NZREX Common Clinical Conditions β 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?
- Amoxicillin 500 mg three times daily for 5 days (Correct answer)
- Ciprofloxacin 500 mg twice daily for 7 days
- Metronidazole 400 mg three times daily for 10 days
- Flucloxacillin 500 mg four times daily for 14 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: What is the CURB-65 score used for in NZ clinical practice?
- Assessing the severity of community-acquired pneumonia and guiding management (outpatient vs. hospital admission) (Correct answer)
- Classifying types of urinary tract infections
- Measuring the risk of falls in elderly patients
- Scoring the severity of chronic obstructive pulmonary disease
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 β₯30, Blood pressure <90/60 mmHg, and age β₯65. Scores guide whether patients can be managed at home (0-1), in hospital (2), or in ICU (3-5).
Question 3: In NZ, what is the recommended approach to managing a patient with suspected acute appendicitis?
- Clinical assessment (including McBurney's point tenderness, Rovsing's sign), blood tests (WCC, CRP), CT scan if diagnosis uncertain, and surgical referral for appendicectomy (Correct answer)
- Prescribe antibiotics and review in one week
- Ultrasound only β CT is never used for appendicitis in NZ
- Immediate surgery without any investigations
Correct answer: Clinical assessment (including McBurney's point tenderness, Rovsing's sign), blood tests (WCC, CRP), CT scan if diagnosis uncertain, and surgical referral for appendicectomy
In NZ, suspected appendicitis involves clinical assessment (McBurney's point tenderness, rebound tenderness, Rovsing's sign), blood tests (raised WCC and CRP support diagnosis), CT abdomen/pelvis if diagnosis is uncertain, and referral for surgical management (appendicectomy).
Question 4: A patient in NZ presents with a first unprovoked seizure. What investigations and management are appropriate?
- Blood tests (glucose, electrolytes, calcium), CT brain, EEG referral, and discussion about driving restrictions under NZTA guidelines β antiepileptic medication not usually started after a single seizure (Correct answer)
- Immediate lifelong antiepileptic medication
- No investigation needed for a single seizure
- MRI brain only, with no further follow-up required
Correct answer: Blood tests (glucose, electrolytes, calcium), CT brain, EEG referral, and discussion about driving restrictions under NZTA guidelines β antiepileptic medication not usually started after a single seizure
After a first unprovoked seizure in NZ, appropriate management includes blood tests (glucose, electrolytes, calcium), CT brain (to exclude structural cause), EEG referral, discussion about NZ driving restrictions, and safety advice. Antiepileptic drugs are not usually started after a single seizure.
Question 5: What is the NZ approach to managing type 2 diabetes, including the first-line pharmacological treatment?
- 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
- Dietary changes only with no medication for the first 5 years
- 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 6: In NZ, what is the recommended management of acute gout?
- NSAIDs (e.g., naproxen), colchicine, or short-course prednisone for acute flare β do NOT start or change allopurinol during an acute attack (Correct answer)
- Allopurinol immediately at the highest dose
- Aspirin for pain relief
- Antibiotics to treat the joint infection
Correct answer: NSAIDs (e.g., naproxen), colchicine, or short-course prednisone for acute flare β 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.
NZREX Common Clinical Conditions
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?