NZREX Common Clinical Conditions 2

Question 1

What is the NZ guideline for investigating a patient with iron deficiency anaemia?

Accepted Answer

Full blood count, iron studies, and investigation for the source of blood loss (coeliac serology, upper and lower GI investigation if appropriate)

Answer

Full blood count and iron tablets only

Answer

No investigation needed — just prescribe iron supplements

Answer

Bone marrow biopsy as the first investigation

Question 2

A patient in NZ presents with sudden onset severe headache — the 'worst headache of my life'. What is the most important diagnosis to exclude?

Accepted Answer

Subarachnoid haemorrhage (SAH) — investigate with CT brain (within 6 hours) and lumbar puncture if CT is normal

Answer

Migraine — treat with triptans

Answer

Tension headache — treat with paracetamol

Answer

Sinusitis — prescribe nasal decongestants

Question 3

In NZ, what is the recommended approach to managing a patient presenting with deep vein thrombosis (DVT)?

Accepted Answer

Confirm with compression ultrasound, start anticoagulation (usually a DOAC such as rivaroxaban), and investigate for underlying cause if unprovoked

Answer

Prescribe aspirin and elevate the leg only

Answer

Immediate surgical removal of the clot

Answer

No treatment needed if the patient is asymptomatic

Question 4

What is the NZ screening recommendation for cervical cancer?

Accepted Answer

HPV screening test every 5 years for people aged 25-69 with a cervix (changed from cytology-based screening)

Answer

Annual cervical smear for all women from age 18

Answer

Screening only recommended after age 40

Answer

No cervical screening programme exists in NZ

Question 5

A NZ patient presents with symptoms of hypothyroidism. What investigations should be ordered?

Accepted Answer

TSH (thyroid-stimulating hormone) as the initial screening test, followed by free T4 if TSH is abnormal

Answer

Free T3 and free T4 only — TSH is not useful

Answer

Thyroid ultrasound as the first investigation

Answer

No investigation needed — diagnose based on clinical symptoms alone

Question 6

In NZ, what is the recommended first-line treatment for Helicobacter pylori eradication?

Accepted Answer

Triple therapy: proton pump inhibitor, amoxicillin, and clarithromycin for 14 days

Answer

A single dose of metronidazole

Answer

Proton pump inhibitor alone for 8 weeks

Answer

No treatment — H. pylori is harmless