APRIL 2008 SCENARIOS POSTED BY A CANDIDATE.... Hi, everyone I've just passed the NZREX.

I want to thank all the members of this forum because the information that I found here really helped me a lot. I'm going to post the exam questions that I've managed to recall. I hope they will be helpful to those who are going to sit this exam later. There were 16, but I can only recall 15. There should be only 2 questions in the communication, 3 in the physical examination and 4 in the history-taking catergory, but I have 3, 4 and 5 questions respectively . No. 3, 5 and 11 might belong to the prioritisation/acute serious conditions categories (in dynamic form). <Communication> 1.Woman says she wants to use oral contraceptive pills. Help the woman make a decision. (Explain benefits, risks, clarify if she has any of the risk factors, etc) 2.Woman worries about her dad who has just undergone an elective surgery for abdominal aneurysm, now in ICU connected to a ventilator. Explain what aneurysm is , future management (extubation, transfer to general ward etc). Address the daughter's distress and guilt as she is the one who talked her father into this. Reassure she did the right thing. 3.Explain a gastrocopy+biopsy report (duodenal ulcer). Positive urea breath test too. Includes diagnosis, treatment, etc. The patient's worried about having cancer. <Physical examination> 4.A boy has just had an asthma attack. 5.A young woman had a termination procedure , now has vaginal bleeding ,fever, dizziness, abd pain. Examine the actress and then, using a dummy, do a pelvic examination (bimanual and speculum). Findings will be given by the examiner. Give diagnosis and treatment plan (retained tissues cause infection) 6.Old man suffers from rt ankle pain after excercise. He has great pain when lateral ankle is palpate and limited ankle inversion. 7.Young man has sorethroat and a neck lump. I think it's infectious mononucleosis. Check ears, eyes, throat, neck, liver spleen.

<Take history> 8.Woman complains tiredness. Duration: 6 months. Onset: after divorce. Has most symptoms of depression. 9.Man has chronic cough. Hemoptysis, smoker. No TB risk factors. Most likely lung cancer. 10.Woman complains unilateral subacute hearing loss. Vertigo(?), tinnitus. I think it's Meniere's disease. 11.Man has acute severe occipital headache after exercise. FH: sister had 'stroke' around 30, had operation and recovered. Could be SAH. The examiner asked about plan (CT), what to do if CT negative (LP if still suspect SAH?) 12.Young woman, has vomitting. Most likely anorexia nervosa. Has amenorrhea, on diet, exercise vigorously etc. <Static stations> 13.Interpret X-ray and choose plan: have to determine whether there's fracture of fibula, skull, wrist, ribs and/or pneumothorax. (Prioritasation?) 14.differentiate different types of anemia :IDA, chronic disease, vitb12 deficiency etc.(Tests/procedures?) 15.Pyelonephritis: interpret lab data ,diagnose, choose plan.(Acute serious conditions?) I reckon none of the patients was real. One very useful tip is : At the communication stations, always ask the actor if he has any questions . They will ask you to explain things that you forgot to explain (eg.'Do I have cancer? Can my father talk after extubation?) I spent some time before the exam trying to memorize some important lab numbers, because in Taiwan we use different units. But it's totally unnecessary because all abnormal numbers will be highlighted. Books: Murtagh's General Practice, Tally&O'Connor's Clinical Examination and an OSCE book. My background: Trained in Taiwan. Have two years of work experience

(resident of the internal medicine department). All the best.