NZREX Common Clinical Conditions

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?

Accepted Answer

Amoxicillin 500 mg three times daily for 5 days

Answer

Ciprofloxacin 500 mg twice daily for 7 days

Answer

Metronidazole 400 mg three times daily for 10 days

Answer

Flucloxacillin 500 mg four times daily for 14 days

Question 2

What is the CURB-65 score used for in NZ clinical practice?

Accepted Answer

Assessing the severity of community-acquired pneumonia and guiding management (outpatient vs. hospital admission)

Answer

Classifying types of urinary tract infections

Answer

Measuring the risk of falls in elderly patients

Answer

Scoring the severity of chronic obstructive pulmonary disease

Question 3

In NZ, what is the recommended approach to managing a patient with suspected acute appendicitis?

Accepted 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

Answer

Prescribe antibiotics and review in one week

Answer

Ultrasound only — CT is never used for appendicitis in NZ

Answer

Immediate surgery without any investigations

Question 4

A patient in NZ presents with a first unprovoked seizure. What investigations and management are appropriate?

Accepted Answer

Blood tests (glucose, electrolytes, calcium), CT brain, EEG referral, and discussion about driving restrictions under NZTA guidelines — antiepileptic medication not usually started after a single seizure

Answer

Immediate lifelong antiepileptic medication

Answer

No investigation needed for a single seizure

Answer

MRI brain only, with no further follow-up required

Question 5

What is the NZ approach to managing type 2 diabetes, including the first-line pharmacological treatment?

Accepted Answer

Lifestyle modification (diet, exercise, weight management) plus metformin as first-line pharmacotherapy, with HbA1c monitoring every 3-6 months

Answer

Insulin injections from diagnosis

Answer

Dietary changes only with no medication for the first 5 years

Answer

Sulfonylureas as first-line treatment in NZ

Question 6

In NZ, what is the recommended management of acute gout?

Accepted Answer

NSAIDs (e.g., naproxen), colchicine, or short-course prednisone for acute flare — do NOT start or change allopurinol during an acute attack

Answer

Allopurinol immediately at the highest dose

Answer

Aspirin for pain relief

Answer

Antibiotics to treat the joint infection