NRE Non-Negotiable 100 MCQs - Answer Key

Correct answers with reasons.

Q1. A 62-year-old man has sudden tearing chest pain radiating to the back with a BP difference between arms. Best immediate test? Answer: B. CT angiography of the aorta Reason: Aortic dissection is best confirmed by CT angiography; the BP difference and tearing pain are the giveaway.

Q2. A Rh-negative mother delivers an Rh-positive baby 2 hours ago. Best prophylaxis? Answer: A. Anti-D within 72 hours Reason: Anti-D must be given within 72 hours after a sensitising event.

Q3. A woman has symmetric MCP/PIP pain and morning stiffness lasting more than 1 hour. Best confirmatory test? Answer: B. Anti-CCP Reason: Anti-CCP is the most useful confirming test when RA is the stem clue.

Q4. An elderly patient has DIP pain and Heberden nodes, worse with activity. Diagnosis? Answer: B. Osteoarthritis Reason: DIP involvement with Heberden nodes points to osteoarthritis.

Q5. A child has cola-coloured urine and periorbital edema 2 weeks after a sore throat. Diagnosis? Answer: B. Post-streptococcal GN Reason: The 1-3 week delay after infection and low C3 pattern fit post-strep GN.

Q6. Hematuria occurs during an upper respiratory infection, not weeks later. Most likely diagnosis? Answer: A. IgA nephropathy Reason: Synpharyngitic hematuria is classic for IgA nephropathy.

Q7. A toxic child has drooling, stridor, tripod posture, and a thumb sign. First step? Answer: B. Secure airway in controlled setting Reason: Epiglottitis is an airway-first emergency.

Q8. A child has unilateral foul-smelling nasal discharge. Most likely cause? Answer: B. Foreign body in nostril Reason: A unilateral foul discharge in a child is a nasal foreign body until proven otherwise.

Q9. Sudden severe testicular pain, high-riding testis, absent cremasteric reflex. Best action? Answer: B. Urgent surgical exploration Reason: Testicular torsion needs immediate exploration; do not wait for imaging.

Q10. Sudden severe abdominal pain, board-like rigidity, and free air under diaphragm. Best management? Answer: B. Urgent laparotomy Reason: Perforated peptic ulcer is a surgical abdomen.

Q11. Progressive dysphagia starts with solids then liquids and there is weight loss. Diagnosis? Answer: B. Esophageal carcinoma Reason: Solids first then liquids is mechanical obstruction, usually cancer.

Q12. Dysphagia to both liquids and solids with bird-beak appearance. Diagnosis? Answer: A. Achalasia Reason: Liquids and solids together with bird-beak points to achalasia.

Q13. A cirrhotic patient vomits blood. Best endoscopic control? Answer: A. Band ligation Reason: Esophageal varices are treated with endoscopic band ligation.

Q14. After triple therapy for peptic ulcer disease, which test best confirms H. pylori eradication? Answer: B. Urea breath test Reason: Urea breath test is the preferred non-invasive eradication test.

Q15. Chronic abdominal pain is relieved by defecation and workup is normal. Diagnosis? Answer: B. IBS Reason: Pain relieved by defecation with normal tests is IBS.

Q16. Smoker with productive cough for 2 years. Diagnosis? Answer: B. Chronic bronchitis Reason: Productive cough for at least 3 months in 2 consecutive years defines chronic bronchitis.

Q17. Dullness on one side of chest with trachea pushed away from that side. Likely diagnosis? Answer: B. Pleural effusion Reason: Dullness and tracheal shift away fit pleural effusion.

Q18. Hemoptysis with hematuria and RBC casts. Diagnosis? Answer: A. Goodpasture syndrome Reason: Pulmonary-renal syndrome with anti-GBM antibodies is Goodpasture.

Q19. Purple striae, proximal weakness, HTN, eosinopenia, lymphocytopenia. Diagnosis? Answer: A. Cushing syndrome Reason: Cortisol excess gives purple striae and eosinopenia.

Q20. Tetany with positive Chvostek sign suggests deficiency of which electrolyte? Answer: C. Calcium Reason: Chvostek sign is a low-calcium clue.

Q21. The earliest biochemical change in primary hyperparathyroidism is often: Answer: B. Hypophosphatemia Reason: PTH causes phosphaturia early, so phosphate falls first.

Q22. Resting tremor, rigidity, bradykinesia, shuffling gait. Diagnosis? Answer: B. Parkinson disease Reason: Resting tremor and bradykinesia point to Parkinson disease.

Q23. Ptosis and diplopia worsen through the day and improve with rest. Best symptomatic treatment? Answer: A. Pyridostigmine Reason: Myasthenia gravis is treated symptomatically with pyridostigmine.

Q24. Ascending weakness after a recent infection with absent reflexes. Diagnosis? Answer: B. Guillain-Barre syndrome Reason: Ascending flaccid paralysis after infection is GBS.

Q25. Transient monocular blindness. Most accurate label? Answer: B. Amaurosis fugax Reason: Transient monocular blindness is amaurosis fugax, a TIA equivalent.

Q26. Auer rods and MPO positivity on smear indicate: Answer: B. AML Reason: Auer rods are pathognomonic for AML.

Q27. Massive splenomegaly with myeloid left shift and BCR-ABL. Diagnosis? Answer: A. CML Reason: Philadelphia chromosome and splenomegaly fit CML.

Q28. Microcytic anemia with low ferritin and high TIBC. Diagnosis? Answer: B. Iron deficiency anemia Reason: Low ferritin and high TIBC are classic for iron deficiency anemia.

Q29. Macrocytosis, glossitis, posterior column signs, and low B12. Cause? Answer: B. Pernicious anemia Reason: Pernicious anemia is a common cause of B12 deficiency with neurologic signs.

Q30. Sudden painful red first MTP joint. Diagnosis? Answer: B. Gout Reason: Podagra is gout until proven otherwise.

Q31. Most common cause of community-acquired pneumonia? Answer: B. Streptococcus pneumoniae Reason: Streptococcus pneumoniae is the classic CAP organism.

Q32. Fever, neck stiffness, and bulging fontanelle in an infant. Best confirmatory test? Answer: B. Lumbar puncture Reason: LP is the key diagnostic test if no contraindication to raised ICP exists.

Q33. ATT commonly causes hyperuricemia and joint pains due to which drug? Answer: C. Pyrazinamide Reason: Pyrazinamide is the classic cause of gout-like pain on ATT.

Q34. Fever, cough, coryza, conjunctivitis, and Koplik spots. Diagnosis? Answer: B. Measles Reason: Koplik spots are the giveaway for measles.

Q35. Warfarin with high INR and minor gum bleeding. Best reversal? Answer: B. Oral vitamin K Reason: Minor bleeding with high INR is typically managed with vitamin K.

Q36. A child accidentally takes a toxic paracetamol dose. Best antidote? Answer: B. N-acetylcysteine Reason: N-acetylcysteine is the antidote for paracetamol toxicity.

Q37. Sedated patient with normal pupils and ataxia suggests benzodiazepine overdose. Antidote? Answer: B. Flumazenil Reason: Flumazenil is the benzo antidote.

Q38. Gingival hyperplasia and hirsutism in an epileptic patient. Drug? Answer: B. Phenytoin Reason: Phenytoin is famous for gum hypertrophy and hirsutism.

Q39. Alcoholic patient with confusion, ataxia, and ophthalmoplegia. Immediate vitamin? Answer: B. Thiamine Reason: Thiamine deficiency causes Wernicke encephalopathy.

Q40. Diabetic patient with HTN and microalbuminuria. Best BP drug class? Answer: A. ACE inhibitor Reason: ACE inhibitors protect the kidney in diabetic nephropathy.

Q41. Groin swelling below and lateral to the pubic tubercle. Hernia type? Answer: B. Femoral Reason: Femoral hernia lies below and lateral to the pubic tubercle.

Q42. Hernia through Hesselbach triangle is: Answer: B. Direct inguinal Reason: Hesselbach triangle is the site of direct inguinal hernia.

Q43. Midline neck swelling moves with tongue protrusion. Diagnosis? Answer: B. Thyroglossal duct cyst Reason: Movement with tongue protrusion is classic thyroglossal duct cyst.

Q44. Hard irregular breast lump with skin dimpling and nodes. Best first principle? Answer: A. Triple assessment Reason: Breast lumps are handled by triple assessment.

Q45. Young woman with a painless mobile breast lump. Most likely diagnosis? Answer: A. Fibroadenoma Reason: A mobile painless lump in a young woman is typical fibroadenoma.

Q46. Bloody nipple discharge from a single duct with no palpable lump. Likely diagnosis? Answer: A. Intraductal papilloma Reason: Single-duct bloody discharge strongly suggests intraductal papilloma.

Q47. Periumbilical pain migrates to the right iliac fossa with rebound tenderness. Diagnosis? Answer: B. Appendicitis Reason: Migration of pain to RIF is classic appendicitis.

Q48. Tension pneumothorax with hypotension and absent breath sounds. Immediate management? Answer: B. Needle decompression Reason: Needle decompression comes before any imaging.

Q49. Circumferential burn with weak pulses and paresthesia. Next step? Answer: A. Escharotomy Reason: Escharotomy is needed for vascular compromise in circumferential burns.

Q50. Pelvic fracture with shock is most likely due to: Answer: B. Blood loss Reason: Pelvic fractures can cause massive internal hemorrhage.

Q51. RUQ pain, fever, jaundice, and CBD stone with sepsis. Urgent intervention? Answer: B. ERCP with stone extraction Reason: Septic obstructive cholangitis needs urgent ERCP.

Q52. Epigastric mass 4-6 weeks after pancreatitis. Diagnosis? Answer: B. Pancreatic pseudocyst Reason: A walled-off collection after pancreatitis is a pseudocyst.

Q53. Painless bright red bleeding in late pregnancy with soft uterus. Diagnosis? Answer: A. Placenta previa Reason: Painless bleeding and a soft uterus point to placenta previa.

Q54. Painful bleeding in pregnancy with tender rigid uterus. Diagnosis? Answer: B. Placental abruption Reason: Pain and uterine tenderness are classic abruption clues.

Q55. Amenorrhea, abdominal pain, bleeding, and shock in a reproductive-age woman. First diagnosis to rule out? Answer: B. Ectopic pregnancy Reason: Ectopic pregnancy must be excluded first.

Q56. Severe pre-eclampsia with headache and low platelets. Best seizure prophylaxis? Answer: A. Magnesium sulfate Reason: Magnesium sulfate prevents eclampsia.

Q57. Pregnant woman at 24-28 weeks needs confirmation of gestational diabetes. Best test? Answer: B. OGTT Reason: OGTT is the screening/diagnostic test of choice in pregnancy.

Q58. Preterm labor where fetal lung maturity is the priority. Best drug? Answer: A. Betamethasone Reason: Antenatal corticosteroids improve fetal lung maturity.

Q59. Infertility, obesity, hirsutism, irregular cycles, polycystic ovaries. Diagnosis? Answer: B. PCOS Reason: PCOS combines hyperandrogenism, oligomenorrhea, and polycystic ovaries.

Q60. Primary amenorrhea with absent uterus, 46XY karyotype, normal breasts, and blind vagina. Diagnosis? Answer: B. Androgen insensitivity syndrome Reason: 46XY with female phenotype and absent uterus is androgen insensitivity.

Q61. Heavy menstrual bleeding since menarche, pregnancy test negative, coagulation normal. Most common cause? Answer: B. Anovulatory cycles Reason: Anovulatory bleeding is the commonest cause of adolescent menorrhagia.

Q62. Markedly raised beta-hCG after pregnancy-related bleeding. Important next step in surveillance? Answer: B. Serial beta-hCG monitoring Reason: Gestational trophoblastic disease needs serial beta-hCG follow-up.

Q63. Child with upslanting eyes, single palmar crease, and intellectual disability. Diagnosis? Answer: B. Down syndrome Reason: The phenotype is classic trisomy 21.

Q64. Newborn after difficult delivery has waiter’s tip posture. Injury? Answer: B. Erb palsy Reason: Upper trunk (C5-C6) injury causes Erb palsy.

Q65. Drowsy child cannot drink and has profuse vomiting/diarrhea. Best fluid? Answer: B. IV Ringer lactate Reason: Severe dehydration requires IV fluids, usually Ringer lactate.

Q66. Newborn resuscitation compression-to-ventilation ratio? Answer: B. 3:1 Reason: Neonatal CPR uses 3 compressions to 1 breath.

Q67. Bleeding from umbilical stump in a newborn who did not receive prophylaxis. Deficiency? Answer: B. Vitamin K Reason: Vitamin K deficiency causes bleeding in the newborn.

Q68. Bowed legs, rachitic rosary, low Ca/phosphate, high ALP. Cause? Answer: A. Vitamin D deficiency Reason: Rickets is due to vitamin D deficiency.

Q69. Barking cough, steeple sign, non-toxic child. Diagnosis? Answer: B. Croup Reason: Croup is the non-toxic barking cough emergency.

Q70. Poor eye contact, hand flapping, delayed speech. Diagnosis? Answer: B. Autism spectrum disorder Reason: Social communication deficits plus repetitive behaviors fit autism.

Q71. Painful red eye with halos and fixed mid-dilated pupil. Diagnosis? Answer: B. Acute angle-closure glaucoma Reason: This is acute angle-closure glaucoma until proven otherwise.

Q72. Child with severe eye itching in summer and cobblestone papillae. Diagnosis? Answer: B. Vernal keratoconjunctivitis Reason: Itching + summer + cobblestone papillae = vernal keratoconjunctivitis.

Q73. Severe pain/redness/hypopyon one day after cataract surgery. Diagnosis? Answer: B. Endophthalmitis Reason: Post-op hypopyon and pain are endophthalmitis.

Q74. Child with long-standing squint and reduced vision despite normal ocular structures. Complication? Answer: B. Amblyopia Reason: Strabismus can lead to amblyopia.

Q75. Fibular neck injury causes foot drop. Nerve? Answer: B. Common peroneal nerve Reason: The common peroneal nerve wraps around the fibular neck.

Q76. Midshaft humerus fracture with wrist drop. Nerve? Answer: B. Radial nerve Reason: Radial nerve injury causes wrist drop.

Q77. Surgical neck humerus fracture with deltoid weakness and regimental badge numbness. Nerve? Answer: B. Axillary nerve Reason: Axillary nerve supplies deltoid and regimental badge sensation.

Q78. Unable to make OK sign after supracondylar fracture. Nerve injured? Answer: B. Anterior interosseous nerve Reason: Anterior interosseous nerve injury prevents the OK sign.

Q79. Facial palsy with hyperacusis indicates a lesion: Answer: B. Proximal to nerve to stapedius Reason: Hyperacusis means the nerve to stapedius is involved, so the lesion is proximal to it.

Q80. Ipsilateral cranial nerve palsy with contralateral hemiplegia. Lesion site? Answer: B. Brainstem Reason: Crossed findings are a brainstem sign.

Q81. TB, PSGN, AIHA, and contact dermatitis are examples used to test: Answer: B. Hypersensitivity types Reason: These are standard examples for hypersensitivity I-IV.

Q82. Long-standing GERD leading to squamous to columnar metaplasia is: Answer: B. Barrett esophagus Reason: Barrett esophagus is metaplastic change from chronic reflux.

Q83. Immediate increase in vascular permeability in acute inflammation is mediated by: Answer: A. Histamine Reason: Histamine is the classic early mediator of permeability.

Q84. A chronic burn scar turns into a non-healing raised ulcer. Diagnosis? Answer: B. Marjolin ulcer Reason: Marjolin ulcer is SCC arising in a chronic scar.

Q85. Distinguish TTP from DIC in a lab question. Which is typical of TTP? Answer: B. Normal coagulation profile Reason: TTP usually has normal PT/APTT; DIC does not.

Q86. Vomiting with high pH, high HCO3, low chloride. Acid-base disorder? Answer: B. Metabolic alkalosis Reason: Vomiting is the classic cause of metabolic alkalosis.

Q87. At high altitude, the early blood gas change is: Answer: A. Low pCO2 Reason: Hyperventilation lowers pCO2 at altitude.

Q88. High-flow pancreatic secretion is rich in: Answer: B. Bicarbonate Reason: Ductal pancreatic secretions are bicarbonate-rich.

Q89. At rest, the membrane potential is mainly determined by: Answer: B. Potassium Reason: Resting membrane potential is mainly K-dependent.

Q90. In anaphylactic shock compared with cardiogenic shock, the most expected change is: Answer: B. Higher CO Reason: Anaphylaxis is a vasodilated high-output shock.

Q91. A population grows at 2% yearly. Approximate doubling time? Answer: B. 35 years Reason: Rule of 70: 70/2 = about 35 years.

Q92. Which study design best fits division of patients into surgery and diet groups? Answer: B. Randomized controlled trial Reason: Assigning interventions makes it an RCT.

Q93. Data presented as parts of a whole in percentages is best shown by: Answer: B. Pie chart Reason: Percentages/parts of a whole are shown with a pie chart.

Q94. When data are skewed, the best central tendency is: Answer: B. Median Reason: Median is best for skewed data.

Q95. Child ingests kerosene. Most important complication? Answer: B. Aspiration pneumonitis Reason: Kerosene is most dangerous because of aspiration pneumonitis.

Q96. Rigor mortis timing is used to estimate: Answer: B. Post-mortem interval Reason: Rigor mortis helps estimate PMI.

Q97. Salivation, lacrimation, bronchorrhea, and miosis after pesticide exposure suggest: Answer: B. Organophosphate poisoning Reason: Cholinergic toxidrome points to organophosphates.

Q98. Ear pain and fullness after a flight with retracted congested tympanic membrane. Diagnosis? Answer: B. Otic barotrauma Reason: Pressure change after flying causes barotrauma.

Q99. Child with fever, neck stiffness, and pharyngeal abscess on exam. Anatomic space? Answer: B. Retropharyngeal space Reason: A pharyngeal abscess in a child is often retropharyngeal.

Q100. Well-demarcated erythematous plaques with silvery scales and nail pitting. Diagnosis? Answer: B. Psoriasis Reason: Extensor plaques with silvery scale and nail pitting are psoriasis.