NZREX Clinical Diagnosis & Management 2 — Questions and Answers
Question 1: Which antibiotic is the first-line treatment for community-acquired pneumonia in a previously healthy adult managed in the community in New Zealand?
- Amoxicillin (Correct answer)
- Azithromycin
- Doxycycline
- Ceftriaxone
Correct answer: Amoxicillin
New Zealand guidelines recommend amoxicillin as first-line for community-acquired pneumonia (CAP) in previously healthy adults managed in the community, as Streptococcus pneumoniae remains the most common causative organism.
Question 2: A 28-year-old woman presents at 10 weeks gestation with a urinary tract infection. Which antibiotic is most appropriate?
- Nitrofurantoin (avoiding near term) (Correct answer)
- Trimethoprim
- Ciprofloxacin
- Doxycycline
Correct answer: Nitrofurantoin (avoiding near term)
Nitrofurantoin is safe in the first and second trimester for UTI in pregnancy. Trimethoprim is avoided in the first trimester (folate antagonist), ciprofloxacin and doxycycline are contraindicated in pregnancy.
Question 3: Which of the following best describes the management of a first unprovoked generalised tonic-clonic seizure?
- Investigate for cause; antiepileptic medication is not automatically started after a single seizure (Correct answer)
- Start sodium valproate immediately
- Refer for brain surgery assessment
- Start levetiracetam and advise no further driving ever
Correct answer: Investigate for cause; antiepileptic medication is not automatically started after a single seizure
After a single unprovoked seizure, investigation (MRI, EEG) is performed to identify cause and recurrence risk. Antiepileptic drugs are not routinely started unless there is high recurrence risk or neurological abnormality.
Question 4: A 45-year-old man has a fasting blood glucose of 7.2 mmol/L and HbA1c of 52 mmol/mol (6.9%). What is the most appropriate initial management?
- Lifestyle modification (diet, exercise, weight loss) (Correct answer)
- Start metformin immediately
- Start insulin
- Repeat HbA1c in 3 years with no intervention
Correct answer: Lifestyle modification (diet, exercise, weight loss)
An HbA1c of 48–53 mmol/mol (6.5–7.0%) meets diagnostic criteria for type 2 diabetes. For newly diagnosed T2DM with these levels, lifestyle modification is the recommended first-line intervention before adding pharmacotherapy.
Question 5: Which clinical tool is used to decide whether anticoagulation is indicated in atrial fibrillation?
- CHA2DS2-VASc score (Correct answer)
- CHADS2 score
- Wells score
- HAS-BLED score
Correct answer: CHA2DS2-VASc score
The CHA2DS2-VASc score estimates stroke risk in atrial fibrillation. Anticoagulation is recommended for men with a score ≥2 and women with a score ≥3. HAS-BLED assesses bleeding risk but does not determine whether to anticoagulate.
Question 6: A 3-year-old child presents with a barking cough, stridor at rest, and mild respiratory distress. What is the most appropriate treatment?
- A single dose of oral dexamethasone (Correct answer)
- Nebulised salbutamol
- Oral amoxicillin
- IV adrenaline alone
Correct answer: A single dose of oral dexamethasone
Croup (viral laryngotracheobronchitis) is treated with corticosteroids to reduce subglottic inflammation. A single dose of oral dexamethasone (0.15–0.6 mg/kg) is the recommended first-line treatment for moderate croup.
NZREX Clinical Diagnosis & Management 2
Which antibiotic is the first-line treatment for community-acquired pneumonia in a previously healthy adult managed in the community in New Zealand?