NRE October 2026 Prediction Exam

Batch 1 of 4 - Answer Key with Reasons

Prepared for: Ahmad Zafar
Purpose: Answer key for PMDC/NRE-I style prediction exam simulation.
Provenance: Prediction-derived from May 2026 intelligence, Dec 2025 paper patterns, NRE50 logic, QBank sampling, and PM&DC syllabus weighting.

Answers

Q1. B. CT angiography of the aorta
Reason: Tearing chest/back pain, BP difference between arms, and widened mediastinum point to aortic dissection. CT angiography confirms it.

Q2. B. Beta-blocker
Reason: Reduced EF heart failure has mortality benefit from evidence-based beta-blockers, ACEi/ARB/ARNI, and mineralocorticoid antagonists. Diuretics improve symptoms but not survival.

Q3. B. Cushing syndrome
Reason: Purple striae, proximal weakness, hypertension, eosinopenia, and lymphocytopenia are classic cortisol excess clues.

Q4. C. Anti-CCP antibody
Reason: Symmetric MCP/PIP arthritis with prolonged morning stiffness is RA. Anti-CCP is more specific than RF and much more useful than ESR alone.

Q5. B. Osteoarthritis
Reason: Elderly patient, pain worse with activity, and DIP Heberden nodes point to OA. RA usually targets MCP/PIP and spares DIP.

Q6. B. Post-streptococcal glomerulonephritis
Reason: Cola urine 1-3 weeks after sore throat with low C3 and RBC casts is PSGN. IgA occurs during or immediately after URTI.

Q7. A. Goodpasture syndrome
Reason: Hemoptysis plus hematuria/RBC casts is pulmonary-renal syndrome. Anti-GBM positivity makes Goodpasture the answer.

Q8. B. Chronic bronchitis
Reason: Productive cough for at least 3 months per year for 2 consecutive years in a smoker is chronic bronchitis.

Q9. B. Urea breath test
Reason: Urea breath test is the best non-invasive confirmation of H. pylori eradication after therapy. Serology can stay positive.

Q10. C. Irritable bowel syndrome
Reason: Pain relieved by defecation, stress association, normal colonoscopy, and no inflammatory markers fit IBS.

Q11. B. Substantia nigra
Reason: Parkinson disease is due to loss of dopaminergic neurons in the substantia nigra pars compacta.

Q12. B. Acute myeloid leukemia
Reason: Auer rods and MPO positivity indicate myeloid lineage, so AML.

Q13. B. Streptococcus pneumoniae
Reason: Streptococcus pneumoniae is the most common cause of community-acquired pneumonia and classically causes lobar consolidation.

Q14. B. Needle decompression
Reason: Hypotension, JVD, absent breath sounds, and tracheal deviation indicate tension pneumothorax. Decompress before imaging.

Q15. B. Emergency laparotomy
Reason: Free air under diaphragm with board-like rigidity indicates perforated viscus, classically perforated peptic ulcer. This needs surgery.

Q16. C. Urgent surgical exploration
Reason: Sudden testicular pain, high-riding testis, and absent cremasteric reflex mean torsion. Do not delay for Doppler if unavailable.

Q17. B. ERCP with sphincterotomy and stone extraction
Reason: Charcot triad plus hypotension and CBD stone is severe ascending cholangitis. Urgent biliary drainage by ERCP is required.

Q18. B. Esophageal carcinoma
Reason: Progressive dysphagia starting with solids then liquids is mechanical obstruction, especially with weight loss and anemia.

Q19. B. Achalasia
Reason: Dysphagia to liquids and solids from the beginning with bird-beak appearance indicates achalasia.

Q20. C. Femoral hernia
Reason: Femoral hernia lies below and lateral to the pubic tubercle.

Q21. B. Core needle biopsy
Reason: Suspicious breast lump plus inconclusive FNAC needs tissue diagnosis. Core biopsy is the best next step.

Q22. A. Pancreatic pseudocyst
Reason: Painless epigastric mass 4-6 weeks after pancreatitis without fever suggests pseudocyst, not abscess.

Q23. B. Escharotomy
Reason: Circumferential full-thickness burn with distal vascular compromise needs escharotomy.

Q24. A. Internal hemorrhage from pelvic vessels
Reason: Pelvic fracture can cause major retroperitoneal blood loss even when FAST is negative.

Q25. A. Appendectomy
Reason: Migrating periumbilical to RIF pain with rebound is classic appendicitis. Definitive treatment is appendectomy.

Q26. C. Within 72 hours
Reason: Anti-D is given within 72 hours of delivery or other sensitising events.

Q27. A. Placenta previa
Reason: Painless bright red bleeding with soft non-tender uterus is placenta previa. Abruption is painful with tender uterus.

Q28. B. Ectopic pregnancy
Reason: Amenorrhea, abdominal pain, spotting, and shock in a reproductive-age woman demands ectopic pregnancy exclusion first.

Q29. B. Magnesium sulfate
Reason: Severe pre-eclampsia/HELLP features require magnesium sulfate for seizure prophylaxis.

Q30. B. Secure airway in a controlled setting
Reason: Toxic child, drooling, tripod posture, stridor, and thumb sign indicate epiglottitis. Airway comes first.

Q31. B. IV Ringer lactate
Reason: Drowsy child unable to drink has severe dehydration. IV rehydration is required.

Q32. D. 3:1
Reason: Neonatal resuscitation uses 3 compressions to 1 ventilation.

Q33. B. Acute angle-closure glaucoma
Reason: Painful red eye, halos, vomiting, and fixed mid-dilated pupil are classic acute angle closure.

Q34. A. Endophthalmitis
Reason: Severe pain, hypopyon, and reduced vision soon after cataract surgery is post-operative endophthalmitis.

Q35. B. Nasal foreign body
Reason: Unilateral foul-smelling blood-stained nasal discharge in a child is a foreign body until proven otherwise.

Q36. B. Type II
Reason: Autoimmune hemolytic anemia is antibody-mediated cytotoxic hypersensitivity against RBC surface antigens.

Q37. B. Metaplasia
Reason: Barrett esophagus is replacement of squamous epithelium by columnar epithelium, which is metaplasia.

Q38. A. Histamine
Reason: Histamine is the key early mediator causing immediate vascular permeability in acute inflammation.

Q39. B. Common peroneal nerve
Reason: The common peroneal nerve winds around the fibular neck and injury causes foot drop.

Q40. B. Radial nerve
Reason: Midshaft humerus fracture injures the radial nerve and causes wrist drop.

Q41. B. Axillary nerve
Reason: Surgical neck humerus fracture injures axillary nerve, causing deltoid weakness and regimental badge sensory loss.

Q42. A. Metabolic alkalosis
Reason: Vomiting causes loss of gastric acid, leading to high pH, high bicarbonate, and low chloride.

Q43. B. It decreases
Reason: High altitude hypoxia triggers hyperventilation, which blows off CO2 and lowers pCO2.

Q44. B. Increased cardiac output
Reason: Anaphylaxis is distributive shock with low SVR and often high early cardiac output, unlike cardiogenic shock.

Q45. B. Flumazenil
Reason: Flumazenil reverses benzodiazepine effect. Naloxone is for opioids.

Q46. A. Phenytoin
Reason: Phenytoin causes gingival hyperplasia, hirsutism, ataxia, and coarsening.

Q47. A. Niacin
Reason: Diarrhea, dermatitis, and dementia/cognitive change after maize-based diet indicate pellagra due to niacin deficiency.

Q48. A. Galactose-1-phosphate uridyltransferase
Reason: Galactosemia causes vomiting, jaundice, E. coli sepsis, and positive reducing substances after milk feeding.

Q49. B. 35 years
Reason: Rule of 70: doubling time equals 70 divided by growth rate. 70/2 = 35 years.

Q50. A. Aspiration pneumonitis
Reason: Kerosene ingestion is dangerous mainly because of aspiration pneumonitis, not systemic toxicity.