NZREX Clinical Diagnosis & Management

Question 1

A 60-year-old man presents with sudden onset crushing central chest pain radiating to the left arm, diaphoresis, and nausea. His ECG shows ST elevation in leads II, III, and aVF. Which artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

ST elevation in leads II, III, and aVF indicates inferior STEMI, which is most commonly caused by occlusion of the right coronary artery (RCA), which supplies the inferior wall of the left ventricle in most patients.

Question 2

Which of the following is the first-line treatment for anaphylaxis?

Accepted Answer

Intramuscular adrenaline 0.5 mg (1:1000)

Answer

IM adrenaline (epinephrine) 0.5 mg of 1:1000 solution into the anterolateral thigh is the life-saving first-line treatment for anaphylaxis. Antihistamines and corticosteroids are adjuncts only.

Question 3

A 35-year-old woman presents with a 6-month history of weight loss, heat intolerance, palpitations, and a smooth goitre. TSH is suppressed with elevated free T4. What is the most likely diagnosis?

Accepted Answer

Graves' disease

Answer

Graves' disease is the most common cause of hyperthyroidism in young women, caused by TSH receptor antibodies. It presents with a diffusely smooth goitre, ophthalmopathy, and hyperthyroid symptoms.

Question 4

Which investigation is the gold standard for diagnosing pulmonary embolism?

Accepted Answer

CT pulmonary angiography (CTPA)

Answer

CTPA is the gold standard investigation for diagnosing pulmonary embolism, providing direct visualisation of clot within the pulmonary vasculature with high sensitivity and specificity.

Question 5

A 55-year-old with known cirrhosis presents with confusion, asterixis, and fetor hepaticus. Ammonia is elevated. What is the most appropriate immediate management?

Accepted Answer

Lactulose orally or via nasogastric tube

Answer

Lactulose reduces ammonia absorption from the gut by acidifying colonic contents and promoting ammonia excretion. It is first-line for hepatic encephalopathy. Rifaximin is used as adjunct or maintenance.

NZREX Practice Test

NZREX Practice Test

NZREX Clinical Diagnosis & Management