NZREX Clinical Diagnosis & Management 4

Question 1

Which of the following is a contraindication to the use of metformin?

Accepted Answer

eGFR below 30 mL/min/1.73m²

Answer

Metformin is contraindicated in significant renal impairment (eGFR <30) due to the risk of lactic acidosis from metformin accumulation. It is dose-reduced at eGFR 30–45 and should be temporarily withheld before contrast procedures.

Question 2

A 5-year-old presents with a 2-day history of high fever, sore throat, and a fine sandpaper-like erythematous rash. Throat swab grows Group A Streptococcus. What is the diagnosis?

Accepted Answer

Scarlet fever

Answer

Scarlet fever is caused by Group A Streptococcus and presents with fever, pharyngitis, and a diffuse erythematous 'sandpaper' rash, often with strawberry tongue. It is treated with penicillin/amoxicillin.

Question 3

Which radiological finding on a plain chest X-ray is characteristic of pulmonary oedema?

Accepted Answer

Bilateral perihilar ('bat wing') shadowing with upper lobe venous diversion

Answer

Pulmonary oedema produces bilateral perihilar ('bat wing' or 'butterfly') shadowing, upper lobe blood diversion (cephalisation), Kerley B lines, and pleural effusions, reflecting elevated left atrial pressure.

Question 4

A 22-year-old woman presents with dysuria and vaginal discharge. High vaginal swab grows Neisseria gonorrhoeae. Which treatment regimen is most appropriate per New Zealand guidelines?

Accepted Answer

IM ceftriaxone 500 mg stat plus azithromycin 1 g orally stat

Answer

New Zealand guidelines recommend dual therapy for gonorrhoea: IM ceftriaxone (to address increasing fluoroquinolone resistance) plus azithromycin (to provide additional coverage and reduce resistance development). Contact tracing is mandatory.

Question 5

Which of the following most accurately describes the management of stable angina?

Accepted Answer

Short-acting nitrate PRN, regular antiplatelet, statin, and beta-blocker or calcium channel blocker

Answer

Stable angina is managed with sublingual GTN for acute episodes, aspirin, a statin, and an anti-anginal agent (beta-blocker first-line, or calcium channel blocker). Revascularisation is considered if symptoms are not controlled.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical Diagnosis & Management 4