Clinical Diagnosis & Management Flashcards

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

Answer: eGFR below 30 mL/min/1.73m²

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.

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?

Answer: Scarlet fever

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.

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

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

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.

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?

Answer: IM ceftriaxone 500 mg stat plus azithromycin 1 g orally stat

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.

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

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

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.

A patient on warfarin presents with an INR of 9.2 and minor bleeding from the gums. What is the most appropriate management?

Answer: Withhold warfarin and give oral vitamin K 1–3 mg

For a supratherapeutic INR with minor bleeding, warfarin is withheld and low-dose oral vitamin K (1–3 mg) is given to allow gradual INR correction without over-reversal. IV vitamin K and FFP are reserved for serious or life-threatening bleeding.