NZREX Clinical Diagnosis & Management 3

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?

Accepted Answer

Continuous nebulised salbutamol, IV magnesium sulphate, high-flow oxygen, senior review

Answer

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?

Accepted Answer

Gallstones

Answer

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?

Accepted Answer

Benign prostatic hyperplasia (BPH)

Answer

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?

Accepted Answer

Identify and treat the underlying cause while starting oral iron supplementation

Answer

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?

Accepted Answer

CT chest with contrast

Answer

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.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical Diagnosis & Management 3