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

In NZ, iron deficiency anaemia requires investigation for the underlying cause, not just iron replacement. This includes coeliac serology, and for appropriate patients (especially males and postmenopausal females), upper and lower GI investigation to exclude malignancy or other GI pathology.

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

A sudden-onset, severe headache (thunderclap headache) must be investigated urgently to exclude subarachnoid haemorrhage. In NZ, the standard approach is CT brain (highly sensitive within 6 hours of onset). If CT is negative and clinical suspicion remains, a lumbar puncture should be performed.

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

NZ DVT management involves confirming the diagnosis with compression ultrasound, starting anticoagulation (DOACs such as rivaroxaban are increasingly first-line), and investigating for underlying causes (malignancy screen, thrombophilia testing) if the DVT is unprovoked.

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

NZ transitioned to HPV-based primary screening. The National Cervical Screening Programme recommends HPV screening every 5 years for eligible people aged 25-69 with a cervix, replacing the previous 3-yearly cytology (smear) programme.

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

In NZ, TSH is the most sensitive initial screening test for thyroid dysfunction. An elevated TSH suggests hypothyroidism, which should be followed up with a free T4 level. Thyroid antibodies (anti-TPO) may be checked to determine the cause (e.g., Hashimoto's thyroiditis).

NZREX Practice Test

NZREX Practice Test

NZREX Common Clinical Conditions 2