Medicine
Medicine
The NZREX Clinical medicine station tests whether you can take a focused history, examine safely, and act on red flags in an undifferentiated adult. Examiners watch for structured ABCDE assessment, appropriate vital-sign interpretation, and clear handover using SBAR. New Zealand practice expects you to consider ACS, sepsis, stroke, PE, and acute kidney injury early, and to ask about medicines, allergies, and access to primary care.
Core rules
- Start with airway, breathing, circulation and disability, even in a clinic station.
- For chest pain, obtain a 10-minute ECG and troponin; give aspirin unless contraindicated; assess bleeding risk before thrombolysis.
- For breathlessness, classify severity by work of breathing, SpO2, and ABG where indicated.
- Sepsis: take cultures, measure lactate, give broad-spectrum antibiotics within one hour of recognition.
- Always document capacity and consent, including the Health and Disability Commissioner Code.
Worked example
A 58-year-old man has 40 minutes of central crushing chest pain, nausea and sweating. He has no history of GI bleeding. Your reasoning should show: ABCDE stable; ECG shows ST elevation in II, III, aVF; give aspirin 300 mg chewed, GTN, analgesia; activate primary PCI pathway; check troponin but do not delay reperfusion; ask about allergies and anticoagulants; explain diagnosis and consent for transfer.
Traps
Anchoring on indigestion, omitting a pregnancy test in a woman of childbearing age, forgetting to check both arms' blood pressure when dissection is possible, and giving thrombolysis without excluding contraindications.