NZREX Clinical Diagnosis & Management 3 — Questions and Answers
Question 1: A 25-year-old presents with acute severe asthma. SpO2 is 90%, PEFR is 30% predicted. Which of the following is most appropriate?
- Continuous nebulised salbutamol, IV magnesium sulphate, high-flow oxygen, senior review (Correct answer)
- Discharge with inhaler and written action plan
- Oral prednisolone and reassess in 1 hour
- Oral antibiotics and bronchodilator
Correct answer: Continuous nebulised salbutamol, IV magnesium sulphate, high-flow oxygen, senior review
A PEFR <33% predicted indicates life-threatening asthma requiring hospital admission. Management includes continuous nebulised salbutamol, IV corticosteroids, IV magnesium, high-flow oxygen, and immediate senior/ICU review.
Question 2: Which of the following is the most common cause of acute pancreatitis in New Zealand?
- Gallstones (Correct answer)
- Alcohol
- Hypertriglyceridaemia
- Medications
Correct answer: Gallstones
Gallstones are the most common cause of acute pancreatitis in New Zealand and internationally, followed by alcohol. The mnemonic I GET SMASHED lists the major causes.
Question 3: A 68-year-old man presents with urinary hesitancy, weak stream, and nocturia ×3. Digital rectal examination reveals a smooth, symmetrically enlarged prostate. PSA is 3.5 ng/mL. What is the most likely diagnosis?
- Benign prostatic hyperplasia (BPH) (Correct answer)
- Prostate cancer
- Prostatitis
- Bladder outflow obstruction from urethral stricture
Correct answer: Benign prostatic hyperplasia (BPH)
The combination of lower urinary tract symptoms (LUTS), smooth symmetric prostate enlargement, and a PSA in the age-appropriate range is consistent with benign prostatic hyperplasia (BPH). Prostate cancer typically causes an irregular, nodular gland.
Question 4: Which of the following is the most appropriate management for a patient with iron deficiency anaemia confirmed on blood tests?
- Identify and treat the underlying cause while starting oral iron supplementation (Correct answer)
- Start IV iron without investigating the cause
- Blood transfusion as first-line
- Erythropoietin injections
Correct answer: Identify and treat the underlying cause while starting oral iron supplementation
The underlying cause of iron deficiency (e.g., GI blood loss, poor intake, malabsorption) must be identified and treated. Oral iron supplementation repletes stores. Blood transfusion is reserved for symptomatic severe anaemia.
Question 5: A 55-year-old smoker presents with haemoptysis, weight loss, and a new right hilar mass on chest X-ray. What is the most important next investigation?
- CT chest with contrast (Correct answer)
- Bronchoscopy alone
- Sputum cytology only
- V/Q scan
Correct answer: CT chest with contrast
CT chest with contrast is the most appropriate next investigation to characterise the hilar mass, assess extent of disease, identify mediastinal involvement, and guide bronchoscopy or biopsy for tissue diagnosis.
Question 6: A patient is diagnosed with deep vein thrombosis (DVT) provoked by a long-haul flight. How long should anticoagulation be continued?
- 3 months (Correct answer)
- 6 weeks
- 12 months
- Indefinitely
Correct answer: 3 months
Provoked DVT (transient reversible risk factor such as travel, surgery, immobilisation) is treated with anticoagulation for 3 months, after which the risk of recurrence is low and the provoking factor has resolved.
NZREX Clinical Diagnosis & Management 3
A 25-year-old presents with acute severe asthma.
SpO2 is 90%, PEFR is 30% predicted.
Which of the following is most appropriate?