NRE October 2026 Prediction Exam

Batch 2 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 2 Weightage

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

Questions

Q1. A 55-year-old diabetic man presents 90 minutes after onset of crushing central chest pain. ECG shows ST elevation in leads II, III, and aVF. Which coronary territory is most likely involved?

A. Anterior wall supplied by LAD
B. Inferior wall supplied by RCA
C. Lateral wall supplied by LCX
D. Septal wall supplied by LAD

Q2. A 72-year-old man with atrial fibrillation develops sudden right-sided weakness and aphasia. CT brain shows no hemorrhage. Symptoms began 2 hours ago. What is the most appropriate acute treatment if there are no contraindications?

A. IV thrombolysis
B. Warfarin immediately
C. Aspirin only and discharge
D. No treatment because CT is normal

Q3. A 55-year-old smoker with COPD presents with increasing dyspnea and purulent sputum. ABG shows pH 7.27, PaCO2 72 mmHg, and PaO2 52 mmHg. He is drowsy but arousable. What is the most appropriate respiratory support?

A. High-flow oxygen by non-rebreather mask
B. Non-invasive ventilation
C. Reassurance and salbutamol only
D. Immediate discharge on oral antibiotics

Q4. A 24-year-old man with type 1 diabetes presents with vomiting, abdominal pain, deep rapid breathing, dehydration, glucose 480 mg/dL, and positive ketones. What is the most important initial management?

A. Oral metformin
B. IV fluids with insulin protocol
C. Fluid restriction
D. High-dose steroids

Q5. A 42-year-old woman has weight loss, heat intolerance, tremor, palpitations, diffuse goitre, and exophthalmos. What is the most likely diagnosis?

A. Hashimoto thyroiditis
B. Graves disease
C. Subacute thyroiditis
D. Toxic multinodular goitre

Q6. A 48-year-old woman has malar rash, oral ulcers, joint pain, proteinuria, positive ANA, high anti-dsDNA titre, and low complement levels. What do low C3/C4 levels most strongly suggest?

A. Active immune-complex disease
B. Cure of disease
C. Isolated osteoarthritis
D. Drug-induced hypothyroidism

Q7. A 45-year-old renal transplant recipient has a gradual rise in serum creatinine 1 year after transplant. He is afebrile, compliant with medication, and ultrasound is normal. What is the best next step?

A. Renal allograft biopsy
B. Stop immunosuppression
C. Start anti-tuberculous therapy
D. Reassure only

Q8. A 35-year-old man develops fever, rash, eosinophilia, and acute kidney injury after taking antibiotics for a urinary tract infection. Urinalysis shows white-cell casts. What is the most likely diagnosis?

A. Acute interstitial nephritis
B. Acute tubular necrosis
C. IgA nephropathy
D. Minimal change disease

Q9. A 70-year-old man has macrocytic anemia, glossitis, numbness in feet, loss of vibration sense, and positive intrinsic-factor antibodies. What is the most likely diagnosis?

A. Iron deficiency anemia
B. Pernicious anemia
C. Thalassemia trait
D. Anemia of chronic disease

Q10. A 58-year-old man has painless cervical lymphadenopathy, fever, night sweats, and weight loss. Excisional biopsy shows Reed-Sternberg cells. What is the diagnosis?

A. Hodgkin lymphoma
B. Multiple myeloma
C. Acute lymphoblastic leukemia
D. Aplastic anemia

Q11. A young man has sudden episodes of intense fear, palpitations, sweating, chest tightness, and shortness of breath lasting 10 minutes. Between attacks, examination and ECG are normal. What is the most likely diagnosis?

A. Generalized anxiety disorder
B. Panic disorder
C. Schizophrenia
D. Bipolar disorder

Q12. A 40-year-old man has auditory hallucinations, delusions that strangers are plotting against him, disorganized speech, and social withdrawal for 8 months. What is the most likely diagnosis?

A. Schizophrenia
B. Brief psychotic disorder
C. Panic disorder
D. Major depressive disorder only

Q13. A 25-year-old man has severe unilateral headache with lacrimation, conjunctival injection, nasal congestion, and restlessness. Attacks last 45 minutes and recur at the same time each night. What is the diagnosis?

A. Migraine
B. Cluster headache
C. Tension headache
D. Trigeminal neuralgia

Q14. A 35-year-old woman has spontaneous bloody discharge from a single duct of one nipple. No breast lump is palpable. What is the most likely diagnosis?

A. Intraductal papilloma
B. Fibroadenoma
C. Breast abscess
D. Fat necrosis

Q15. A 22-year-old woman has a painless, firm, mobile, well-circumscribed breast lump. Ultrasound is consistent with a benign solid lesion. What is the most likely diagnosis?

A. Fibroadenoma
B. Invasive ductal carcinoma
C. Mastitis
D. Duct ectasia

Q16. A 60-year-old man presents with painless jaundice, weight loss, dark urine, pale stools, and a palpable non-tender gallbladder. What is the most likely diagnosis?

A. Acute viral hepatitis
B. Carcinoma head of pancreas
C. Acute cholecystitis
D. Gilbert syndrome

Q17. A 65-year-old man has absolute constipation, abdominal distension, and bilious vomiting. Abdominal X-ray shows a massively dilated loop with a coffee-bean appearance arising from the pelvis. What is the most likely diagnosis?

A. Sigmoid volvulus
B. Acute appendicitis
C. Paralytic ileus
D. Duodenal atresia

Q18. A patient falls astride a metal bar and develops blood at the urethral meatus, perineal bruising, and inability to pass urine. What is the best next investigation before catheterization?

A. Retrograde urethrogram
B. Intravenous pyelogram
C. CT brain
D. Colonoscopy

Q19. A man with acute urinary retention due to BPH is catheterized. Over the next few hours he passes very large volumes of urine. Which complication should be monitored?

A. Post-obstructive diuresis with electrolyte loss
B. Acute appendicitis
C. Hyperthyroidism
D. Tetanus

Q20. A young man has a painless scrotal swelling that feels like a bag of worms and becomes more prominent on standing. Which diagnosis is most likely?

A. Hydrocele
B. Varicocele
C. Testicular torsion
D. Epididymo-orchitis

Q21. A 45-year-old man has severe colicky flank pain radiating to the groin with microscopic hematuria. What is the most likely diagnosis?

A. Renal colic due to ureteric stone
B. Acute hepatitis
C. Testicular cancer
D. Nephrotic syndrome

Q22. A patient has a deep leg wound after a road traffic accident. The limb becomes increasingly painful, tense, and painful on passive stretch. Distal pulses are still present. What is the diagnosis?

A. Compartment syndrome
B. Cellulitis only
C. Deep vein thrombosis
D. Varicose veins

Q23. A 45-year-old woman has a solitary thyroid nodule. FNAC shows papillary thyroid carcinoma. Which feature is classically associated with this tumor?

A. Psammoma bodies
B. Auer rods
C. Reed-Sternberg cells
D. Caseating granuloma

Q24. A trauma patient arrives unconscious with noisy breathing and facial injuries. According to ATLS, what is the first priority?

A. Airway with cervical spine protection
B. CT abdomen
C. Definitive fracture fixation
D. Oral analgesia

Q25. A man has a hernia protruding through Hesselbach triangle. Which type of hernia is this?

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

Q26. A pregnant woman at 26 weeks has glycosuria on urine dipstick. Which test is best to diagnose gestational diabetes?

A. Random urine glucose
B. Oral glucose tolerance test
C. Serum ketones
D. Ultrasound only

Q27. A 30-year-old woman has infertility, obesity, hirsutism, acne, irregular cycles, and multiple small peripheral ovarian follicles on ultrasound. What is the diagnosis?

A. Polycystic ovarian syndrome
B. Endometriosis
C. Premature ovarian failure
D. Asherman syndrome

Q28. A 31-week pregnant woman has regular uterine contractions and cervical dilatation. Delivery appears likely despite initial treatment. Which drug is given specifically to improve fetal lung maturity?

A. Betamethasone
B. Oxytocin
C. Methyldopa
D. Misoprostol

Q29. A newborn delivered after difficult labor has the left arm adducted and internally rotated with forearm pronated, known as waiter-tip posture. Which nerve roots are injured?

A. C8-T1
B. C5-C6
C. T1-T2
D. C7-T1

Q30. A 2-year-old has delayed walking, bowed legs, widened wrists, and rachitic rosary. Labs show low calcium, low phosphate, and high alkaline phosphatase. What is the cause?

A. Vitamin D deficiency
B. Vitamin K deficiency
C. Vitamin B12 deficiency
D. Niacin deficiency

Q31. A newborn develops bleeding from the umbilical stump and gastrointestinal tract. He did not receive prophylaxis after birth. Which deficiency is responsible?

A. Vitamin A
B. Vitamin K
C. Vitamin D
D. Vitamin C

Q32. A 5-year-old child presents with vomiting, abdominal pain, and hematemesis after accidentally ingesting several iron tablets. What is the antidote?

A. N-acetylcysteine
B. Desferrioxamine
C. Atropine
D. Flumazenil

Q33. A 10-year-old boy has severe itching, redness, watery discharge, and cobblestone papillae on the upper tarsal conjunctiva every summer. What is the most likely diagnosis?

A. Vernal keratoconjunctivitis
B. Bacterial conjunctivitis
C. Acute angle-closure glaucoma
D. Cataract

Q34. A child with long-standing inward deviation of one eye has reduced visual acuity in that eye despite normal ocular structures. What complication is developing?

A. Amblyopia
B. Retinal detachment
C. Papilledema
D. Cataract

Q35. A man develops ear pain and fullness after airplane descent. Otoscopy shows a retracted congested tympanic membrane. What is the diagnosis?

A. Otic barotrauma
B. Cholesteatoma
C. Otitis externa
D. Acoustic neuroma

Q36. A patient has microangiopathic hemolytic anemia, thrombocytopenia, neurologic symptoms, and renal dysfunction. PT and APTT are normal. Which diagnosis is most likely?

A. Disseminated intravascular coagulation
B. Thrombotic thrombocytopenic purpura
C. Hemophilia A
D. Von Willebrand disease

Q37. A chronic burn scar develops a raised non-healing ulcer at its edge many years later. Which malignancy is classically associated with this?

A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Lymphoma

Q38. A biopsy from a patient with tuberculosis shows granulomas with central caseous necrosis. Which type of hypersensitivity reaction is mainly involved?

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

Q39. A supracondylar fracture of humerus is followed by inability to make an OK sign with the thumb and index finger. Which nerve is injured?

A. Anterior interosseous nerve
B. Posterior interosseous nerve
C. Ulnar nerve
D. Axillary nerve

Q40. A patient has facial weakness and hyperacusis after a facial nerve lesion. The lesion must be proximal to which branch?

A. Chorda tympani
B. Nerve to stapedius
C. Greater auricular nerve
D. Auriculotemporal nerve

Q41. A patient has ipsilateral oculomotor nerve palsy and contralateral hemiplegia. Where is the lesion?

A. Midbrain
B. Cerebellum
C. Occipital cortex
D. Lumbar spinal cord

Q42. During the rapid depolarization phase of an action potential in a neuron, which ion movement is mainly responsible?

A. Sodium influx
B. Potassium efflux
C. Chloride influx
D. Calcium efflux

Q43. A patient with hypovolemic shock has a low cardiac output and compensatory peripheral vasoconstriction. Which vascular parameter is expected to increase?

A. Total peripheral resistance
B. Venous oxygen saturation
C. Stroke volume
D. Capillary refill speed

Q44. A patient on warfarin has INR 7.0 with minor gum bleeding but no major hemorrhage. What is the most appropriate reversal?

A. Protamine sulfate
B. Oral vitamin K and hold warfarin
C. Naloxone
D. Platelet transfusion only

Q45. A chronic alcoholic presents with confusion, ataxia, and ophthalmoplegia. Which treatment must be given before glucose?

A. Thiamine
B. Vitamin K
C. Calcium gluconate
D. Folic acid only

Q46. A patient develops dark urine after taking antimalarial medication. Peripheral smear suggests hemolysis. Which enzyme deficiency is most likely?

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

Q47. A doctor divides hemorrhoid patients into two groups: one receives surgery and the other receives dietary modification. Outcomes are compared. What type of study is this?

A. Case-control study
B. Randomized controlled trial
C. Cross-sectional survey
D. Case report

Q48. A dataset is markedly skewed by a few very high income values. Which measure best represents central tendency?

A. Mean
B. Median
C. Range
D. Standard deviation

Q49. A body is found with rigor mortis beginning in the face and neck but not fully established in the limbs. What is this finding mainly used to estimate?

A. Post-mortem interval
B. Blood group
C. Cause of poisoning
D. Identity by fingerprints

Q50. A farmer is brought with salivation, lacrimation, bronchorrhea, vomiting, sweating, bradycardia, and pinpoint pupils after pesticide exposure. What is the most appropriate antidote combination?

A. Atropine and pralidoxime
B. Naloxone and flumazenil
C. Vitamin K and FFP
D. Deferoxamine and calcium