NZREX Paediatrics and Obstetrics — Questions and Answers
Question 1: In NZ, what is the recommended immunisation schedule milestone at 6 weeks of age?
- First doses of rotavirus, DTaP-IPV-HepB/Hib, and pneumococcal conjugate vaccines (Correct answer)
- No immunisations are given until 3 months in NZ
- Only BCG vaccine is given at 6 weeks
- MMR vaccine is given at 6 weeks
Correct answer: First doses of rotavirus, DTaP-IPV-HepB/Hib, and pneumococcal conjugate vaccines
The NZ National Immunisation Schedule starts at 6 weeks with the first doses of rotavirus (oral), DTaP-IPV-HepB/Hib (hexavalent), and PCV13 (pneumococcal conjugate). This is a key milestone that NZREX candidates should know.
Question 2: A child presents to a NZ ED with croup. What is the initial management?
- Oral dexamethasone (single dose 0.15-0.6 mg/kg) and nebulised adrenaline if severe stridor at rest (Correct answer)
- Immediate intubation for all cases
- Antibiotics as first-line treatment
- Steam inhalation only
Correct answer: Oral dexamethasone (single dose 0.15-0.6 mg/kg) and nebulised adrenaline if severe stridor at rest
NZ management of croup follows a severity-based approach: oral dexamethasone is given to all presentations (mild to severe), and nebulised adrenaline (1:1000, 5 ml) is added for severe cases with stridor at rest. Antibiotics are not indicated as croup is viral.
Question 3: In NZ paediatric practice, what are the red flag features of a febrile child that suggest serious bacterial infection?
- Non-blanching rash, bulging fontanelle, altered consciousness, prolonged capillary refill (>3 seconds), and inconsolable crying (Correct answer)
- Fever above 37.5°C in any child
- Runny nose and cough with mild fever
- Fever that responds to paracetamol
Correct answer: Non-blanching rash, bulging fontanelle, altered consciousness, prolonged capillary refill (>3 seconds), and inconsolable crying
Red flags in a febrile NZ child include: non-blanching (petechial/purpuric) rash (meningococcal disease), bulging fontanelle in infants, altered consciousness/lethargy, prolonged capillary refill time, tachycardia, inconsolable high-pitched crying, and poor feeding.
Question 4: What is the APGAR score used for in NZ neonatal assessment, and what are its five components?
- Assessment of newborn wellbeing at 1 and 5 minutes — Appearance (colour), Pulse, Grimace (reflex), Activity (tone), Respiration (Correct answer)
- A measure of gestational age at birth
- A score for the mother's post-delivery recovery
- A classification of birth weight categories
Correct answer: Assessment of newborn wellbeing at 1 and 5 minutes — Appearance (colour), Pulse, Grimace (reflex), Activity (tone), Respiration
The APGAR score is used in NZ to assess newborn wellbeing at 1 and 5 minutes after birth. Each of the five components — Appearance (skin colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration — is scored 0-2, giving a total of 0-10.
Question 5: In NZ, what is the management of neonatal jaundice?
- Assess total serum bilirubin, plot against treatment thresholds based on gestational age and hours of life, and treat with phototherapy if above the threshold (Correct answer)
- All jaundiced babies require exchange transfusion
- Jaundice in newborns is always pathological and requires antibiotics
- No treatment is ever needed — neonatal jaundice always resolves spontaneously
Correct answer: Assess total serum bilirubin, plot against treatment thresholds based on gestational age and hours of life, and treat with phototherapy if above the threshold
NZ neonatal jaundice management involves: measuring total serum bilirubin (TSB), plotting it on a gestational age-specific treatment threshold chart, and initiating phototherapy if the TSB is above the treatment line. Exchange transfusion is reserved for very high levels or treatment failure.
Question 6: A woman presents to a NZ maternity unit at 32 weeks gestation with preterm contractions. What is the key pharmacological intervention to improve neonatal outcomes?
- Antenatal corticosteroids (betamethasone) to promote fetal lung maturity (Correct answer)
- IV antibiotics to prevent neonatal sepsis
- Oxytocin to accelerate delivery
- Oral iron supplements to prevent neonatal anaemia
Correct answer: Antenatal corticosteroids (betamethasone) to promote fetal lung maturity
In NZ, antenatal corticosteroids (betamethasone 11.4 mg IM, two doses 24 hours apart) are given to mothers at risk of preterm delivery between 24-34 weeks gestation. They significantly improve fetal lung maturity and reduce the risk of neonatal respiratory distress syndrome, intraventricular haemorrhage, and death.
NZREX Paediatrics and Obstetrics
In NZ, what is the recommended immunisation schedule milestone at 6 weeks of age?