NZREX Emergency Medicine 2

Question 1

A 55-year-old presents with sudden onset severe headache, vomiting, and neck stiffness. CT brain is normal. Lumbar puncture shows xanthochromia. What is the diagnosis?

Accepted Answer

Subarachnoid haemorrhage

Answer

Xanthochromia (yellow CSF discolouration due to bilirubin from haemolysed red blood cells) after a thunderclap headache confirms subarachnoid haemorrhage (SAH) when CT is normal. LP is most sensitive >12 hours after headache onset.

Question 2

A patient is brought in with a GCS of 8 after a road traffic accident. What is the GCS score threshold typically used to guide intubation?

Accepted Answer

GCS ≤8

Answer

A GCS of ≤8 is the widely accepted threshold indicating the patient cannot protect their own airway, requiring intubation. 'GCS of 8 — intubate' is a clinical rule of thumb used in trauma and emergency medicine.

Question 3

Which of the following is the first-line treatment for hypoglycaemia in a conscious patient who can swallow?

Accepted Answer

15–20 g of fast-acting carbohydrate orally (e.g., glucose tablets or sugary drink)

Answer

Conscious patients with hypoglycaemia who can swallow safely should receive 15–20 g of fast-acting oral carbohydrate. IV dextrose and IM glucagon are reserved for unconscious patients or those unable to swallow.

Question 4

A 35-year-old woman presents with acute severe asthma not responding to initial bronchodilators. Her SpO2 is 88% despite oxygen. What is the next most appropriate intervention?

Accepted Answer

IV magnesium sulphate 2 g over 20 minutes

Answer

IV magnesium sulphate is recommended for acute severe asthma not responding to initial bronchodilators, as it causes bronchial smooth muscle relaxation. This should be given alongside IV corticosteroids, continuous salbutamol, and senior review.

Question 5

In a patient with suspected carbon monoxide poisoning, which intervention is most important?

Accepted Answer

High-flow 100% oxygen via non-rebreather mask

Answer

High-flow 100% oxygen accelerates elimination of carbon monoxide (CO) from haemoglobin. It reduces the half-life of carboxyhaemoglobin from ~5 hours on room air to ~60–90 minutes. Hyperbaric oxygen is considered for severe cases but high-flow O2 is the immediate priority.

NZREX Practice Test

NZREX Practice Test

NZREX Emergency Medicine 2