NZREX Emergency and Acute Medicine

Question 1

In NZ emergency medicine, what is the ABCDE approach to assessing a critically unwell patient?

Accepted Answer

Airway, Breathing, Circulation, Disability (neurological), Exposure — a systematic priority-based assessment

Answer

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?

Accepted Answer

12-lead ECG — should be performed within 10 minutes of arrival

Answer

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?

Accepted Answer

A neurological assessment scoring Eye opening (1-4), Verbal response (1-5), and Motor response (1-6) — total range 3 to 15

Answer

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 ≤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?

Accepted Answer

Intramuscular adrenaline (epinephrine) 0.5 mg (1:1000) into the anterolateral thigh

Answer

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?

Accepted Answer

High-flow oxygen, nebulised salbutamol, ipratropium bromide, oral prednisolone or IV hydrocortisone, and reassess response

Answer

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.

NZREX Practice Test

NZREX Practice Test

NZREX Emergency and Acute Medicine