Mixed Deck — All NZREX Topics Flashcards

What is the NZ approach to prescribing for Māori and Pacific patients that NZREX candidates should understand?

Answer: Consider cultural factors affecting medication adherence, involve whānau/family in education, and ensure prescribing information is culturally and linguistically appropriate

NZ prescribers should consider cultural factors that may affect medication understanding, acceptance, and adherence. This includes involving whānau/family in medication education, ensuring information is linguistically appropriate, and respecting cultural health beliefs alongside evidence-based medicine.

What is the MCNZ's expectation regarding doctors maintaining professional boundaries in NZ?

Answer: Doctors must maintain clear professional boundaries, avoid dual relationships, and never engage in sexual or exploitative relationships with current patients

The MCNZ requires doctors to maintain clear professional boundaries in all patient interactions. This includes avoiding dual relationships (social, financial), never engaging in sexual relationships with current patients, and being aware of power imbalances in the doctor-patient relationship.

Under NZ employment law, what are the key considerations for overseas-trained doctors regarding their working conditions?

Answer: NZ employment law provides for minimum employment standards, including leave entitlements, rest breaks, and protection against unfair dismissal

NZ employment law (Employment Relations Act 2000) provides minimum standards for all workers including overseas-trained doctors: rest and meal breaks, annual leave (4 weeks), sick leave (10 days/year), public holidays, and protection against unjustified dismissal.

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

Answer: Intramuscular adrenaline 0.5 mg (1:1000)

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.

What does the term 'tikanga Māori' mean in the context of healthcare?

Answer: Māori customary values and practices that guide appropriate and respectful behaviour

Tikanga Māori refers to the customary values, protocols, and practices of Māori society. In healthcare, understanding tikanga guides culturally safe interactions, for example around death and dying, tapu/noa, and whānau involvement.

When performing a cardiovascular examination in the NZREX, what clinical signs should you specifically check in the hands?

Answer: Clubbing, splinter haemorrhages, Janeway lesions, Osler's nodes, and peripheral cyanosis

In a cardiovascular examination, the hands may reveal important signs: clubbing (cyanotic heart disease), splinter haemorrhages (endocarditis), Janeway lesions (painless, endocarditis), Osler's nodes (painful, endocarditis), and peripheral cyanosis.

Which antibiotic is the first-line treatment for community-acquired pneumonia in a previously healthy adult managed in the community in New Zealand?

Answer: Amoxicillin

New Zealand guidelines recommend amoxicillin as first-line for community-acquired pneumonia (CAP) in previously healthy adults managed in the community, as Streptococcus pneumoniae remains the most common causative organism.

In NZ, what is open disclosure and when should it be used?

Answer: An honest, transparent discussion with patients and whānau when an adverse event or error has occurred during their care

Open disclosure is the NZ standard requiring honest, transparent communication with patients and their whānau/family when an adverse event, near miss, or error occurs during care. It includes an apology, explanation of what happened, and steps to prevent recurrence.

A doctor is asked by a pharmaceutical company to speak at a conference and will receive a payment. What is the most ethical approach?

Answer: Disclose the conflict of interest to the audience and ensure the content is evidence-based and independent

Conflicts of interest (COI) in medicine must be disclosed transparently. Receiving payment from industry creates a potential COI that can bias clinical recommendations. Disclosure does not eliminate bias but allows the audience to judge the information critically.

Which of the following is most consistent with a diagnosis of irritable bowel syndrome (IBS)?

Answer: Abdominal pain relieved by defecation, altered stool form, no red flag symptoms

IBS is a functional gut disorder characterised by abdominal pain related to defecation, altered stool frequency and form, without red flag features (bleeding, weight loss, nocturnal symptoms, anaemia). Organic causes must be excluded first.

During a NZREX cranial nerve examination, which cranial nerves are tested when you ask the patient to smile and raise their eyebrows?

Answer: Cranial nerve VII (facial nerve) — assessing both upper and lower motor neuron function

Asking a patient to smile and raise their eyebrows tests cranial nerve VII (facial nerve). The ability to raise eyebrows helps distinguish between upper motor neuron (forehead spared) and lower motor neuron (forehead affected) lesions.

A patient reports productive cough, fever, and right-sided pleuritic chest pain. On examination there is dullness to percussion and bronchial breathing at the right base. What is the most likely diagnosis?

Answer: Right lower lobe pneumonia

Dullness to percussion with bronchial breathing indicates consolidation, consistent with lobar pneumonia. A pleural effusion would cause absent (not bronchial) breath sounds and stony dullness.

When using an interpreter for a patient who does not speak English, which approach is most appropriate?

Answer: Use a trained professional interpreter, ideally not a family member

Professional interpreters ensure accuracy, confidentiality, and neutrality. Family members (especially children) should not interpret as they may filter information, lack medical vocabulary, and compromise confidentiality or create conflict of interest.

In the NZREX examination, what communication framework is recommended for breaking bad news?

Answer: The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary

The SPIKES framework is widely used in NZ medical practice for breaking bad news: Set up the interview (privacy, sit down), assess the patient's Perception, obtain Invitation (how much they want to know), give Knowledge/information, address Emotions with empathy, and provide Strategy/summary.

In NZ paediatric practice, what are the red flag features of a febrile child that suggest serious bacterial infection?

Answer: Non-blanching rash, bulging fontanelle, altered consciousness, prolonged capillary refill (>3 seconds), and inconsolable crying

Red flags in a febrile NZ child include: non-blanching (petechial/purpuric) rash (meningococcal disease), bulging fontanelle in infants, altered consciousness/lethargy, prolonged capillary refill time, tachycardia, inconsolable high-pitched crying, and poor feeding.

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

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.

Which antibiotic class is generally contraindicated in children under 12 years due to the risk of arthropathy and potential damage to developing cartilage?

Answer: Fluoroquinolones (e.g., ciprofloxacin)

Fluoroquinolones are contraindicated in children under 12 (and generally under 18 in most guidelines) due to evidence of arthropathy and cartilage toxicity demonstrated in animal studies and paediatric case reports.

A patient with schizophrenia refuses antipsychotic medication during a voluntary admission. What is the most appropriate initial response?

Answer: Explore the reasons for refusal, address concerns, and attempt to negotiate — do not impose medication without legal authority

A voluntary patient retains the right to refuse treatment. The clinician should explore reasons for refusal (e.g., side effects, insight, fears), attempt therapeutic negotiation, and only consider the Mental Health Act if the patient meets criteria for compulsory assessment.

In NZ emergency medicine, what is the FAST assessment in trauma?

Answer: Focused Assessment with Sonography for Trauma — a bedside ultrasound looking for free fluid in the abdomen, pelvis, and pericardium

FAST (Focused Assessment with Sonography for Trauma) is a bedside ultrasound examination used in NZ EDs to rapidly detect free fluid (blood) in the peritoneal cavity (four views), pelvis, and pericardium in trauma patients.

In the NZREX, what clinical findings differentiate an upper motor neuron (UMN) from a lower motor neuron (LMN) lesion?

Answer: UMN: increased tone, hyperreflexia, upgoing plantar response, no fasciculations; LMN: decreased tone, hyporeflexia, downgoing plantar response, fasciculations and wasting

UMN lesions cause increased tone (spasticity), hyperreflexia, extensor plantar response (Babinski positive), and no fasciculations. LMN lesions cause decreased tone (flaccidity), hyporeflexia, flexor plantar response, and fasciculations with muscle wasting.