NZREX Clinical Diagnosis & Management 2

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?

Accepted Answer

Amoxicillin

Answer

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?

Accepted Answer

Nitrofurantoin (avoiding near term)

Answer

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?

Accepted Answer

Investigate for cause; antiepileptic medication is not automatically started after a single seizure

Answer

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?

Accepted Answer

Lifestyle modification (diet, exercise, weight loss)

Answer

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?

Accepted Answer

CHA2DS2-VASc score

Answer

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.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical Diagnosis & Management 2