen)
    (i) Tenderness
  15. Mention five (5) behaviours which are unacceptable in a therapeutic relationship
    (a) Abuse (physical, emotional, verbal, sexual or financial)
    (b) Initiating a social/personal relationship with a patient
    (c) Neglect
    (d) Acting as a representative for patients under powers of attorney or representation
    agreements
    (e) Prejudice – neither the client nor the therapist should ever use racist or sexist language or
    behaviours
  16. Mention five (5) strategies the clinician might consider using in maintaining therapeutic
    relationships during history taking
    (a) Understanding the limits of the therapeutic relationship
    (b) Adhering to the plan of care
    (c) Communicating the expectations for and limits of confidentiality
    (d) Being sensitive to the context in which the care is provided
    (e) Implementing reflective practice
    (f) Concluding the therapeutic relationship
  17. Mention six (6) different situations that need special attention during History taking
    (a) Patient becoming silent
    (b) Confusing patient
    (c) Patient with altered capacity
    (d) Talkative patient
    (e) Crying patient
    (f) Angry or disruptive patient
    (g) Interview across language barrier
    (h) Patient with low literacy
    (i) Patient with impaired hearing
    (j) Patient with impaired vision
    (k) Patient with limited intelligence
    (l) Patient with personal problems
  18. Mention four (4) important parameters to document in general survey of the patient during
    general examination
    (a) Physical appearance (age, sexual development, skin colour, facial features, signs of acute
    distress, visible devices and equipment)
    (b) Body structure (stature, nutrition, symmetry, posture, position, body build and contour,
    obvious physical deformities)
    (c) Mobility (may verbalize, gait and range of motion as noted upon walking into exam room)
    (d) Behaviours (facial expression, mood and affect, speech, dress, personal hygiene)
  19. Mention six (6) essential equipments for physical examination
    (a) A stethoscopes for auscultation
    (b) Sphygmomanometer for measuring blood pressure
    (c) A thermometer for measuring body temperature
    (d) Cotton for testing the sense of light touch
    (e) Gloves and lubricant for oral, vaginal and rectal examinations
    (f) A penlight for inspection of hidden body parts like in the ears
    (g) Safety pins for testing two point discrimination
    (h) Watch with second hand for evaluation of pulse
    (i) Ophthalmoscope for examination of eyes and otoscope for examination of ears
    (j) Patella hammer for examining reflex
    (k) Tape measures for evaluation of lengths
  20. Mention five (5) general signs of cardiovascular diseases examination
    (a) Finger clubbing
    (b) Cyanosis
    (c) Anaemia
    (d) Coldness of the extremities
    (e) Lower limb oedema
    (f) Splinter haemorrhages in the nail bed
    (g) Janeway lesions (painless erythematous lesions on the palms)
    (h) Osler’s nodes (tender erythematous nodules in the pulps of the fingers)
  21. Mention five (5) general signs of respiratory disease during examination
    (a) Finger clubbing
    (b) Cyanosis
    (c) Nasal flaring
    (d) Head-nodding with every breath
    (e) Nicotine stains
  22. Mention five (5) general signs of per abdominal diseases during examination
    (a) Koilonychia
    (b) Leuconychia
    (c) Clubbing of the fingers
    (d) Spider naevi
    (e) Palmar erythema
    (f) Dupytren’s contracture
    (g) Coarse jerky tremor of hepatic or uraemic failure
  23. Mention three reactions of the patient that indicate pathology on assessing abdominal
    muscular tone:
    (a) Guarding (muscles contract as pressure is applied)
    (b) Rigidity (rigid abdominal wall indicates peritoneal inflammation)
    (c) Rebound tenderness (release of pressure causes pain)
  24. Mention four (4) important parameters to assess in higher center during CNS examination of
    the patient
    (a) Level of consciousness
    (b) Orientation to Time Place and Person
    (c) Memory i.e. both long and short term memories
    (d) Speech
    (e) Appearance, behaviour and communication
  25. Mention four (4) routine sensory modalities that can be tested at the bed side:
    (a) Light touch
    (b) Position sense (the appreciation of passive movement)
    (c) Vibration
    (d) Pain
  26. Mention four (4) components of natal history during pediatric history taking
    (a) Place of delivery; Hospital or home delivery,
    (b) Duration of pregnancy during delivery ;if the pregnancy full term or not
    (c) Mode of delivery; if it is a spontaneous vertex delivery (SVD), assisted breach delivery
    (ASD), caesarean section (CS), vacuum or forceps delivery?
    (d) If the baby cried immediately after birth? Or was it after some hours
    (e) When the baby was the baby able to suck after delivery
  27. Mention four (4) major parameters for developmental milestones during pediatric history
    taking
    (a) Movement and posture
    (b) Vision and manipulation
    (c) Hearing and speech
    (d) Social behavior
  28. Mention six (6) common complaints of pregnant women
    (a) No menses (amenorrhea) (all trimesters)
    (b) Nausea with or without vomiting (first trimester)
    (c) Breast tenderness, tingling (first trimester)
    (d) Weight loss (first trimester)
    (e) Fatigue (first/ third trimester)
    (f) Groin/lower abdominal pain (second trimester (14- 20 weeks))
    (g) Abdominal striae (late second or third trimester)
    (h) Concentration (third trimester)
    (i) Loss of mucous plug (third trimester)
    (j) Oedema (third trimester)
    (k) Heartburn constipation (all trimesters)
    (l) Backache (all trimesters)
    (m) Urinary frequency (all trimesters)
    (n) Leucorrhoea (all trimesters)
  29. Mention three (3) cranial nerves which have only sensory functions
    (a) Olfactory nerve
    (b) Optic nerve
    (c) Vestibulocochlear nerve
  30. Mention four (4) cranial nerves which have both sensory and motor functions
    (a) Trigeminal nerve
    (b) Facial nerve
    (c) Glossopharyngeal nerve
    (d) Vagus nerve
  31. Mention five (5) cranial nerves which have only motor functions
    (a) Oculomotor nerve
    (b) Trochlea nerve
    (c) Abducent nerve
    (d) Accessory nerve
    (e) Hypoglossal nerve
  32. Mention five (5) components of gynecological history
    (a) Attaining menarche (Menarche: Establishment of ‘menstrual function’ the time of the first
    menstrual period).
    (b) Menstrual cycle and its regularity
    (c) Periods/ amount of blood loss
    (d) Gynaecological surgery
    (e) Contraception history
    (f) Previous infections and their treatment
  33. Mention five (5) causes of enlargement of the spleen
    (a) Infective eg; infective endocarditis, typhoid, tuberculosis, HIV, malaria
    (b) Inflammatory eg Rheumatoid arthritis
    (a) Haematological eg; leukaemia, lymphoma, sickle cell disease
    (b) Portal hypertension
  34. List FIVE (5) symptoms of nervous system
    (a) Headache
    (b) Dizziness/Vertigo
    (c) Head injury
    (d) Seizures
    (e) Weakness
    (f) Incoordination
    (g) Numbness/Tingling
    (h) Difficulty swallowing
    (i) Difficulty speaking
    (j) Tremors
  35. The Glasgow Coma Scale is employed in estimating and categorizing the level of consciousness
    on the basis of overall social capability or dependence on others. Write down components of verbal response and their score
    (a) Oriented ——————————————————————–5 points
    (b) Confused conversation, but able to answer questions ———4 points
    (c) Inappropriate responses, words discernible———————–3 points
    (d) Incomprehensible speech ———————————————2 points
    (e) None ————————————————————————1 point
  36. The Glasgow Coma Scale is employed in estimating and categorizing the level of consciousness
    on the basis of overall social capability or dependence on others. Write down components of motor response and their score
    (a) Obeys commands for movement ———————– 6 points
    (b) Purposeful movement to painful stimulus ———– 5 points
    (c) Withdraws from pain ————————————— 4 points
    (d) Abnormal (spastic) flexion, decorticate posture —–3 points
    (e) Extensor (rigid) response, decerebrate posture—— 2 points
    (f) None ———————————————————— 1 point
  37. Mention five (5) components of a social history during history taking
    (a) Occupation and last year of schooling
    (b) Home situation and significant others
    (c) Sources of stress, both recent and long term
    (d) Important life experience such military service, job history, financial situation, and
    retirement
    (e) Leisure activities, religious affiliation and spiritual beliefs, and activities of daily living
    (ADLs)
  38. List five (5) components of a good pediatric history that differentiate it with the adult history
    (a) Antenatal history
    (b) Natal history
    (c) Postal history
    (d) Developmental milestones
    (e) Immunization history
    (f) Dietary history
  39. During assessment for information and documentation in the antenatal card, (RCH 4 Card),
    the introduction part consist a lot. List five (5) of them of obstetric history importance.
    (a) Name
    (b) Age in years
    (c) Gravidity
    (d) Parity
    (e) LNMP
    (f) EDD
    (g) GA
  40. List four (4) methods you can use to determine the Expected Date of Delivery (EDD).
    (a) Naegele’s rule:
    (b) Extrapolation from the fundal height at booking
    (c) Ultrasound
    (d) Extrapolation from the first date of quickening
  41. List down ways you will use in taking history from a patient with Impaired Vision
    (a) When meeting a blind person, shake hands to establish contact
    (b) Explain who you are and why you are there
    (c) Orient the patient to the surrounding and report if anyone else is present in the room
    (d) Adjust the light
    (e) Encourage the patient to wear glasses whenever possible
    (f) Use only words to communicate because gestures cannot be seen by the patient
  42. Mention five (5) ways of preparing the patient for abdominal examination
    (a) Position – patient should be in supine position on the bed or examination couch
    (b) The patient’s hands should remain at their sides, with their head resting on a pillow.
    (c) If the neck is flexed, the abdominal musculature becomes tense and the examination made
    more difficult
    (d) When the patient is allowed to bend their knees so that the soles of their feet rest on the
    examination table, their abdomen will relax.
    (e) The patient should be exposed only from the pubic symphysis below to the costal margin above – in women to just below the breasts.
  43. List five (5) anatomical areas where Cyanosis can be seen during physical examination
    (a) Lips
    (b) Tongue
    (c) Palms
    (d) Soles
    (e) Skin
  44. Mention four (4) positive findings that can be seen on the HAND during general examination,
    giving at least one example of possible underlined disease condition
    (a) Pallor-Anemia from any cause I.e. infections, nutritional deficiency.
    (b) Jaundice-Malaria, Liver diseases i.e. hepatitis, Liver Cirrhosis
    (c) Finger clubbing-CHD, PTB, Bronchiectasis
    (d) Cyanosis- respiratoty diseases,Cardiovascular diseases eg TOF
    (e) Skin lesions- scabies, dermatitis, Impetigo
    (f) Coldness- Shock 45. Mention the vital signs and their respective equipments used to measure each particular vital
    sign
    (a) Blood Pressure- Sphygmomanometer
    (b) Body temperature – Thermometer
    (c) Heart rate- Stop watch
    (d) Respiratory rate – Stop watch
  45. Sara is a 5 years old girl who brought to you at the hospital as you was an “on call” doctor on
    that particular day, Her mother reported to you that over recent few weeks she noticed her
    daughter to have abdominal swelling that tend to advance as the time goes. You examine
    Sara and you find her abdomen is grossly distended. What are the possible impressions (at
    least five) for her complain
    (a) Fluid/Ascites
    (b) Flatus
    (c) Feaces
    (d) Fat
    (e) Mass i.e hepatomegally, spleenomegally
  46. List five (5) characteristics of therapeutic relationship
    (a) Rapport
    (b) Trust
    (c) Genuineness
    (d) Unconditional positive regard
    (e) Empathy
    (f) Collaboration
    (g) Humour
  47. List five (5) areas that you can assess for Pallor
    (a) Conjuctiva
    (b) Tongue
    (c) Buccal mucosa
    (d) Palms
    (e) Vagina
  48. Briefly describe the general components of a patient history
  49. Discuss the techniques for Skilled Interviewing during history taking
  50. Describe the characteristics of a therapeutic relationship
  51. Discuss how you would differentiate an enlarged spleen from an enlarged kidney on
    abdominal examination.
  52. Explain how a chief complaint of abdominal pain is amplified in history of present illness
    during history taking.
  53. NOTE: Be aware of History taking in special situations

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