NRE October 2026 Prediction Exam

Batch 1 of 4 - 50 MCQs
Unsolved paper

Prepared for: Ahmad Zafar
Purpose: PMDC/NRE-I style prediction exam simulation.
Timing target: 50 questions in 50 minutes.

Batch 1 Weightage

Subject block	Questions
Medicine and Allied	13
Surgery and Allied	12
Obstetrics and Gynaecology	4
Paediatrics	3
Ophthalmology	2
ENT	1
Applied Pathology	3
Applied Anatomy	3
Applied Physiology	3
Clinical Pharmacology	2
Applied Biochemistry	2
Community Medicine	1
Forensic Medicine and Toxicology	1
Total	50

Questions

Q1. A 58-year-old hypertensive man presents to the emergency department with sudden severe tearing chest pain radiating to the back. His right arm BP is 190/110 mmHg and left arm BP is 150/90 mmHg. Chest X-ray shows a widened mediastinum. What is the most appropriate investigation to confirm the diagnosis?

A. ECG
B. CT angiography of the aorta
C. Serum troponin I
D. D-dimer

Q2. A 62-year-old man with long-standing hypertension presents with progressive exertional dyspnea, orthopnea, bilateral ankle swelling, and raised JVP. Echocardiography shows a dilated left ventricle with ejection fraction of 30%. Which drug class has proven mortality benefit in this condition?

A. Loop diuretic only
B. Beta-blocker
C. Short-acting nifedipine
D. Digoxin only

Q3. A 45-year-old woman has weight gain, proximal muscle weakness, purple abdominal striae, new-onset hypertension, eosinopenia, and lymphocytopenia. Which diagnosis best explains this pattern?

A. Addison disease
B. Cushing syndrome
C. Hypothyroidism
D. Primary hyperparathyroidism

Q4. A 32-year-old woman has symmetrical pain and swelling of the MCP and PIP joints of both hands. Morning stiffness lasts more than 1 hour and improves with activity. Which investigation is most specific for confirming the diagnosis?

A. ANA
B. ESR
C. Anti-CCP antibody
D. Serum uric acid

Q5. A 68-year-old woman has chronic knee pain and stiffness that worsens with walking and improves with rest. Examination shows hard swellings at the DIP joints. What is the most likely diagnosis?

A. Rheumatoid arthritis
B. Osteoarthritis
C. Reactive arthritis
D. Systemic lupus erythematosus

Q6. An 8-year-old child develops facial puffiness, cola-coloured urine, and mild hypertension 2 weeks after a sore throat. Urine microscopy shows RBC casts and serum C3 is low. What is the most likely diagnosis?

A. IgA nephropathy
B. Post-streptococcal glomerulonephritis
C. Minimal change disease
D. Acute pyelonephritis

Q7. A 34-year-old man presents with hemoptysis and shortness of breath. Urinalysis shows hematuria and RBC casts. Anti-GBM antibodies are positive. What is the most likely diagnosis?

A. Goodpasture syndrome
B. Sarcoidosis
C. Bronchiectasis
D. Pulmonary embolism

Q8. A 56-year-old smoker has productive cough for most days of the year for the last 2 years. He has scattered rhonchi and mild wheeze on examination. What is the most likely diagnosis?

A. Bronchial asthma
B. Chronic bronchitis
C. Pulmonary tuberculosis
D. Lung carcinoma

Q9. A 40-year-old man completed triple therapy for H. pylori-associated peptic ulcer disease 5 weeks ago. He is now asymptomatic. Which non-invasive test is best to confirm eradication?

A. H. pylori IgG serology
B. Urea breath test
C. Barium meal
D. Blood culture

Q10. A 29-year-old woman has recurrent crampy abdominal pain for 2 years. Pain improves after defecation and worsens during stress. Colonoscopy, CBC, and inflammatory markers are normal. What is the most likely diagnosis?

A. Crohn disease
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Colorectal carcinoma

Q11. A 66-year-old man has resting pill-rolling tremor, bradykinesia, cogwheel rigidity, and a shuffling gait. Which structure is primarily affected?

A. Cerebellar vermis
B. Substantia nigra
C. Hippocampus
D. Medulla

Q12. A patient with pancytopenia has a peripheral smear showing blasts with Auer rods. Myeloperoxidase staining is positive. What is the diagnosis?

A. Acute lymphoblastic leukemia
B. Acute myeloid leukemia
C. Chronic lymphocytic leukemia
D. Multiple myeloma

Q13. A 42-year-old man presents with fever, cough, pleuritic chest pain, and rusty sputum. Chest X-ray shows lobar consolidation. What is the most common causative organism of community-acquired pneumonia?

A. Haemophilus influenzae
B. Streptococcus pneumoniae
C. Klebsiella pneumoniae
D. Pseudomonas aeruginosa

Q14. A trauma patient is hypotensive and dyspneic. Examination shows absent breath sounds on the left, distended neck veins, and tracheal deviation to the right. What is the immediate management?

A. Chest X-ray before intervention
B. Needle decompression
C. CT chest
D. IV diuretics

Q15. A 50-year-old man presents with sudden severe epigastric pain. Abdomen is rigid and board-like. Erect chest X-ray shows free air under the diaphragm. What is the definitive management?

A. IV PPI and discharge
B. Emergency laparotomy
C. Colonoscopy
D. Oral antibiotics only

Q16. A 16-year-old boy wakes up with sudden severe testicular pain and vomiting. The affected testis is high-riding and the cremasteric reflex is absent. Doppler ultrasound is not immediately available. What should be done?

A. Urine culture and antibiotics
B. Analgesia and review after 6 hours
C. Urgent surgical exploration
D. CT abdomen

Q17. A 48-year-old woman has right upper quadrant pain, fever, jaundice, hypotension, and a dilated common bile duct with a stone on ultrasound. What is the most urgent intervention?

A. Elective laparoscopic cholecystectomy
B. ERCP with sphincterotomy and stone extraction
C. Oral analgesics and outpatient review
D. HIDA scan

Q18. A 61-year-old man has progressive dysphagia that began with solids and later involved liquids. He has weight loss and iron deficiency anemia. What is the most likely diagnosis?

A. Achalasia
B. Esophageal carcinoma
C. Diffuse esophageal spasm
D. Globus hystericus

Q19. A 35-year-old man has dysphagia to both liquids and solids from the beginning. Barium swallow shows a bird-beak appearance. What is the most likely diagnosis?

A. Esophageal carcinoma
B. Achalasia
C. Peptic stricture
D. Zenker diverticulum

Q20. A woman has a groin swelling located below and lateral to the pubic tubercle. Which hernia is most likely?

A. Direct inguinal hernia
B. Indirect inguinal hernia
C. Femoral hernia
D. Umbilical hernia

Q21. A 43-year-old woman has a 2 cm hard irregular breast lump with skin dimpling. Mammography is suspicious and FNAC is inconclusive. What is the best next step?

A. Reassurance and follow-up
B. Core needle biopsy
C. Immediate chemotherapy
D. Antibiotics

Q22. A man develops a painless epigastric mass 5 weeks after an attack of acute pancreatitis. He is afebrile and relatively well. What is the most likely diagnosis?

A. Pancreatic pseudocyst
B. Pancreatic abscess
C. Gastric carcinoma
D. Splenic rupture

Q23. A patient with circumferential full-thickness burn of the forearm develops tense swelling, severe pain, paresthesia, and weak distal pulses. What is the most appropriate immediate step?

A. Elevation only
B. Escharotomy
C. Oral antibiotics
D. Skin grafting immediately

Q24. A patient with a pelvic fracture after a road traffic accident becomes hypotensive and tachycardic. Abdomen is soft and FAST is negative. What is the most likely cause of shock?

A. Internal hemorrhage from pelvic vessels
B. Tension pneumothorax
C. Acute MI
D. Septic shock

Q25. A 22-year-old man has periumbilical pain that migrates to the right iliac fossa with fever, nausea, and rebound tenderness at McBurney point. What is the definitive treatment?

A. Appendectomy
B. Colonoscopy
C. Proton pump inhibitor
D. Antituberculous therapy

Q26. A Rh-negative primigravida delivers an Rh-positive baby. The baby is well. When should anti-D immunoglobulin ideally be given to the mother?

A. Within 24 hours only
B. Within 48 hours only
C. Within 72 hours
D. After 7 days

Q27. A 32-week pregnant woman presents with painless bright red vaginal bleeding. Uterus is soft and non-tender. Fetal heart rate is normal. What is the most likely diagnosis?

A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Ectopic pregnancy

Q28. A 25-year-old woman has 7 weeks of amenorrhea, lower abdominal pain, vaginal spotting, and dizziness. BP is 90/60 mmHg. What diagnosis must be ruled out first?

A. Fibroid uterus
B. Ectopic pregnancy
C. Endometriosis
D. Polycystic ovarian syndrome

Q29. A 27-year-old primigravida at 35 weeks has BP 170/110 mmHg, 3+ proteinuria, severe headache, epigastric pain, and platelets of 85,000/uL. What drug should be given for seizure prophylaxis?

A. Diazepam
B. Magnesium sulfate
C. Methyldopa
D. Phenytoin

Q30. A 4-year-old child is toxic, febrile, drooling, sitting forward, and has inspiratory stridor. Lateral neck X-ray shows a thumb sign. What is the most important immediate step?

A. Examine throat with tongue depressor
B. Secure airway in a controlled setting
C. Oral antibiotics and discharge
D. Nebulized salbutamol only

Q31. A 2-year-old child has acute watery diarrhea and profuse vomiting. He is drowsy and unable to drink. What is the best initial treatment?

A. Oral rehydration only
B. IV Ringer lactate
C. Oral loperamide
D. Reassurance only

Q32. During neonatal resuscitation, what is the recommended compression-to-ventilation ratio?

A. 30:2
B. 15:2
C. 5:1
D. 3:1

Q33. A 60-year-old woman presents with severe ocular pain, red eye, halos around lights, headache, vomiting, and a fixed mid-dilated pupil. What is the most likely diagnosis?

A. Acute conjunctivitis
B. Acute angle-closure glaucoma
C. Cataract
D. Retinal detachment

Q34. A patient has severe pain, redness, reduced vision, and hypopyon 1 day after cataract surgery. What is the most likely diagnosis?

A. Endophthalmitis
B. Allergic conjunctivitis
C. Lens dislocation
D. Viral keratitis

Q35. A 3-year-old child has persistent unilateral foul-smelling nasal discharge with occasional blood staining. What is the most likely diagnosis?

A. Allergic rhinitis
B. Nasal foreign body
C. Acute tonsillitis
D. Nasal polyposis

Q36. A patient with autoimmune hemolytic anemia has a positive direct Coombs test. Which type of hypersensitivity reaction is this?

A. Type I
B. Type II
C. Type III
D. Type IV

Q37. Chronic GERD leads to replacement of lower esophageal squamous epithelium by columnar epithelium. What is this change called?

A. Hyperplasia
B. Metaplasia
C. Anaplasia
D. Necrosis

Q38. In acute inflammation, which mediator is mainly responsible for the immediate increase in vascular permeability?

A. Histamine
B. IL-2
C. Interferon gamma
D. Thromboxane A2

Q39. A patient has foot drop after a fracture near the neck of the fibula. Which nerve is most likely injured?

A. Tibial nerve
B. Common peroneal nerve
C. Femoral nerve
D. Obturator nerve

Q40. A patient has wrist drop after a midshaft humerus fracture. Which nerve is damaged?

A. Axillary nerve
B. Radial nerve
C. Median nerve
D. Ulnar nerve

Q41. A patient cannot abduct the shoulder after surgical neck fracture of the humerus. There is sensory loss over the regimental badge area. Which nerve is injured?

A. Radial nerve
B. Axillary nerve
C. Musculocutaneous nerve
D. Long thoracic nerve

Q42. A patient with repeated vomiting has ABG showing pH 7.50, raised bicarbonate, and low chloride. What is the acid-base disorder?

A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis

Q43. A person rapidly ascends to high altitude and hyperventilates due to hypoxia. What happens to arterial pCO2 initially?

A. It increases
B. It decreases
C. It remains unchanged
D. It becomes zero

Q44. A patient in anaphylactic shock has warm skin and profound vasodilation. Compared with cardiogenic shock, which hemodynamic pattern is expected early?

A. Increased systemic vascular resistance
B. Increased cardiac output
C. Severe bradycardia
D. Fixed high pulmonary wedge pressure

Q45. A patient is deeply sedated after taking benzodiazepines. Respiratory rate is mildly reduced, pupils are normal, and there is no opioid history. Which antidote reverses benzodiazepine effect?

A. Naloxone
B. Flumazenil
C. Atropine
D. Protamine sulfate

Q46. An epileptic patient develops gingival hyperplasia and hirsutism after long-term therapy. Which drug is responsible?

A. Phenytoin
B. Carbamazepine
C. Valproate
D. Lamotrigine

Q47. A man with chronic maize-based diet develops diarrhea, dermatitis around the neck, and cognitive changes. Which vitamin deficiency is most likely?

A. Niacin
B. Thiamine
C. Riboflavin
D. Pyridoxine

Q48. A newborn develops vomiting, jaundice, and E. coli sepsis after milk feeding. Urine reducing substances are positive but glucose oxidase is negative. Which enzyme is deficient?

A. Galactose-1-phosphate uridyltransferase
B. Phenylalanine hydroxylase
C. Glucose-6-phosphatase
D. Aldolase B

Q49. A town has an annual population growth rate of 2%. What is the approximate doubling time using the rule of 70?

A. 20 years
B. 35 years
C. 50 years
D. 70 years

Q50. A child accidentally ingests kerosene oil. Which complication is most important to anticipate?

A. Aspiration pneumonitis
B. Acute pancreatitis
C. Hemolytic anemia
D. Tetanus