NZREX Paediatrics and Obstetrics 2 β Questions and Answers
Question 1: In NZ, what is the recommended management of pre-eclampsia?
- Blood pressure control, monitoring for severe features (headache, visual disturbance, epigastric pain, proteinuria), magnesium sulphate for severe pre-eclampsia, and delivery as definitive treatment (Correct answer)
- Bed rest alone is sufficient treatment
- Pre-eclampsia resolves spontaneously and needs no intervention
- Diuretics are the first-line treatment in NZ
Correct answer: Blood pressure control, monitoring for severe features (headache, visual disturbance, epigastric pain, proteinuria), magnesium sulphate for severe pre-eclampsia, and delivery as definitive treatment
NZ pre-eclampsia management includes: antihypertensive medication (labetalol or nifedipine), monitoring for severe features (headache, visual changes, epigastric pain, deranged liver/renal function), magnesium sulphate for seizure prophylaxis in severe cases, and planned delivery as the only definitive cure.
Question 2: What is the NZ approach to managing a child with suspected non-accidental injury (NAI)?
- Document findings carefully, obtain a thorough history, perform a skeletal survey and relevant investigations, report to Oranga Tamariki (child protection), and ensure the child's safety (Correct answer)
- Confront the parents immediately about the suspected abuse
- Discharge the child with a follow-up appointment only
- Report to police but not to child protection services
Correct answer: Document findings carefully, obtain a thorough history, perform a skeletal survey and relevant investigations, report to Oranga Tamariki (child protection), and ensure the child's safety
NZ management of suspected NAI includes: careful documentation of injuries (photographs, body map), thorough history from all caregivers, appropriate investigations (skeletal survey, bloods, ophthalmology review), mandatory report to Oranga Tamariki (Ministry for Children), and ensuring the child's immediate safety.
Question 3: In NZ paediatric resuscitation, what is the correct compression-to-ventilation ratio for infants?
- 15 compressions to 2 ventilations (with two rescuers) using the two-thumb encircling technique (Correct answer)
- 30 compressions to 2 ventilations as for adults
- 5 compressions to 1 ventilation
- Continuous compressions with no ventilations
Correct answer: 15 compressions to 2 ventilations (with two rescuers) using the two-thumb encircling technique
ANZCOR guidelines used in NZ recommend a 15:2 compression-to-ventilation ratio for infant CPR with two healthcare rescuers. The preferred technique is the two-thumb encircling hands technique, compressing the lower third of the sternum to one-third of the chest depth.
Question 4: What is the NZ approach to managing postpartum haemorrhage (PPH)?
- Call for help, ABC assessment, uterine massage, IV oxytocin, establish IV access with fluid resuscitation, and consider additional uterotonics and surgical intervention if not responding (Correct answer)
- Observation only β PPH resolves spontaneously
- Oral tranexamic acid is sufficient for all cases
- Hysterectomy is the first-line treatment
Correct answer: Call for help, ABC assessment, uterine massage, IV oxytocin, establish IV access with fluid resuscitation, and consider additional uterotonics and surgical intervention if not responding
NZ PPH management follows a structured approach: call for help, ABCDE assessment, bimanual uterine compression/massage, IV oxytocin (10 units), establish large-bore IV access with fluid resuscitation, consider additional uterotonics (ergometrine, misoprostol), IV tranexamic acid, and surgical intervention if medical management fails.
Question 5: A 3-year-old in NZ presents with wheeze and respiratory distress. How do you differentiate bronchiolitis from asthma?
- Bronchiolitis typically affects infants under 12 months, is preceded by coryzal symptoms, and occurs in first episodes; asthma involves recurrent episodes, often with atopy or family history (Correct answer)
- They are the same condition with different names
- Bronchiolitis only occurs in summer
- Asthma does not cause wheeze in children under 5
Correct answer: Bronchiolitis typically affects infants under 12 months, is preceded by coryzal symptoms, and occurs in first episodes; asthma involves recurrent episodes, often with atopy or family history
In NZ paediatrics, bronchiolitis typically affects infants under 12 months (peak 2-6 months), is preceded by upper respiratory symptoms, and is usually a first-time wheeze episode caused by RSV. Asthma is characterised by recurrent wheeze episodes, often with personal or family history of atopy (eczema, allergic rhinitis).
Question 6: What is the NZ screening test for gestational diabetes mellitus (GDM)?
- A polycose (glucose challenge) screening test at 24-28 weeks gestation, followed by a 75g oral glucose tolerance test (OGTT) if positive (Correct answer)
- Random blood glucose test at the first antenatal visit only
- HbA1c at 36 weeks gestation
- No screening is performed for GDM in NZ
Correct answer: A polycose (glucose challenge) screening test at 24-28 weeks gestation, followed by a 75g oral glucose tolerance test (OGTT) if positive
In NZ, gestational diabetes screening involves a polycose (50g glucose challenge test) at 24-28 weeks gestation. If the result is elevated (β₯7.8 mmol/L at 1 hour), a confirmatory 75g OGTT is performed. Women with risk factors may be screened earlier.
NZREX Paediatrics and Obstetrics 2
In NZ, what is the recommended management of pre-eclampsia?