NZREX Emergency and Acute Medicine β Questions and Answers
Question 1: In NZ emergency medicine, what is the ABCDE approach to assessing a critically unwell patient?
- Airway, Breathing, Circulation, Disability (neurological), Exposure β a systematic priority-based assessment (Correct answer)
- Assess, Bandage, Compress, Defibrillate, Evacuate
- Antibiotics, Blood tests, CT scan, Diagnosis, Examination
- Awareness, Balance, Coordination, Dexterity, Endurance
Correct answer: Airway, Breathing, Circulation, Disability (neurological), Exposure β a systematic priority-based assessment
The ABCDE approach used in NZ emergency medicine is: Airway (with cervical spine protection if trauma), Breathing (rate, oxygen saturation, chest examination), Circulation (pulse, blood pressure, perfusion), Disability (GCS, pupils, blood glucose), and Exposure (full examination, temperature).
Question 2: A patient presents to a NZ emergency department with chest pain. What is the first-line investigation to rule out an acute myocardial infarction?
- 12-lead ECG β should be performed within 10 minutes of arrival (Correct answer)
- Chest X-ray
- CT coronary angiography
- Echocardiogram
Correct answer: 12-lead ECG β should be performed within 10 minutes of arrival
A 12-lead ECG should be performed within 10 minutes of arrival for any patient presenting with chest pain to a NZ ED. This is the first-line investigation to identify ST-elevation myocardial infarction (STEMI) requiring urgent intervention.
Question 3: In NZ, what is the Glasgow Coma Scale (GCS) and what are its three components?
- A neurological assessment scoring Eye opening (1-4), Verbal response (1-5), and Motor response (1-6) β total range 3 to 15 (Correct answer)
- A measure of blood glucose levels
- A scoring system for wound severity
- A classification of seizure types
Correct answer: A neurological assessment scoring Eye opening (1-4), Verbal response (1-5), and Motor response (1-6) β total range 3 to 15
The GCS assesses level of consciousness using three components: Eye opening (1-4), Verbal response (1-5), and Motor response (1-6). The total score ranges from 3 (deep coma) to 15 (fully alert). A GCS β€8 generally indicates the need for intubation.
Question 4: A patient presents to a NZ ED with anaphylaxis. What is the first-line drug treatment?
- Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000) into the anterolateral thigh (Correct answer)
- Intravenous hydrocortisone 200 mg
- Oral antihistamine (cetirizine 10 mg)
- Intravenous salbutamol 250 mcg
Correct answer: Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000) into the anterolateral thigh
The first-line treatment for anaphylaxis in NZ (and internationally) is intramuscular adrenaline 0.5 mg of 1:1000 solution injected into the anterolateral thigh. This can be repeated every 5 minutes if no improvement. Other medications are adjuncts.
Question 5: In NZ emergency practice, what is the recommended approach to managing a patient with acute asthma exacerbation?
- High-flow oxygen, nebulised salbutamol, ipratropium bromide, oral prednisolone or IV hydrocortisone, and reassess response (Correct answer)
- Inhaled corticosteroids only
- Antibiotics and complete bed rest
- IV aminophylline as first-line treatment
Correct answer: High-flow oxygen, nebulised salbutamol, ipratropium bromide, oral prednisolone or IV hydrocortisone, and reassess response
NZ acute asthma management follows a stepwise approach: oxygen to maintain SpO2 94-98%, nebulised salbutamol (repeated as needed), nebulised ipratropium bromide, systemic corticosteroids (oral prednisolone or IV hydrocortisone), and continuous reassessment with escalation if needed.
Question 6: What is the NZ protocol for managing a patient presenting with acute stroke symptoms?
- Urgent CT brain to differentiate ischaemic from haemorrhagic stroke, with consideration of thrombolysis (tPA) within 4.5 hours for eligible ischaemic strokes (Correct answer)
- Start aspirin immediately without imaging
- Perform a lumbar puncture as the first investigation
- Observe for 24 hours before any intervention
Correct answer: Urgent CT brain to differentiate ischaemic from haemorrhagic stroke, with consideration of thrombolysis (tPA) within 4.5 hours for eligible ischaemic strokes
In NZ, acute stroke management requires urgent CT brain imaging to differentiate ischaemic from haemorrhagic stroke. For eligible ischaemic strokes, IV thrombolysis (alteplase/tPA) should be considered within 4.5 hours of symptom onset. Time is critical.
NZREX Emergency and Acute Medicine
In NZ emergency medicine, what is the ABCDE approach to assessing a critically unwell patient?