NZREX Clinical Examination — Questions and Answers

Question 1: A patient presents to a NZ general practice with symptoms of community-acquired pneumonia. According to NZ guidelines, what is the first-line antibiotic treatment for non-severe CAP?

Metronidazole 400 mg three times daily for 10 days
Flucloxacillin 500 mg four times daily for 14 days
Amoxicillin 500 mg three times daily for 5 days (Correct answer)
Ciprofloxacin 500 mg twice daily for 7 days

Correct answer: Amoxicillin 500 mg three times daily for 5 days

In NZ, the first-line treatment for non-severe community-acquired pneumonia in adults is amoxicillin 500 mg three times daily for 5 days, according to the BPAC NZ and NZ antimicrobial guidelines.

Question 2: A patient with type 2 diabetes presents with a 3-month history of tingling and numbness in both feet in a 'glove and stocking' distribution. Which type of neuropathy does this suggest?

Autonomic neuropathy
Radiculopathy
Mononeuritis multiplex
Distal symmetrical sensory polyneuropathy (Correct answer)

Correct answer: Distal symmetrical sensory polyneuropathy

Distal symmetrical sensory polyneuropathy is the most common form of diabetic neuropathy, presenting with 'glove and stocking' distribution of sensory symptoms due to length-dependent axonal damage.

Question 3: 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?

Left main coronary artery
Left anterior descending artery
Left circumflex artery
Right coronary artery (Correct answer)

Correct answer: Right coronary artery

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 4: A patient presents to a NZ ED with anaphylaxis. What is the first-line drug treatment?

Oral antihistamine (cetirizine 10 mg)
Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000) into the anterolateral thigh (Correct answer)
Intravenous hydrocortisone 200 mg
Intravenous salbutamol 250 mcg

Correct answer: Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000) into the anterolateral thigh

The first-line treatment for anaphylaxis in NZ (and internationally) is intramuscular adrenaline 0.5 mg of 1:1000 solution injected into the anterolateral thigh. This can be repeated every 5 minutes if no improvement. Other medications are adjuncts.

Question 5: What is the NZ approach to managing disagreements between healthcare team members regarding patient care?

The most senior person's opinion always prevails without discussion
Discuss concerns openly and respectfully, use evidence to support clinical positions, escalate through appropriate channels if unresolved, and always prioritise patient safety (Correct answer)
Report all disagreements to the Medical Council
Avoid raising disagreements to maintain team harmony

Correct answer: Discuss concerns openly and respectfully, use evidence to support clinical positions, escalate through appropriate channels if unresolved, and always prioritise patient safety

NZ healthcare promotes a culture where all team members can raise concerns about patient care, discuss them openly and respectfully using evidence, and escalate through appropriate channels if needed. Patient safety always takes priority over hierarchy or interpersonal dynamics.

Question 6: What is the NZ approach to managing type 2 diabetes, including the first-line pharmacological treatment?

Dietary changes only with no medication for the first 5 years
Lifestyle modification (diet, exercise, weight management) plus metformin as first-line pharmacotherapy, with HbA1c monitoring every 3-6 months (Correct answer)
Insulin injections from diagnosis
Sulfonylureas as first-line treatment in NZ

Correct answer: Lifestyle modification (diet, exercise, weight management) plus metformin as first-line pharmacotherapy, with HbA1c monitoring every 3-6 months

NZ management of type 2 diabetes starts with lifestyle modification (healthy diet, regular exercise, weight management) and metformin as first-line pharmacotherapy. HbA1c targets are individualised (generally <53 mmol/mol), with monitoring every 3-6 months and treatment escalation as needed.

Question 7: Which of the three principles of Te Tiriti o Waitangi is represented by the Crown's obligation to actively protect Māori health?

Partnership (Kāwanatanga)
Participation (Oritetanga)
Protection (Tiakitanga) (Correct answer)
Equity (Ōritetanga)

Correct answer: Protection (Tiakitanga)

The principle of Protection (Tiakitanga) requires the Crown and health practitioners to actively protect Māori health, taonga (treasures including health practices), and wellbeing. This goes beyond passive non-discrimination.

Question 8: What is the primary legislation that established the current NZ health system structure replacing DHBs in 2022?

Pae Ora (Healthy Futures) Act 2022 (Correct answer)
New Zealand Public Health and Disability Act 2000
Health and Disability Commissioner Act 1994
Health Practitioners Competence Assurance Act 2003

Correct answer: Pae Ora (Healthy Futures) Act 2022

The Pae Ora (Healthy Futures) Act 2022 abolished the 20 DHBs and established Health New Zealand (Te Whatu Ora), the Māori Health Authority (Te Aka Whai Ora), and Public Health Agency as the new national health entities.

Question 9: In NZ medical practice, what is the correct approach when a patient requests a treatment you believe is not in their best interest?

Explain your clinical reasoning, discuss the evidence, explore the patient's perspective, but ultimately respect their autonomy while documenting the discussion (Correct answer)
Report the patient to the Medical Council
Agree to the request to avoid conflict
Refuse the request without explanation

Correct answer: Explain your clinical reasoning, discuss the evidence, explore the patient's perspective, but ultimately respect their autonomy while documenting the discussion

NZ medical ethics requires doctors to provide clear clinical reasoning and evidence, explore the patient's values and concerns, and ultimately respect patient autonomy. The discussion, including any disagreement, should be thoroughly documented.

Question 10: When taking a sexual health history, which approach is most appropriate in the context of the NZREX consultation?

Defer to a specialist for sexual health questions
Use open, non-judgmental language and normalise questions by explaining they are routine (Correct answer)
Only ask about sexual history if the patient raises it
Assume heterosexuality unless the patient states otherwise

Correct answer: Use open, non-judgmental language and normalise questions by explaining they are routine

A non-judgmental, normalising approach (e.g., 'I ask all my patients these questions') is essential for sexual health history-taking, enabling accurate disclosure and appropriate testing, including STI screening.

Question 11: When performing a focused musculoskeletal examination of the knee, which test specifically assesses the anterior cruciate ligament?

McMurray test
Valgus stress test
Lachman test (Correct answer)
Patellar tap

Correct answer: Lachman test

The Lachman test assesses anterior cruciate ligament (ACL) integrity by applying an anterior force to the tibia with the knee at 20–30° flexion. It is more sensitive than the anterior drawer test.

Question 12: A doctor is about to perform a lumbar puncture. Which elements must be covered in obtaining informed consent for this procedure?

Assurance that the procedure is routine and safe
Only the purpose and expected outcome
A full written consent form without verbal discussion
Purpose, process, risks, benefits, alternatives, and the right to withdraw consent (Correct answer)

Correct answer: Purpose, process, risks, benefits, alternatives, and the right to withdraw consent

Informed consent requires explaining: why the procedure is needed, how it is performed, risks (including uncommon but serious risks), benefits, alternatives (including doing nothing), and confirmation the patient can change their mind.

Question 13: When documenting a skin lesion, which descriptor refers to a solid raised lesion less than 1 cm in diameter?

Vesicle
Plaque
Papule (Correct answer)
Macule

Correct answer: Papule

A papule is a solid, raised skin lesion less than 1 cm in diameter. A macule is flat, a vesicle is fluid-filled, and a plaque is a raised flat-topped lesion greater than 1 cm.

Question 14: Which auscultatory finding is characteristic of aortic stenosis?

Pan-systolic murmur loudest at the apex radiating to the axilla
Mid-diastolic murmur loudest at the apex with the patient in the left lateral position
Early diastolic murmur at the left lower sternal border
Ejection systolic murmur loudest at the right upper sternal border radiating to the carotids (Correct answer)

Correct answer: Ejection systolic murmur loudest at the right upper sternal border radiating to the carotids

Aortic stenosis produces an ejection systolic (crescendo-decrescendo) murmur heard best at the right upper sternal border (aortic area) that radiates to the carotid arteries due to turbulent flow across the stenotic valve.

Question 15: In the context of Māori health, what does 'taha wairua' refer to and why is it clinically relevant?

Family health — relevant to social history only
Physical health — relevant to medication management
Mental health — relevant to psychiatric assessment only
Spiritual health — relevant because spiritual wellbeing affects overall health and may influence treatment decisions and recovery (Correct answer)

Correct answer: Spiritual health — relevant because spiritual wellbeing affects overall health and may influence treatment decisions and recovery

Taha wairua (spiritual health) is one of the four walls of Te Whare Tapa Whā. For many Māori patients, spiritual wellbeing is integral to overall health. Ignoring this dimension results in incomplete, culturally unsafe care.

Question 16: A patient has asymmetric reflexes with brisk reflexes on the right and absent reflexes on the left arm. Which type of lesion would cause absent reflexes?

Upper motor neurone lesion
Lower motor neurone lesion (Correct answer)
Cerebellar lesion
Basal ganglia lesion

Correct answer: Lower motor neurone lesion

Absent or reduced reflexes indicate a lower motor neurone lesion affecting the reflex arc (anterior horn cell, nerve root, peripheral nerve, neuromuscular junction, or muscle). UMN lesions cause brisk/exaggerated reflexes.

Question 17: In NZ, what professional standards apply to a doctor's use of social media?

Doctors must maintain confidentiality, professional boundaries, and should not post identifiable patient information or bring the profession into disrepute (Correct answer)
Social media use is completely prohibited for doctors in NZ
Doctors may share patient cases publicly if they remove the patient's name
There are no professional standards regarding social media use

Correct answer: Doctors must maintain confidentiality, professional boundaries, and should not post identifiable patient information or bring the profession into disrepute

The MCNZ requires doctors to maintain patient confidentiality on social media (no identifiable information), uphold professional boundaries (avoid patient friend requests), and not post content that could bring the medical profession into disrepute or undermine public trust.

Question 18: In the NZREX clinical exam, how should you assess for cerebellar dysfunction?

Test for dysmetria (finger-nose test), dysdiadochokinesia (rapid alternating movements), intention tremor, gait ataxia, and nystagmus (Correct answer)
Perform a Mini Mental State Examination
Test deep tendon reflexes only
Only check for Romberg's sign

Correct answer: Test for dysmetria (finger-nose test), dysdiadochokinesia (rapid alternating movements), intention tremor, gait ataxia, and nystagmus

Cerebellar examination includes testing for dysmetria (finger-nose and heel-shin tests), dysdiadochokinesia (inability to perform rapid alternating movements), intention tremor, gait ataxia (broad-based, unsteady gait), and nystagmus.

Question 19: What is the CURB-65 score used for in NZ clinical practice?

Classifying types of urinary tract infections
Assessing the severity of community-acquired pneumonia and guiding management (outpatient vs. hospital admission) (Correct answer)
Scoring the severity of chronic obstructive pulmonary disease
Measuring the risk of falls in elderly patients

Correct answer: Assessing the severity of community-acquired pneumonia and guiding management (outpatient vs. hospital admission)

CURB-65 assesses CAP severity using five criteria: Confusion, Urea >7 mmol/L, Respiratory rate ≥30, Blood pressure <90/60 mmHg, and age ≥65. Scores guide whether patients can be managed at home (0-1), in hospital (2), or in ICU (3-5).

Question 20: Which symptom in a patient with haematuria most increases concern for bladder cancer?

Haematuria at the end of the urinary stream
Haematuria with flank pain and fever
Painless macroscopic haematuria (Correct answer)
Microscopic haematuria with urinary tract infection symptoms

Correct answer: Painless macroscopic haematuria

Painless macroscopic (visible) haematuria in adults is a red flag symptom for urothelial malignancy (bladder or kidney cancer) until proven otherwise, and requires urgent investigation with urine cytology and cystoscopy.

Question 21: Which examination finding is most specific for meningism?

Lhermitte's sign
Babinski's sign
Kernig's sign (Correct answer)
Romberg's sign

Correct answer: Kernig's sign

Kernig's sign (inability to extend the knee when the hip is flexed to 90°) is a specific sign of meningeal irritation, seen in meningitis and subarachnoid haemorrhage.

Question 22: Which clinical sign is used to assess for hepatomegaly during abdominal examination?

Begin percussion in the right iliac fossa and move superiorly until dullness is detected (Correct answer)
Auscultate over the right upper quadrant for a bruit
Percuss from the left iliac fossa toward the right upper quadrant
Palpate deeply in the left hypochondrium

Correct answer: Begin percussion in the right iliac fossa and move superiorly until dullness is detected

Hepatomegaly is assessed by starting percussion in the right iliac fossa (where the liver is absent) and moving upward to detect the superior border of liver dullness, then palpating to confirm the inferior border.

Question 23: A 45-year-old presents with gradual onset dyspnoea and bilateral pitting oedema to the knees. Which examination finding would most support a diagnosis of congestive heart failure?

Barrel chest with pursed-lip breathing
Tracheal deviation to the right
Elevated JVP with S3 gallop (Correct answer)
Dullness at the right base only

Correct answer: Elevated JVP with S3 gallop

Elevated JVP and S3 gallop are classic signs of congestive heart failure, reflecting increased venous pressure and a dilated, poorly compliant ventricle.

Question 24: Which of the following is the most appropriate first step when approaching a systemically unwell patient?

ABCDE assessment (Correct answer)
Full history and examination
Ordering blood tests
Calling the senior doctor

Correct answer: ABCDE assessment

The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is the internationally recognised framework for assessing and managing the acutely unwell patient in a structured, prioritised manner.

Question 25: In NZ, what is the recommended management of acute gout?

Aspirin for pain relief
Antibiotics to treat the joint infection
NSAIDs (e.g., naproxen), colchicine, or short-course prednisone for acute flare — do NOT start or change allopurinol during an acute attack (Correct answer)
Allopurinol immediately at the highest dose

Correct answer: NSAIDs (e.g., naproxen), colchicine, or short-course prednisone for acute flare — do NOT start or change allopurinol during an acute attack

Acute gout in NZ is treated with NSAIDs (naproxen preferred), colchicine, or a short course of prednisone. Importantly, allopurinol should NOT be started or dose-changed during an acute attack as this can prolong the flare. Allopurinol is for long-term prophylaxis.

Question 26: What is the Health and Disability Commissioner's role in NZ and why is it important for NZREX candidates to understand?

A medical researcher who publishes clinical guidelines
An independent officer who investigates complaints about health services and holds providers accountable under the Code of Rights (Correct answer)
An administrator who manages hospital waiting lists
A politician who funds health services

Correct answer: An independent officer who investigates complaints about health services and holds providers accountable under the Code of Rights

The Health and Disability Commissioner investigates complaints about health providers under the Code of Health and Disability Services Consumers' Rights. NZREX candidates must understand the Code because it defines patient rights that doctors must uphold in NZ practice.

Question 27: In NZ, what is the initial management of a tension pneumothorax?

Chest X-ray first to confirm the diagnosis
Oral antibiotics and observation
CT scan of the chest before any intervention
Immediate needle decompression in the 2nd intercostal space, midclavicular line (or 4th/5th ICS, anterior axillary line), followed by chest drain insertion (Correct answer)

Correct answer: Immediate needle decompression in the 2nd intercostal space, midclavicular line (or 4th/5th ICS, anterior axillary line), followed by chest drain insertion

Tension pneumothorax is a clinical diagnosis requiring immediate treatment. Needle decompression should be performed urgently (2nd ICS, midclavicular line, or 4th/5th ICS, anterior axillary line) followed by definitive management with a chest drain (intercostal catheter).

Question 28: When explaining a diagnosis of cancer to a patient, which communication approach is recommended?

Use clear language, pause frequently, check understanding, allow silence, and invite questions (Correct answer)
Deliver all information at once to be efficient
Use medical jargon to appear competent
Avoid telling the patient and inform family first

Correct answer: Use clear language, pause frequently, check understanding, allow silence, and invite questions

Breaking serious news (SPIKES protocol) involves a structured approach: check what the patient knows, ask how much they want to know, give information in clear chunks, explore emotions, summarise, and plan. Patient-centred communication improves coping and trust.

Question 29: What is the purpose of the Pharmaceutical Management Agency (PHARMAC) in New Zealand?

To manage the government's investment in medicines and medical devices to get best health outcomes within a fixed budget (Correct answer)
To license pharmaceutical companies operating in NZ
To set prescription charges for patients
To regulate the safety of new medicines before market approval

Correct answer: To manage the government's investment in medicines and medical devices to get best health outcomes within a fixed budget

PHARMAC decides which medicines and devices are subsidised on the NZ Pharmaceutical Schedule, negotiating prices to maximise health benefit within a fixed budget. Medsafe (not PHARMAC) approves medicine safety.

Question 30: The principle of 'equity' in Te Tiriti o Waitangi is associated with which article?

Article 2 — Māori rangatiratanga
Article 3 — equal rights and citizenship for all New Zealanders (Correct answer)
Article 4 — freedom of religion
Article 1 — Crown governance

Correct answer: Article 3 — equal rights and citizenship for all New Zealanders

Article 3 of Te Tiriti guarantees Māori the same rights and privileges as all New Zealand citizens (ōritetanga/equity). In health, this underpins the obligation to ensure Māori achieve health outcomes equivalent to non-Māori.

NZREX Clinical Examination

The New Zealand Registration Examination (NZREX Clinical) is an OSCE-format exam administered by the Medical Council of New Zealand (MCNZ) that assesses international medical graduates across seven clinical domains including history taking, physical examination, investigations, clinical reasoning, management, communication, professionalism, and cultural safety.

120

Questions

180 min

Time Limit

65%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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