QUESTIONS AND ANSWERS | CLINICAL SKILLS | CMT NTA LEVEL 4

 1. This is a finding from a patient with left sided pleural effusion:

A. Symmetrical chest expansion

B. Stone dullness on the left side                          

C. Increased tactile vocal fremitus

D. Trachea deviate to the left side

E. Increased breath sounds on the left side

 

2. Regarding mental status examination:

A. Cannot be used to assess the patient’s behaviour

B. Patient short and long term memory can be determined.

C. Orientation to people time and place is normally not done         

D. A full mental status examination is often short when done using GCS.

E. Level of consciousness can be determined using rapid eye movement technique.

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3. A 26-year-old female present to you with the history of recurrent admissions.

Which part of history need more details?

A. Main complain

B. Family social history

C. Past medical history

D. Gynecological history  

E. History of present illness

 

4. Regarding “Empathy” as the characteristic of therapeutic relationship:

A. The clinician need to the patient talk openly

B. The clinician needs to be able to enter into the client private world

C. The client need to ask for help from the clinician and give appreciation

D. The clinician need to feel what the client is feeling and show emotional reaction.

E. The clinician needs to make patient decision during the whole process of history taking

 

5. One of the following is not relevant when taking antenatal history:

A. History blood transfusion

B. Date of the first antenatal visits

C. Investigations done on the first visit

D. History of tetanus toxoid immunization

E. History of intermittent preventive therapy

 

 

6. When reviewing other systems during history taking:

A. The affected system is reviewed first

B. Review all systems including the affected system    

C. Ask questions in series starting from affected system

D. System mentioned in the main complaint is reviewed first.

E. Review systems which are not included in history of the presenting illness

 

7. One of the following is a technique used when attending a confused patient:

A. Empathy

B. Evaluation of mental status

C. Clarifying the patient concerns

D. Avoiding being confrontational

E. Encouraging the patient to continue

 

8. Regarding taking past medical history to a 15-year-old male patient:

A. Childhood illness are not asked

B. Immunizations history is not part of it

C. History of blood transfusion and surgery is asked                         

D. Normally we ask the history of chronic illness in the family

E. It gives the detailed information of what the patient is suffering

 

9. Regarding examination of cardiovascular system:

A. Heart sounds are best heard using your palm

B. Pulse should be counted in one complete minute

C. The apex beat is located using stethoscope diaphragm.

D. Jugular venous pressure is measured when the patient is lying flat

E. Apex beat is normally located in 5^th  intercostal space along the anterior axillary line

 

10. The following instrument is used to examine deep tendon during nervous system examination:

A. Test tube     

B. Safety pin

C. Tuning fork

D. Cotton wool

E. Patella hammer

 

 

 

 

 

SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS

Instructions:

· This section consists of Four (4) questions with five (5) options each

· Write the word “TRUE” and NOT letter ‘T’ for a correct statement and the word “FALSE” NOT letter ‘F’ for incorrect statement in the space provided before each option

· All responses should be in CAPITAL letters

· Half (1/2) a mark will be awarded for each correct response

· Responses with letters ‘T’ and ‘F’ will not be awarded any mark

· There will be a penalty of half (1/2) of allocated marks for responses with small letters.

1. Regarding palpation of the abdomen:

A. FALSE  Affected area is palpated first.

B. TRUE    Tenderness is assessed by superficial palpation

C. FALSE  Liver is palpated at the left hypochondria region

D. TRUE    Digital rectal examination is the part of examination

E. TRUE    Deep palpation aims at feeling enlarged abdominal organs

 

2. Regarding history taking in obstetrics and Gynecology:

A. TRUE  Natal history follows after antenatal history

B. FALSE  History of gravidity and parity is of no use

C. TRUE  Menarche history is asked in Gynecological history.

D. FALSE  Use of contraceptives is asked in the past obstetrics history

E. TRUE The details of LNMP EDD and GA comes immediately after demographic data

 

3. Regarding inspection:

A. TRUE   A pen torch can be used

B. TRUE   Involves observing patient’s behaviour

C. FALSE  Is normally done at the end of examination

D. FALSE  The patient is asked to point area of maximum tenderness.

E. TRUE   It is the first examination technique that involves observational

 

4. The following can be done using palpation:

A. TRUE    Assessment of organ size

B. FALSE  Chest movements assessment

C. FALSE  Assessments of eye movements

D. FALSE Assessment of pharyngeal colour

E. TRUE   Assessment of lymph nodes enlargement

 

 

SECTION C: MATCHING QUESTIONS 10 MARKS

Instructions:

· This section consists of two (2) questions of matching with five (5) options each

· Match the items from column B with those in column A by writing the letter of correct response in the space provided on each option. USE CAPITAL LETTERS

· Each correct response is awarded one (1) mark

Each item from column B is used only once

 

1. Match the Cranial nerve numbers from COLUMN B with their corresponding names in COLUMN A.

	S/N	ANSWER	COLUMN A (Name of Cranial nerve)		COLUMN B (Cranial nerve number)
	1.	F	Hypoglossal		A	I
	2.	B	Optic		B	II
	3.	G	Vestibulocochlear		C	V
	4.	A	Olfactory		D	VII
	5.	E	Accessory		E	XI
					F	XII
					G	VIII
					H	VI

2. Match the clinical findings from COLUMN B with their corresponding physical examination which detects them in COLUMN A.

S/N	ANSWER	COLUMN A (Physical examination)	COLUMN B  (Clinical findings)
1.	E	General examination	A	Chest Pain
2.	G	Respiratory system examination	B	Colour Blindness
3.	H	Cardiovascular system examination	C	Headache
4.	D	Abdominal examination	D	Hepatomegaly
5.	B	Central nervous system examination	E	Jaundice
			F	Nausea
			G	Stony dullness
			H	Murmurs

 

 

SECTION D: SHORT ANSWER QUESTIONS 40 MARKS

Instructions:

· This section consists of Eight (8) questions.

· Write your answers in the space provided on each question.

· Write a readable handwrite; DIRTY WORK IS NOT ALLOWED

 

1. Write five (5) differential diagnoses of a patient presenting with the following findings during respiratory system examination; asymmetrical chest expansion and the trachea shifted to the left. (5 Marks)

 

Answer          (5 points@1 mark)

i. Pleural effusion

ii. Pneumothorax

iii. Haemothorax

iv. Thoracic empyema

v. Haemo-pneumothorax

 

2. Mention five (5) features that can be elicited when palpating an abdominal swelling.   (5 Marks)

Answers    (any 5 @ 1mark)

i. Site

ii. Size

iii. Shape

iv. Consistence

v. Surface

vi. Surroundings

vii. Whether you can get above it

viii. Movement with respiration

ix. mobility

x. Tenderness

 

3. Mention five (5) causes of abdominal distension (5 Marks)

 

Answers (any 5 points@1 mark)

i. Fat

ii. Faces

iii. Foetus

iv. Fluid

v. Flatus/gas

 

 

 

4. With regard to CNS:

a) Three (3) deep reflexes (3 Marks)

 

Answer     (any 3 points@1 mark)

i. Triceps jerk                                            

ii. Biceps jerk                                             

iii. Jaw jerk

iv. Knee jerk

v. Ankle jerk

vi. Clonus

b) Two (2) superficial reflexes (2 Marks)

 

Answer (any 2 points@1 mark)

i. Abdominal reflex

ii. Plantar reflex

iii. Cremasteric reflex

 

5. List down five (5) importance’s of taking notes and documenting patient information.

(5 Marks)

Answers (any 5 points @ 1 mark

i. Ensure continuity of care as it serves a communication tool among health care providers.

ii. Plan and evaluate a patients treatment

iii. Collection of data that may useful for research and education

iv. Recollect a memory and / or justify defend care provided

v. Create a database to evaluate effectiveness of treatment

vi. Create a permanent records for the patient’s future care

vii. Medical records may serve as a legal document to verify care given

viii. Substantiate billing /payment

ix. Provide evidence of care given to the patient.

 

6. Outline five (5) important things to consider when taking obstetric history (5 Marks)

 

Answers      (any 5 points@1mark)

i. Make sure the complaints are assisting you in performing physical examination

ii. Make sure you are able to identify urgency of treatment and take actions.

iii. Depending on the response of the patient identify key findings revealed during history taking

iv. Remember to document both positive and negative findings.

v. Make sure you are able to interpret mood and body language of the patient during history taking

 

 

 

7. Mention five (5) characteristics of an effective therapeutic relationship (5 Marks)

 

Answers      (any 5 points @ 1 mark)

i. Creation of good rapport

ii. Empathy

iii. Honest

iv. Respect

v. Genuineness

vi. Trust

vii. Collaboration

viii. Personal closeness

ix. Warmth and care

x. Sense of humor

xi. Insight and experience

 

8. Mention five important things you need to prepare before starting general examination.  (5 Marks)

Answer        (any 5 points@1 mark)

i. Reflect your approach to the patient

ii. Prepare the environment

iii. Prepare and check your equipment

iv. Make the patient comfortable

v. Ask for consent

 

 

 

SECTION E: GUIDED EESSAY QUESTION 30 MARKS

Instructions

· This section consists of three (3) questions which are supposed to be answered in a narrative way

· Write your answer on the blank pages of this question paper; each question should start on a new page

· There will be a penalty of three (3) marks from score attained in this section if question(s) is/are not answered in essay form

 

1. Describe tips to consider when taking clinical notes (10 Marks)

 

Answer

 

Definition (1 mark)

Clinical notes is a written account of patient information which includes medical history physical findings results of diagnostic tests and procedure and drugs given.

 

Tips

During history taking (2 marks)

· Record the information as soon as possible before you forget

· Prefer to take notes while talking with the patient at the beginning

· As you gain experience write the heading then leave the space for filling details later.

      During physical examination     (2 marks)

· Make immediate note to specific measurement such as BP, temperature etc.

· Recording multiple items interrupts the flow of examination.

 Use of abbreviations    (2 marks)

· Use of abbreviations makes the process of taking history easy.

· Variation in abbreviation among clinicians is common

· Meaning of abbreviations varies depending on the context.

Order of write up      (1 mark)

· Arrange the patient illness in chronological order

· If the patient has the long term disease which led into comma begin with the events that led into coma

Degree of details     (2 marks)

· It is also an item to consider

· It should be pertinent to subject or problem but not redundant.

 

 

2. Explain important steps required for interpreting patient’s information and making up diagnosis.  (10 Marks)

 

Answer       (5 points@2 marks))

· Identify abnormal finding

· Localize findings anatomically

· Interpret findings items of probable processes

· Make the differential diagnoses about the nature of the patients problems

· Perform further investigations to confirm the diagnoses

· Develop plan agreeable to the patient.

 

3. Explain the techniques needed to take a history from a silent patient (10 Marks)

 

Answer        (any 5 points @ 2marks)

· Appear attentive and give brief encouragement to continue when appropriate.

· Watch the patient closely for non-verbal clues such as difficulty in controlling emotions.

· Try to differentiate between periods of silence: 'normal' periods of silence are necessary to collect thoughts, to remember details.

· Give encouragement to continue

· Patient with dementia or depression may lose their spontaneity of expression; they give short answer and then keep silent.

· If you suspect a mental depression, shift your enquiry to the symptoms of depression.

· If you have a suspicion that the silence may somehow be the patient's response to you, ask directly, e.g.: “You seem very quiet. Have I said something to maybe upset you?”

Patient may have overwhelming symptoms like pain, nausea or dyspnoea