NZREX Clinical flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Glasgow-Blatchford score

Risk stratification tool for upper gastrointestinal bleeding using urea, haemoglobin, systolic blood pressure, heart rate, melaena, syncope, hepatic disease, and cardiac failure. Scores of 0-1 identify very low risk suitable for outpatient care.

CURB-65

Pneumonia severity score: confusion, urea above 7 mmol/L, respiratory rate at least 30, blood pressure systolic below 90 or diastolic 60 or less, and age 65 or older. Each scores one point.

DKA diagnostic triad

Diabetic ketoacidosis requires hyperglycaemia above 11 mmol/L or known diabetes, ketonaemia at least 3 mmol/L or significant ketonuria, and metabolic acidosis with pH below 7.30 or bicarbonate below 18 mmol/L.

Hyperkalaemia emergency treatment

With ECG changes, give intravenous calcium gluconate or calcium chloride first to stabilise the myocardium, then insulin with glucose and nebulised salbutamol to shift potassium into cells. Dialysis for refractory cases.

Osmotic demyelination prevention

Limit sodium correction in hyponatraemia to roughly 8-10 mmol/L per 24 hours. For seizures or reduced consciousness, hypertonic 3% saline boluses aim for an initial 4-6 mmol/L rise before slower correction.

Life-threatening asthma features

Silent chest, cyanosis, exhaustion, bradycardia, hypotension, altered consciousness, and peak flow below 33% predicted. These require immediate oxygen, nebulised beta-2 agonist with ipratropium, systemic steroid, and critical care involvement.

Alvarado score

Clinical score for suspected appendicitis: migration of pain, anorexia, nausea or vomiting, right iliac fossa tenderness, rebound tenderness, fever, leucocytosis, and neutrophilia. Higher totals support surgical assessment and operative management.

Acute limb ischaemia six Ps

Pain, pallor, pulselessness, paraesthesia, paralysis, and perishing cold. Immediate intravenous heparin and urgent vascular referral are needed; fixed mottling or paralysis suggests irreversible ischaemia.

ATLS primary survey

Sequence of catastrophic haemorrhage control, airway with cervical spine protection, breathing and ventilation, circulation with haemorrhage control, disability with neurological assessment, and exposure with prevention of hypothermia.

Postoperative fever timeline

Within 48 hours consider atelectasis and drug reaction; days 3-5 surgical site and urinary infection; days 5-7 abscess or anastomotic leak; beyond day 7 deep vein thrombosis and prosthetic infection.

Post-thyroidectomy haematoma

A rapidly expanding neck swelling after thyroid surgery that compromises the airway. It is an emergency: open the wound at the bedside to release the haematoma, then secure the airway and return to theatre.

Pancreatitis diagnostic criteria

Diagnosis requires two of three: characteristic epigastric pain radiating to the back, serum lipase or amylase more than three times the upper limit of normal, and cross-sectional imaging findings consistent with pancreatitis.

Femoral hernia risk

Femoral hernias pass below the inguinal ligament and carry a higher risk of strangulation than inguinal hernias, particularly in older women. They should be repaired promptly rather than managed expectantly.

Pre-eclampsia definition

New hypertension after 20 weeks of gestation with proteinuria or maternal organ dysfunction such as renal, hepatic, neurological, or haematological involvement, or fetal growth restriction. Delivery is the definitive treatment.

Postpartum haemorrhage sequence

Uterine massage and oxytocin first, then ergometrine, carboprost, and misoprostol. Give tranexamic acid within 3 hours, then consider balloon tamponade, uterine artery embolisation, or surgery for refractory bleeding.

Ectopic pregnancy discriminatory zone

A serum beta-hCG level above which a normal intrauterine pregnancy should be visible on transvaginal ultrasound, commonly around 1500-3500 IU/L depending on the assay. An empty uterus then raises concern for ectopic pregnancy.

Gestational diabetes OGTT thresholds

A 75 g oral glucose tolerance test at 24-28 weeks is diagnostic if fasting glucose is at least 5.1 mmol/L, one-hour at least 10.0 mmol/L, or two-hour at least 8.5 mmol/L, under widely used criteria.

Late decelerations

Fetal heart rate decelerations that begin after the uterine contraction peak and recover after it ends. They suggest uteroplacental insufficiency and fetal hypoxia, requiring maternal repositioning, fluids, and escalation.

Ovarian torsion management

Sudden severe unilateral pelvic pain with nausea suggests torsion. Urgent laparoscopy allows detorsion and ovarian preservation; ultrasound may show an enlarged oedematous ovary with reduced Doppler flow.

Shoulder dystocia manoeuvres

Call for help, then McRoberts manoeuvre with suprapubic pressure. If unsuccessful, use internal rotational manoeuvres, delivery of the posterior arm, or the all-fours position. Avoid fundal pressure and excessive traction.

Bronchiolitis management

Infants under two years with coryza, cough, tachypnoea, wheeze, and crackles, usually from respiratory syncytial virus. Treatment is supportive with oxygen for low saturations and feeding support; bronchodilators and steroids are not routine.

Croup treatment

Barking cough with stridor and hoarse voice. Give oral dexamethasone for all severities; add nebulised adrenaline for stridor at rest or moderate-severe distress, then observe for rebound symptoms.

Febrile infant under 3 months

Any infant under 3 months with temperature of 38°C or above needs urgent full sepsis evaluation, including blood, urine, and cerebrospinal fluid cultures, and empirical intravenous antibiotics.

Kawasaki disease criteria

Fever for at least 5 days plus four of five features: rash, conjunctivitis, oral changes, cervical lymphadenopathy, and extremity changes. Treat with intravenous immunoglobulin and aspirin to reduce coronary aneurysm risk.

Neonatal jaundice red flag

Jaundice appearing within the first 24 hours of life is always pathological. Measure bilirubin and plot against age-specific treatment thresholds; prematurity, haemolysis, and sepsis increase kernicterus risk.

Developmental milestones

Social smile around 6 weeks, sitting unsupported at 6-8 months, walking at 12-18 months, and two-word phrases at 18-24 months. Loss of previously acquired skills requires urgent developmental assessment.

Serotonin syndrome

Caused by serotonergic drugs, with clonus, hyperreflexia, agitation, hyperthermia, and autonomic instability. Stop the offending agent, give benzodiazepines and supportive care, and avoid relying on antipyretics alone.

Neuroleptic malignant syndrome

Lead-pipe rigidity, fever, autonomic instability, and raised creatine kinase after dopamine antagonist exposure. Stop the drug, provide supportive care, and consider dantrolene or bromocriptine in severe cases.

Alcohol withdrawal timeline

Tremor, sweating, anxiety, and seizures occur within 6-48 hours of cessation. Delirium tremens appears at 48-96 hours with confusion, hallucinations, and autonomic instability. Treat with benzodiazepines and give thiamine.

Mental Capacity Act principles

Presume capacity, support the person to decide, do not treat unwise decisions as proof of incapacity, act in best interests when capacity is lacking, and choose the least restrictive option. Capacity is decision-specific.

Rapid tranquillisation

Used only after de-escalation fails and risk to self or others is high. Give a benzodiazepine, an antipsychotic, or both, then monitor vital signs, sedation level, and ECG for arrhythmia.

Anorexia nervosa medical risk

Low body mass index with fear of weight gain and body image distortion. Risk rises with rapid weight loss, bradycardia, hypothermia, and electrolyte disturbance. Refeeding syndrome requires cautious calorie advancement and electrolyte monitoring.