Dr. Ahmad Zafar | Licensure Exam | October 2026
01. Medicine — 26 topics
02. Surgery — 16 topics
03. Paediatrics — 10 topics
04. Obstetrics — 7 topics
05. Gynecology — 4 topics
06. ENT — 3 topics
07. Ophthalmology — 4 topics
08. Forensic Medicine — 3 topics
09. Pharmacology — 6 topics
10. Pathology — 5 topics
11. Anatomy — 6 topics
12. Physiology — 5 topics
13. Infectious Disease — 4 topics
14. Dermatology — 1 topics
01 — MEDICINE 23 CONFIRMED · 3 COMPRESSED
TIER 1 — CONFIRMED / HIGH-STRENGTH
1. Aortic dissection [May2026-confirmed, Dec2025-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Sudden tearing chest/back pain + BP difference between arms |
| Discriminator | CT angiography for diagnosis; Type A surgery, Type B IV beta-blocker |
| One-liner | answer: b — syncope on exertion + radiating to carotids = aortic stenosis. |
| Trap | ⚠ Treating as MI based on chest pain alone |
3. Rheumatoid arthritis [May2026-confirmed, Dec2025-confirmed, QBank-recall, Syllabus-core]
| Trigger | Symmetric MCP/PIP pain + morning stiffness >1 hour |
| Discriminator | Anti-CCP is the best confirming test when asked |
| One-liner | answer: a — symmetric small-joint polyarthritis with morning stiffness over 1 hour = rheumatoid arthritis. |
| Trap | ⚠ Mistaking shoulder pain or age for OA |
4. Osteoarthritis [Dec2025-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Elderly + DIP Heberden nodes + pain worse with use |
| Discriminator | DIP involvement strongly favors OA |
| One-liner | answer: a — weight-bearing joint pain with brief stiffness, crepitus, and osteophytes = primary osteoarthritis. |
| Trap | ⚠ Confusing PIP Bouchard nodes with RA |
6. IgA nephropathy [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Hematuria during or immediately after URTI |
| Discriminator | Synpharyngitic hematuria, often normal C3 |
| One-liner | answer: c — hematuria + proteinuria + rash = iga nephropathy. · answer: d — ace inhibitors reduce intraglomerular pressure and proteinuria — renoprotective in diabetic nephropathy. |
| Trap | ⚠ Post-strep GN timing |
13. Esophageal varices [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Cirrhosis/portal HTN + hematemesis |
| Discriminator | Endoscopic band ligation; vasoactive bridge may be terlipressin/octreotide |
| One-liner | answer: a — esophageal rings + dysphagia = eosinophilic esophagitis. |
| Trap | ⚠ Mallory-Weiss or PPI-only answer |
14. H. pylori eradication confirmation [Dec2025-confirmed, QBank-recall, Syllabus-core]
| Trigger | Treated PUD after triple therapy |
| Discriminator | Urea breath test for eradication |
| One-liner | answer: c — projectile non-bilious vomiting + olive mass + hypochloremic hypokalemic metabolic alkalosis = pyloric stenosis. · diagnosis:ogd + biopsy gold standard. non-invasive h. pylori: urea breath test (best for confirmation of eradication) or stool antigen test. |
| Trap | ⚠ Serology, endoscopy, barium |
15. IBS [Dec2025-confirmed, NRE50-aligned, Prior-prediction]
| Trigger | Chronic abdominal pain relieved by defecation + normal workup |
| Discriminator | No red flags; stress worsens |
| One-liner | — |
| Trap | ⚠ IBD when there is no blood/weight loss |
16. Chronic bronchitis [Dec2025-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Smoker + productive cough for 2 years |
| Discriminator | Productive cough >=3 months/year for 2 years |
| One-liner | answer: a — cough + sputum + wheezing = chronic bronchitis. · 75. a 28-year-old man presents with chronic low back pain and morning stiffness of 6 months' duration that improves with exercise. x-ray shows sacroiliitis with squaring of the ver |
| Trap | ⚠ Asthma or bronchiectasis |
17. Pleural effusion vs collapse [Dec2025-confirmed, Prior-prediction, QBank-recall]
| Trigger | Dullness with tracheal shift |
| Discriminator | Effusion pushes trachea away; collapse pulls toward |
| One-liner | — |
| Trap | ⚠ Pneumothorax if percussion note ignored |
18. Goodpasture syndrome [Dec2025-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Hemoptysis + hematuria/RBC casts |
| Discriminator | Anti-GBM pulmonary-renal syndrome |
| One-liner | answer: b — htn + hematuria + proteinuria + anti-gbm = goodpasture. |
| Trap | ⚠ GPA/Wegener without ENT/sinus clue |
19. Cushing syndrome [May2026-confirmed, Dec2025-confirmed, Prior-prediction]
| Trigger | Purple striae + proximal weakness + HTN + eosinopenia |
| Discriminator | Cortisol excess |
| One-liner | answer: d — moon face + purple striae + weight gain = cushing syndrome. |
| Trap | ⚠ Addison, hypothyroid, diabetes |
20. Hypocalcaemia [May2026-confirmed, QBank-recall, Syllabus-core]
| Trigger | Tetany + Chvostek/Trousseau |
| Discriminator | Low calcium |
| One-liner | — |
| Trap | ⚠ Magnesium or potassium reflex answer |
21. Hyperparathyroidism [Dec2025-confirmed, Prior-prediction]
| Trigger | Bone/renal symptoms or early biochemical clue |
| Discriminator | Early hypophosphatemia; later hypercalcemia |
| One-liner | — |
| Trap | ⚠ Choosing PTH/hypercalcemia for earliest abnormality |
22. Parkinson disease [May2026-confirmed, QBank-recall, Syllabus-core]
| Trigger | Resting tremor + rigidity + bradykinesia + shuffling gait |
| Discriminator | Resting tremor; substantia nigra dopamine loss |
| One-liner | answer: d — tremor + rigidity + bradykinesia = parkinson disease. |
| Trap | ⚠ Essential tremor/intention tremor |
23. Myasthenia gravis [May2026-style, QBank-recall, Syllabus-core]
| Trigger | Ptosis/diplopia worse at day end, improves with rest |
| Discriminator | Pyridostigmine for symptomatic treatment |
| One-liner | answer: d — ptosis + diplopia + worse at day = myasthenia gravis. |
| Trap | ⚠ GBS or Lambert-Eaton |
24. Guillain-Barre syndrome [May2026-style, QBank-recall, Syllabus-core]
| Trigger | Ascending weakness after infection + areflexia |
| Discriminator | Acute inflammatory demyelinating polyneuropathy |
| One-liner | answer: c — ascending flaccid paralysis after infection with albuminocytologic dissociation = guillain-barré syndrome. |
| Trap | ⚠ Myasthenia or MS |
25. Amaurosis fugax / TIA [May2026-confirmed, Prior-prediction]
| Trigger | Transient monocular blindness |
| Discriminator | Retinal artery embolic TIA |
| One-liner | — |
| Trap | ⚠ Treating as completed stroke only |
26. AML [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Auer rods + MPO positive +/- gum hyperplasia |
| Discriminator | Auer rods = AML |
| One-liner | — |
| Trap | ⚠ ALL because of blasts |
27. CML [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Massive splenomegaly + myeloid left shift |
| Discriminator | BCR-ABL / Philadelphia chromosome |
| One-liner | — |
| Trap | ⚠ CLL or myelofibrosis |
28. Iron deficiency anemia [May2026-style, Prior-prediction, Syllabus-core]
| Trigger | Microcytic hypochromic anemia + low ferritin |
| Discriminator | Low ferritin + high TIBC |
| One-liner | answer: b — microcytic hypochromic + low ferritin = iron deficiency anemia. · answer: a — normocytic anemia with normal iron stores in advanced ckd = erythropoietin deficiency. |
| Trap | ⚠ Thalassemia trait |
30. Gout [May2026-style, QBank-recall, Syllabus-core]
| Trigger | Sudden painful red first MTP |
| Discriminator | Podagra |
| One-liner | answer: d — first mtp podagra + needle-shaped negatively birefringent crystals = gout (monosodium urate). · answer: a — uricosuric drug for gout = probenecid. |
| Trap | ⚠ RA/OA |
91. Doubling time [May2026-recall, Prior-prediction]
| Trigger | Population growth rate given |
| Discriminator | Rule of 70 |
| One-liner | — |
| Trap | ⚠ Exact arithmetic trap |
94. Median/biostatistics basics [May2026-confirmed, Syllabus-core]
| Trigger | Skewed data or middle value |
| Discriminator | Median |
| One-liner | — |
| Trap | ⚠ Mean |
TIER 2 — COMPRESSION
| Topic | Recognition trigger | Discriminator | Trap |
|---|
| B12 deficiency | Macrocytosis + glossitis + posterior column signs | Pernicious anemia if Schilling/intrinsic factor clue | Folate deficiency |
| Study design | Groups receive surgery vs diet/intervention | Randomized controlled trial if assigned intervention | Cohort because groups are followed |
| Data presentation | Percentages/proportions asked | Pie chart | Bar chart when parts of whole |
02 — SURGERY 9 CONFIRMED · 7 COMPRESSED
TIER 1 — CONFIRMED / HIGH-STRENGTH
9. Testicular torsion [May2026-confirmed, NRE50-aligned, Syllabus-core]
| Trigger | Sudden severe testicular pain + high-riding testis + absent cremasteric reflex |
| Discriminator | Urgent surgical exploration if Doppler unavailable |
| One-liner | answer: a — testicular torsion = emergency orchiopexy. · answer: c — testicular mass = testicular cancer. |
| Trap | ⚠ Waiting for imaging |
10. Perforated peptic ulcer [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Sudden severe abdominal pain + board-like rigidity + free air |
| Discriminator | Exploratory laparotomy / surgical management |
| One-liner | 2. diagnosis from investigation finding: rat-tail on barium = achalasia. free gas under diaphragm = perforated viscus. inverted u on axr = sigmoid volvulus. coffee bean = caecal/si |
| Trap | ⚠ PPI or endoscopy as definitive step |
11. Esophageal carcinoma [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Progressive dysphagia solids first then liquids + weight loss |
| Discriminator | Mechanical obstruction pattern |
| One-liner | answer: a — esophageal rings + dysphagia = eosinophilic esophagitis. |
| Trap | ⚠ Achalasia |
12. Achalasia [May2026-confirmed, Prior-prediction, Syllabus-core]
| Trigger | Dysphagia to liquids and solids + bird-beak |
| Discriminator | Functional obstruction; manometry/endoscopy depending wording |
| One-liner | 2. diagnosis from investigation finding: rat-tail on barium = achalasia. free gas under diaphragm = perforated viscus. inverted u on axr = sigmoid volvulus. coffee bean = caecal/si |
| Trap | ⚠ Cancer when liquids are involved early |
43. Thyroglossal duct cyst [May2026-confirmed, Syllabus-core]
| Trigger | Midline neck swelling moves with tongue protrusion |
| Discriminator | Thyroglossal duct cyst |
| One-liner | — |
| Trap | ⚠ Thyroid nodule/branchial cyst |
44. Breast carcinoma severity/workup [May2026-confirmed, PMDC-mock, Syllabus-core]
| Trigger | Hard irregular lump, skin changes, nodes |
| Discriminator | Triple assessment; lymph nodes worsen prognosis |
| One-liner | 133. a 55-year-old woman presents with a rapidly enlarging, firm, erythematous breast with skin thickening and a peau d'orange appearance but no discrete mass. which is the most li · answer: c — peau d'orange = inflammatory breast cancer. |
| Trap | ⚠ Fibroadenoma/reassurance |
45. Fibroadenoma [May2026-paper, QBank-recall]
| Trigger | Young woman + painless mobile breast lump |
| Discriminator | Reassurance/follow-up if classic small lesion |
| One-liner | — |
| Trap | ⚠ Mastectomy/cancer management |
50. Pelvic fracture shock [May2026/MediCall-overlap but verified concept, Syllabus-core]
| Trigger | Pelvic fracture + shock |
| Discriminator | Internal hemorrhage/blood loss |
| One-liner | 94. a 40-year-old woman presents 5 days after pelvic surgery with sudden dyspnea and pleuritic chest pain. she is tachycardic at 115/min and spo2 is 88% on room air; ecg shows sinu · 117. a 70-year-old woman presents with 6 weeks of bilateral shoulder and pelvic-girdle stiffness that is worse in the morning, along with malaise. esr is 85 mm/hr and muscle power |
| Trap | ⚠ Fat embolism/head injury |
52. Pancreatic pseudocyst [Dec2025-confirmed, Prior-prediction]
| Trigger | Epigastric mass 4-6 weeks after pancreatitis |
| Discriminator | Pseudocyst without fever |
| One-liner | answer: c — jaundice + pale stools + pancreatic head mass = pancreatic cancer. |
| Trap | ⚠ Abscess/cancer |
TIER 2 — COMPRESSION
| Topic | Recognition trigger | Discriminator | Trap |
|---|
| Femoral hernia location | Groin swelling below pubic tubercle | Below and lateral to pubic tubercle | Inguinal hernia locations |
| Direct inguinal hernia | Hernia through Hesselbach triangle | Direct inguinal | Indirect hernia |
| Intraductal papilloma | Bloody nipple discharge from single duct, no lump | Intraductal papilloma | Breast carcinoma |
| Acute appendicitis | Periumbilical pain migrates to RIF + rebound | Appendectomy/definitive surgical management | Antibiotics only |
| Tension pneumothorax | Hypotension + tracheal deviation + absent breath sounds | Needle decompression before CXR | Waiting for imaging |
| Burns escharotomy | Circumferential burn + weak pulses + paresthesia | Escharotomy | Fasciotomy or fluids only |
| Gallstone disease / cholangitis | RUQ pain + fever + jaundice + CBD stone | Urgent ERCP if septic cholangitis | Cholecystectomy first |
03 — PAEDIATRICS 8 CONFIRMED · 2 COMPRESSED
TIER 1 — CONFIRMED / HIGH-STRENGTH
5. Post-streptococcal GN [May2026-confirmed, Dec2025-confirmed, Prior-prediction]
| Trigger | Cola urine + periorbital edema 1-3 weeks after sore throat |
| Discriminator | Latent period after infection + low C3 |
| One-liner | answer: b — midsystolic click + posture change = mitral valve prolapse. · answer: a — post-surgical immobility + sudden dyspnea + tachycardia + hypoxia = pulmonary embolism. |
| Trap | ⚠ IgA nephropathy, which occurs during URTI |
7. Epiglottitis [May2026-confirmed, Prior-prediction, NRE50-aligned]
| Trigger | Toxic child + drooling + tripod + thumb sign |
| Discriminator | Secure airway first in controlled setting |
| One-liner | — |
| Trap | ⚠ Examining throat or delaying for imaging |
63. Down syndrome [May2026-confirmed, QBank-recall]
| Trigger | Upslanting eyes + single palmar crease |
| Discriminator | Trisomy 21; VSD/AV canal associations |
| One-liner | answer: b — down's syndrome + chd = asd (ostium primum). · 125. a 40-year-old man presents with a reducible bulge in the right groin that appears on standing and disappears on lying down. which is the most likely diagnosis? |
| Trap | ⚠ Patau/Edwards |
64. Erb palsy [May2026-paper, QBank-recall]
| Trigger | Newborn after difficult delivery + waiter's tip |
| Discriminator | C5-C6 upper trunk |
| One-liner | 1. age + symptom → diagnosis: 1.5yr + ear pulling + fever = aom. 6m–3yr + barking cough + stridor = croup. 20yr + ear canal vesicles + facial palsy = ramsay hunt. · 1. age + symptom → diagnosis: 1.5yr + ear pulling + fever = aom. 6m–3yr + barking cough + stridor = croup. 20yr + ear canal vesicles + facial palsy = ramsay hunt. |
| Trap | ⚠ Klumpke palsy |
65. Severe dehydration [May2026-paper, Syllabus-core]
| Trigger | Drowsy child with profuse diarrhea/vomiting unable to drink |
| Discriminator | IV Ringer lactate |
| One-liner | 40. a 65-year-old woman with a history of hypertension presents with sudden-onset severe dyspnea at rest, coughing up pink frothy sputum. auscultation reveals bilateral crackles. w · 51. a 52-year-old man with a history of gallstones presents with severe epigastric pain radiating to the back, worse after eating, and repeated vomiting. serum amylase and lipase a |
| Trap | ⚠ ORS when severe |
66. Neonatal CPR ratio [May2026-confirmed]
| Trigger | Newborn resuscitation compression:ventilation |
| Discriminator | 3:1 |
| One-liner | answer: b — neonatal jaundice + 15 mg/dl = phototherapy. |
| Trap | ⚠ Adult/pediatric ratios |
68. Rickets [May2026-paper, QBank-recall]
| Trigger | Bowed legs + rachitic rosary + low Ca/phosphate + high ALP |
| Discriminator | Vitamin D deficiency |
| One-liner | the diagnostic approach: give 2 injections of vitamin d (200,000 iu im). do x-ray wrist after 2 weeks — look for improvement. if no improvement after 2 injections, the diagnosis ch · best x-ray site for rickets diagnosis = wrist (shows cupping, fraying, flaring at growth plate). |
| Trap | ⚠ Renal failure/excess calcium |
69. Croup [May2026-confirmed, Prior-prediction]
| Trigger | Barking cough + steeple sign + non-toxic |
| Discriminator | Nebulized adrenaline/steroids depending severity |
| One-liner | answer: c — bark-like cough + stridor + nighttime = croup. · 1. age + symptom → diagnosis: 1.5yr + ear pulling + fever = aom. 6m–3yr + barking cough + stridor = croup. 20yr + ear canal vesicles + facial palsy = ramsay hunt. |
| Trap | ⚠ Epiglottitis |
TIER 2 — COMPRESSION
| Topic | Recognition trigger | Discriminator | Trap |
|---|
| Vitamin K deficiency bleeding | Newborn bleeding, no prophylaxis | Vitamin K deficiency | Hemophilia |
| Autism | Poor eye contact + hand flapping + delayed speech | Autism spectrum disorder | CP/ADHD |
10 — PHARMACOLOGY 6 CONFIRMED · 0 COMPRESSED
TIER 1 — CONFIRMED / HIGH-STRENGTH
35. Warfarin reversal [May2026-recall, Dec2025-style, QBank-recall]
| Trigger | Warfarin + high INR +/- bleeding |
| Discriminator | Oral vitamin K for high INR/no major bleed; PCC/FFP if major bleed |
| One-liner | answer: c — warfarin blocks vitamin k epoxide reductase, reducing synthesis of factors ii, vii, ix, and x. |
| Trap | ⚠ Protamine |
36. Paracetamol overdose [May2026-recall, QBank-recall, Syllabus-core]
| Trigger | Child ingests paracetamol |
| Discriminator | N-acetylcysteine if toxic risk/level |
| One-liner | answer: a — n-acetylcysteine replenishes glutathione and prevents hepatic necrosis in paracetamol poisoning. |
| Trap | ⚠ Observation when risk remains unclear |
37. Benzodiazepine antidote [May2026-confirmed, Prior-prediction]
| Trigger | Sedation + normal pupils + ataxia |
| Discriminator | Flumazenil |
| One-liner | answer: c — benzodiazepine ingestion in child = charcoal + supportive care. |
| Trap | ⚠ Naloxone |
38. Phenytoin adverse effects [May2026-confirmed, Prior-prediction]
| Trigger | Gingival hyperplasia + hirsutism |
| Discriminator | Phenytoin signature |
| One-liner | — |
| Trap | ⚠ Carbamazepine/valproate |
39. Wernicke encephalopathy [May2026-confirmed, QBank-recall]
| Trigger | Alcoholic + confusion + ataxia + ophthalmoplegia |
| Discriminator | Thiamine before glucose |
| One-liner | — |
| Trap | ⚠ Giving glucose first |
40. ACE inhibitor in diabetic nephropathy [May2026-confirmed, Prior-prediction]
| Trigger | DM + HTN + microalbuminuria/proteinuria |
| Discriminator | ACEi/ARB renal protection |
| One-liner | answer: d — ace inhibitors reduce intraglomerular pressure and proteinuria — renoprotective in diabetic nephropathy. · answer: c — ace inhibitors are teratogenic in pregnancy (fetal renal damage); methyldopa is the safest first-line option. |
| Trap | ⚠ CCB/thiazide as generic HTN answer |
12 — ANATOMY 4 CONFIRMED · 2 COMPRESSED
TIER 1 — CONFIRMED / HIGH-STRENGTH
75. Common peroneal nerve [May2026-confirmed, Syllabus-core]
| Trigger | Fibular neck injury + foot drop |
| Discriminator | Common peroneal nerve |
| One-liner | answer: d — harsh systolic murmur in infant = vsd (most common chd). · answer: a — most common fingerprint pattern = loops. |
| Trap | ⚠ Sciatic nerve |
76. Radial nerve [May2026-confirmed, Syllabus-core]
| Trigger | Midshaft humerus fracture + wrist drop |
| Discriminator | Radial nerve |
| One-liner | 41. a 50-year-old man presents with palpitations and mild exertional dyspnea. his radial pulse is irregularly irregular, and the ecg shows absent p waves with variable r-r interval |
| Trap | ⚠ Axillary nerve |
77. Axillary nerve [May2026-confirmed, Syllabus-core]
| Trigger | Surgical neck humerus + deltoid weakness + regimental badge numbness |
| Discriminator | Axillary nerve |
| One-liner | — |
| Trap | ⚠ Radial nerve |
80. Brainstem crossed syndrome [May2026-confirmed, Prior-prediction]
| Trigger | Ipsilateral cranial nerve palsy + contralateral hemiplegia |
| Discriminator | Brainstem lesion |
| One-liner | — |
| Trap | ⚠ Internal capsule/cortex |
TIER 2 — COMPRESSION
| Topic | Recognition trigger | Discriminator | Trap |
|---|
| Anterior interosseous nerve | Supracondylar fracture + cannot make OK sign | AIN branch of median nerve | Ulnar or radial nerve |
| Facial nerve lesion level | Facial palsy + hyperacusis | Lesion proximal to nerve to stapedius | Stylomastoid foramen lesion |
14 — INFECTIOUS DISEASE 4 CONFIRMED · 0 COMPRESSED
TIER 1 — CONFIRMED / HIGH-STRENGTH
31. CAP organism [May2026/QBank-recall, Prior-prediction]
| Trigger | Most common CAP organism |
| Discriminator | Streptococcus pneumoniae |
| One-liner | 2. organism identification: gram-negative intracellular diplococci = gonorrhoea. rice-water stools = cholera. cyclical fever + blood film = malaria. rose spots + relative bradycard |
| Trap | ⚠ H. influenzae as second common |
32. Meningitis investigation [May2026-paper, QBank-recall, Syllabus-core]
| Trigger | Fever + neck stiffness/bulging fontanelle |
| Discriminator | Lumbar puncture if no raised ICP contraindication |
| One-liner | answer: a — turbid csf with neutrophils, low glucose, and high protein = acute bacterial meningitis. · answer: c — fever + irritability + bulging fontanelle = meningitis. |
| Trap | ⚠ Blood CP/culture as confirmation |
33. ATT adverse effects [May2026-style, Syllabus-core]
| Trigger | ATT + joint pains/hyperuricemia |
| Discriminator | Pyrazinamide |
| One-liner | — |
| Trap | ⚠ INH or rifampicin |
34. Measles [May2026-style, Syllabus-core]
| Trigger | Fever + cough/coryza/conjunctivitis + Koplik spots |
| Discriminator | Koplik spots |
| One-liner | answer: d — measles r0 = 12-18 (highly infectious). |
| Trap | ⚠ Rubella/scarlet fever |
Review once. Trust the discriminator. No new learning after this read.