NZREX Clinical case studies

NZREX Clinical · Put your knowledge to work in context.

NZREX Clinical is the registration examination pathway that internationally trained doctors pursue when they want to practise medicine in Aotearoa New Zealand, and it is administered by the Medical Council of New Zealand (MCNZ), the body whose stated job is protecting the public by ensuring doctors are competent and fit to practise. The exam is a clinical, performance-based assessment rather than a written knowledge test: candidates rotate through stations across the five core disciplines - Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, and Psychiatry - and are observed taking histories, examining patients, forming differentials, ordering and interpreting investigations, communicating with patients and colleagues, and presenting management plans under time pressure. The NZREX Clinical case studies are 5 cases and about 5,169 words.

An unwell older woman with bradycardia and confusion on digoxin

Mrs H, aged 78, has heart failure with reduced ejection fraction (LVEF 35%) and permanent atrial fibrillation. Her regular medicines are digoxin 250 micrograms daily, furosemide 40 mg each morning, perindopril 4 mg daily and carvedilol 6.25 mg twice daily; her creatinine has been stable at 110 micromol/L.

1,003 words, about 5 min 2

Acute cholecystitis in a patient on a direct oral anticoagulant

Mr T, aged 66, presents to the emergency department with three days of constant right upper quadrant pain radiating to the right scapula, fever and vomiting. Background: type 2 diabetes with an HbA1c of 74 mmol/mol, a BMI of 36, and permanent atrial fibrillation with a CHA2DS2-VASc score of 4, for which he takes apixaban 5 mg twice daily; his last dose was 14 hours ago.

1,010 words, about 5 min 3

Severe pre-eclampsia at 34 weeks with a previous caesarean

Mrs K, 31, G2P1, is 34 weeks and 2 days by first-trimester scan and attends the antenatal day unit with a two-day frontal headache not relieved by paracetamol, vomiting, and brief 'flashing lights' this morning. Her first pregnancy ended in a caesarean section at 39 weeks for fetal distress.

1,031 words, about 5 min 4

A 19-day-old with weight loss, jaundice and hypoglycaemia

Baby W is a 19-day-old boy, born at 39+2 by spontaneous vaginal delivery after an uncomplicated pregnancy, with a birth weight of 3.42 kg. He is exclusively breastfed.

1,067 words, about 5 min 5

First-episode psychosis in a young man who declines admission

Mr R, aged 22, is brought to the emergency department by two flatmates who are worried he has not slept for three nights and has stopped eating. Over six weeks he has withdrawn from university, stopped answering his phone, and told them the radio is broadcasting messages about him and the neighbours are filming him.

1,058 words, about 5 min