NRE INTELLIGENCE REPORT

The Prediction Exam is a 200-MCQ simulated paper. Its subject proportions are not guessed — they are set by the actual recalled-paper pattern: 5 attempts, 822 confirmed recalled questions, 436 tagged topics. The reported weightage below is the prediction's answer to the question the exam asks every sitting: which subjects actually carry the marks.

Medicine owns the exam: 83/200 (41.5%), matching the 43.6% share seen in recalled papers. Surgery (23), Paediatrics (20) and Obstetrics & Gynaecology (17) form the next tier. The remaining ten small subjects carry 56 MCQs (28%) — individually low-yield, collectively the difference between passing and failing.

The predicted distribution tracks the recalled pattern closely — every subject sits within 2.1 percentage points of its recalled share, and most within 0.5 points. Small subjects (Anatomy, Community Medicine, ENT, Ophthalmology, Forensic Medicine) were deliberately floored at 2.5–3% so the bank guarantees coverage the sparse recall data cannot prove.

Answer letters are balanced 50/50 across A–D, the bank was rebalanced Sep 13 2026 (Medicine weight fixed, 156 distractor reasonings realigned, 48 new items added), and 3 questions carry flagged truncated stems (see Flags).

Prediction bank (200) versus the actual recalled-paper distribution (822 confirmed questions across June 2024, December 2024, May 2026, December 2025, June 2025). Δ is the prediction minus the recalled share, in percentage points.

Reading the deltas:

• Medicine −2.1 pp: the largest deviation, and it is deliberate — the prediction floors small subjects instead of over-concentrating every spare mark in Medicine. The real October paper will likely sit at or above the 41.5% line.
• Ophthalmology +1.4 pp and ENT +0.4 pp: raised to guarantee a usable bank. Both subjects recur in every recalled sitting but with too few questions to trust their raw share.
• Everything else sits within ±0.2 pp of the recalled pattern — Surgery 11.5% vs 11.7%, Pharmacology 7.0% vs 7.1%, the small subjects all within a rounding of their real share.

The highest-confidence repeat topics in the October exam — ranked by times recalled across all 5 papers, with the number of different sittings each appeared in. A topic seen in all 5 papers is the closest thing the evidence offers to a guaranteed repeat.

These 25 topics alone account for roughly 160+ recalled questions — every one of them should feel automatic before October. Cross-check your coverage against this list first; if a row is unfamiliar, that is a gap, not an option.

For every subject in the prediction bank, the single-line discriminator each question was built around — all 200 items listed by question number. These are the recognition triggers: the pattern that should fire the answer in one line.

Anatomy — 6 MCQs

• Q1: Sternal angle = T4/T5 disc.
• Q2: Celiac trunk arises at T12 from aorta.
• Q3: Diaphragm motor innervation = phrenic nerve (C3-C5).
• Q4: Inguinal canal in males = spermatic cord.
• Q5: Triangle of Calot: cystic duct + common hepatic duct + liver edge. Cystic artery is inside.
• Q6: Conus medullaris ends at L1/L2.

Physiology — 4 MCQs

• Q7: PCT reabsorbs 65-70% of filtered Na+ and water.
• Q8: Angiotensin II is the primary stimulus for aldosterone.
• Q9: Resting membrane potential = K+ permeability (Nernst equation).
• Q10: Parasympathetic = rest and digest.

Biochemistry — 4 MCQs

• Q11: EFA deficiency in TPN = dermatitis, growth failure.
• Q12: PKU = phenylalanine hydroxylase deficiency.
• Q13: Down's syndrome + CHD = ASD (ostium primum).
• Q14: Kwashiorkor = edema + fatty liver + low albumin.

Pathology — 4 MCQs

• Q15: Acute osteomyelitis in child = Staphylococcus aureus.
• Q16: COCP mechanism = inhibit ovulation via progestin.
• Q17: Abnormal Pap + dysplastic cells = CIN.
• Q18: Changing mole = melanoma (ABCDE criteria).

Pharmacology — 14 MCQs

• Q19: Organophosphate + muscarinic symptoms = atropine.
• Q20: Dextromethorphan = antitussive, acts on cough center.
• Q21: Ferrous sulfate + tetracyclines = absorption antagonism.
• Q22: Uricosuric drug for gout = probenecid.
• Q23: Thyroidectomy + hoarseness + dyspnea = recurrent laryngeal nerve injury.
• Q24: Kerosene ingestion: do NOT induce vomiting (syrup of ipecac).
• Q25: Benzodiazepine ingestion in child = charcoal + supportive care.
• Q26: Acute anaphylaxis = epinephrine (first-line).
• Q27: N-acetylcysteine replenishes glutathione and prevents hepatic necrosis in paracetamol poisoning.
• Q28: Miosis + respiratory depression + depressed consciousness = opioid overdose; naloxone is the antagonist.
• Q29: Warfarin blocks vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX, and X.
• Q30: Unfractionated heparin is monitored and dose-adjusted by aPTT.
• Q31: Aspirin irreversibly acetylates COX-1, blocking thromboxane A2 for the platelet's lifetime (7–10 days).
• Q32: ACE inhibitors are teratogenic in pregnancy (fetal renal damage); methyldopa is the safest first-line option.

Community Medicine — 6 MCQs

• Q33: Triage yellow = delayed/minor injuries.
• Q34: Increased incidence above expected = epidemic.
• Q35: Outbreak definition depends on disease and context.
• Q36: BCG + Hepatitis B at birth.
• Q37: Measles R0 = 12-18 (highly infectious).
• Q38: Sensitivity = true positives / all diseased = 85/100 = 85%.

Medicine — 83 MCQs

• Q39: Crushing chest pain + radiating + ST elevation = inferior STEMI.
• Q40: Pink frothy sputum + crackles + dyspnea = acute LVF.
• Q41: Irregularly irregular + absent P waves = atrial fibrillation.
• Q42: Syncope on exertion + radiating to carotids = aortic stenosis.
• Q43: Progressive dyspnea + orthopnea + EF 30% = HFrEF.
• Q44: Midsystolic click + posture change = mitral valve prolapse.
• Q45: Age 50 + bilateral R stenosis = atherosclerotic.
• Q46: Young woman + rapid regular narrow complex = AVNRT.
• Q47: Apical murmur radiating to axilla = mitral regurgitation.
• Q48: Chest pain + improves sitting forward = pericarditis.
• Q49: AF + stroke = cardioembolic.
• Q50: Click + louder with Valsalva = HCM.
• Q51: Epigastric + back + elevated amylase/lipase = pancreatitis.
• Q52: Jaundice + pale stools + pancreatic head mass = pancreatic cancer.
• Q53: Esophageal rings + dysphagia = eosinophilic esophagitis.
• Q54: Appendicitis confirmed = appendectomy.
• Q55: Bilious emesis after gastric bypass = efferent loop obstruction.
• Q56: RUQ pain after fatty meals + gallstones = biliary colic.
• Q57: Large pneumothorax = chest tube insertion.
• Q58: Cough + sputum + wheezing = chronic bronchitis.
• Q59: Bilateral hilar lymphadenopathy + erythema nodosum = sarcoidosis.
• Q60: Hemoptysis + weight loss + solitary nodule = lung cancer.
• Q61: Progressive dyspnea + reticular opacities = ILD.
• Q62: Hematuria + proteinuria + rash = IgA nephropathy.
• Q63: Oliguria + muddy brown casts = ATN.
• Q64: HTN + hematuria + proteinuria + anti-GBM = Goodpasture.
• Q65: Polyuria + low urine osmolality + no response to DDAVP = nephrogenic DI.
• Q66: Flank pain + hematuria + renal mass = renal cell carcinoma.
• Q67: Weight loss + heat intolerance + AF + suppressed TSH = Graves disease.
• Q68: Hyperpigmentation + hypotension + hyponatremia + elevated ACTH = Addison disease.
• Q69: Thyroid nodule + follicular cells = follicular neoplasm.
• Q70: Galactorrhea + amenorrhea + elevated prolactin = prolactinoma.
• Q71: Polyuria + polydipsia + low C-peptide = Type 1 DM.
• Q72: Episodic HTN + headache + palpitations + elevated VMA = pheochromocytoma.
• Q73: Joint pain + malar rash + photosensitivity + positive ANA = SLE.
• Q74: Dysphagia + Raynaud + sclerodactyly = scleroderma.
• Q75: Back pain + stiffness + fusion + HLA-B27 = ankylosing spondylitis.
• Q76: Young woman + bilateral knee + ANA+ = SLE.
• Q77: Microcytic hypochromic + low ferritin = iron deficiency anemia.
• Q78: Fatigue + weight loss + painless lymphadenopathy + RS cells = Hodgkin lymphoma.
• Q79: Prolonged bleeding time + normal PT/PTT = von Willebrand disease.
• Q80: Normocytic + reticulocytopenia = aplastic anemia.
• Q81: DVT + recurrent miscarriages = antiphospholipid syndrome.
• Q82: Fatigue + jaundice + splenomegaly + spherocytes = hereditary spherocytosis.
• Q83: Sudden weakness + slurred speech + no hemorrhage = ischemic stroke.
• Q84: Visual disturbance + headache = migraine with aura.
• Q85: Tremor + rigidity + bradykinesia = Parkinson disease.
• Q86: Numbness + optic neuritis + white matter lesions = multiple sclerosis.
• Q87: Progressive dementia + aphasia + motor weakness = FTD or vascular dementia.
• Q88: Back pain + fatigue + confusion + hypercalcemia = multiple myeloma.
• Q89: Rheumatic heart + prolonged fever = subacute endocarditis.
• Q90: AF + progressive dyspnea = mitral stenosis.
• Q91: Moon face + purple striae + weight gain = Cushing syndrome.
• Q92: Rusty sputum + lobar consolidation = classic pneumococcal pneumonia.
• Q93: Chronic constitutional symptoms + upper lobe cavitation = pulmonary tuberculosis.
• Q94: Post-surgical immobility + sudden dyspnea + tachycardia + hypoxia = pulmonary embolism.
• Q95: Hyperglycemia + ketoacidosis + Kussmaul breathing in type 1 diabetes = DKA.
• Q96: Euvolemic hyponatremia with concentrated urine and high urine sodium in small cell lung cancer = SIADH.
• Q97: Peaked T waves + widened QRS = cardiotoxic hyperkalemia; IV calcium stabilizes the myocardium first.
• Q98: Normocytic anemia with normal iron stores in advanced CKD = erythropoietin deficiency.
• Q99: Symmetric small-joint polyarthritis with morning stiffness over 1 hour = rheumatoid arthritis.
• Q100: First MTP podagra + needle-shaped negatively birefringent crystals = gout (monosodium urate).
• Q101: HBsAg + IgM anti-HBc + HBeAg = acute hepatitis B with active replication and high infectivity.
• Q102: Ascitic PMN count ≥250/mm³ with fever in cirrhosis = spontaneous bacterial peritonitis.
• Q103: Active variceal bleeding = vasoconstrictor (terlipressin) plus endoscopic band ligation.
• Q104: Moderate acute asthma (PEF 50–75%) with ability to speak = inhaled short-acting beta-agonist first.
• Q105: Turbid CSF with neutrophils, low glucose, and high protein = acute bacterial meningitis.
• Q106: Ascending flaccid paralysis after infection with albuminocytologic dissociation = Guillain-Barré syndrome.
• Q107: Childhood absence epilepsy with 3 Hz spike-and-wave = ethosuximide first-line.
• Q108: Step-ladder fever + relative bradycardia + rose spots + Salmonella on blood culture = typhoid fever.
• Q109: Fever paroxysms + ring forms (trophozoites) inside RBCs on smear = malaria.
• Q110: Retro-orbital headache + thrombocytopenia + hemoconcentration + abdominal pain and vomiting = dengue with warning signs (plasma leakage risk).
• Q111: High TSH with low free T4 = primary hypothyroidism (thyroid gland failure).
• Q112: Isolated thrombocytopenia after a viral illness in a well child with normal hemoglobin and WBC = immune thrombocytopenia.
• Q113: Massive leukocytosis with the full myeloid spectrum and thrombocytosis = CML (confirm with BCR-ABL).
• Q114: Metformin is first-line in type 2 diabetes — weight-neutral with low hypoglycemia risk.
• Q115: ACE inhibitors reduce intraglomerular pressure and proteinuria — renoprotective in diabetic nephropathy.
• Q116: Weight-bearing joint pain with brief stiffness, crepitus, and osteophytes = primary osteoarthritis.
• Q117: Age over 50 + bilateral girdle stiffness without true weakness + high ESR = polymyalgia rheumatica.
• Q118: Macrocytic anemia with hypersegmented neutrophils and neurological signs in a vegetarian = vitamin B12 deficiency.
• Q119: Microcytosis with a HIGH red cell count, normal ferritin, and target cells = beta-thalassemia trait (Mentzer index under 13).
• Q120: Beck triad — hypotension, raised JVP, muffled heart sounds — with pulsus paradoxus = cardiac tamponade.
• Q121: Acral growth + coarse features + bitemporal hemianopia from a pituitary mass = acromegaly (GH excess, raised IGF-1).

Surgery — 23 MCQs

• Q122: Symptomatic gallstones = cholecystectomy.
• Q123: Acute appendicitis = appendectomy.
• Q124: AAA >5.5 cm = elective repair.
• Q125: Reducible inguinal bulge in male = indirect inguinal hernia.
• Q126: Testicular torsion = emergency orchiopexy.
• Q127: Diverticulitis + abscess = percutaneous drainage.
• Q128: Symptomatic hemorrhoids = rubber band ligation.
• Q129: Ruptured ectopic = emergency salpingectomy.
• Q130: Acute pancreatitis = NPO + IV fluids.
• Q131: Invasive ductal carcinoma = mastectomy with staging.
• Q132: Bloody nipple discharge = intraductal papilloma or cancer.
• Q133: Peau d'orange = inflammatory breast cancer.
• Q134: DCIS after lumpectomy = radiation therapy.
• Q135: Frequency + urgency + nocturia in older male = BPH.
• Q136: Testicular mass = testicular cancer.
• Q137: Hematuria + bladder tumor = bladder cancer.
• Q138: Claudication = peripheral arterial disease.
• Q139: Medial malleolus + non-healing = venous ulcer.
• Q140: Painful + swollen + warm leg = DVT.
• Q141: Hip fracture = surgical fixation.
• Q142: Clavicle fracture = sling immobilization (most cases).
• Q143: Complete ACL tear in active patient = reconstruction.
• Q144: Open fracture = emergency debridement + fixation.

Paediatrics — 20 MCQs

• Q145: Fever + irritability + bulging fontanelle = meningitis.
• Q146: Neonatal jaundice + 15 mg/dL = phototherapy.
• Q147: Respiratory distress + scaphoid abdomen = congenital diaphragmatic hernia.
• Q148: 28-week preemie + RDS = hyaline membrane disease.
• Q149: Bark-like cough + stridor + nighttime = croup.
• Q150: Harsh systolic murmur in infant = VSD (most common CHD).
• Q151: Hematuria + oliguria + post-strep = PSGN.
• Q152: Failure to thrive + diarrhea + distension = celiac disease.
• Q153: Limp + hip pain in young child = transient synovitis.
• Q154: Fever + rash + conjunctivitis = Kawasaki disease.
• Q155: Bedwetting + frequency = UTI (must rule out first).
• Q156: Abdominal mass + hematuria in child = Wilms tumor.
• Q157: Knee pain + lytic lesion in adolescent = osteosarcoma.
• Q158: Purpuric rash on buttocks/legs in child = HSP.
• Q159: Infant with coryza progressing to tachypnea, recession, and diffuse crackles in winter = bronchiolitis (RSV).
• Q160: Projectile non-bilious vomiting + olive mass + hypochloremic hypokalemic metabolic alkalosis = pyloric stenosis.
• Q161: Colicky episodic pain with red currant jelly stool in an infant = intussusception.
• Q162: Generalized seizure under 5 years with rapid fever, lasting under 15 minutes, no focal features, full recovery = simple febrile seizure.
• Q163: IVIG within 10 days plus high-dose aspirin reduces coronary aneurysm risk in Kawasaki disease.
• Q164: Edema + heavy proteinuria + hypoalbuminemia + hyperlipidemia without hematuria in a young child = nephrotic syndrome, usually minimal change disease.

Obstetrics & Gynaecology — 17 MCQs

• Q165: First prenatal visit at 12 weeks = confirm gestational age with ultrasound.
• Q166: HTN + proteinuria + edema = preeclampsia.
• Q167: Active labor at 38 weeks = allow to progress.
• Q168: Positive test + intrauterine + spotting = threatened abortion.
• Q169: Preterm labor at 32 weeks = betamethasone + tocolysis + magnesium.
• Q170: Severe nausea + vomiting + weight loss = hyperemesis gravidarum.
• Q171: FHR 170 = tachycardia, continue monitoring first.
• Q172: Abnormal uterine bleeding in perimenopause = endometrial biopsy.
• Q173: Dysmenorrhea + heavy bleeding + fibroid = medical management first.
• Q174: Dominant ovarian cyst = laparoscopic cystectomy (if symptomatic/complex).
• Q175: Postmenopausal bleeding = endometrial cancer until proven otherwise.
• Q176: Irregular menses + hirsutism = PCOS.
• Q177: Symptomatic prolapse = surgical repair (if patient desires).
• Q178: Pelvic pain + cervical motion tenderness + fever = PID.
• Q179: Positive β-hCG above the discriminatory zone with an empty uterus = ectopic pregnancy until proven otherwise.
• Q180: Painless bleeding with placenta over the internal os = placenta previa; digital examination can trigger catastrophic hemorrhage.
• Q181: Universal screening for gestational diabetes is the OGTT at 24–28 weeks, when placental anti-insulin hormones peak.

Psychiatry — 2 MCQs

• Q182: Persistent sadness + anhedonia + sleep disturbance = MDD.
• Q183: Auditory hallucinations + paranoia for 3 months = schizophrenia.

ENT — 6 MCQs

• Q184: Child + sneezing + clear discharge + folds = allergic rhinitis.
• Q185: Nasal obstruction + anosmia = nasal polyps.
• Q186: Unilateral purulent discharge = bacterial sinusitis.
• Q187: Persistent dysphonia in a voice user with bilateral vocal cord swellings at the junction of the anterior and middle thirds = vocal cord nodules.
• Q188: Hearing loss + recurrent ear infections = otitis media with effusion.
• Q189: Recurrent vertigo lasting hours with fluctuating sensorineural hearing loss, tinnitus, and fullness = Meniere disease (endolymphatic hydrops).

Ophthalmology — 6 MCQs

• Q190: RAPD = optic neuritis.
• Q191: Ptosis + diplopia + worse at day = myasthenia gravis.
• Q192: Sudden vision loss + cherry red spot = CRAO.
• Q193: Gradual vision loss + elevated IOP = glaucoma.
• Q194: Blurred vision + painful eye movement = optic neuritis.
• Q195: Floaters + flashes = posterior vitreous detachment.

Forensic Medicine — 5 MCQs

• Q196: Most common fingerprint pattern = loops.
• Q197: Putrefaction order: liver first, prostate last (dense tissue).
• Q198: Sexual assault = full forensic kit within 72 hours.
• Q199: Self-harm = preserve scene, document injuries, assess intent.
• Q200: A statement by a person who believes death is imminent, relating to the cause of death, is a dying declaration and admissible as evidence.

Auto-mined from the prediction bank: groups of questions whose discriminators are mutually confusing and therefore best drilled as a set, not one at a time. Drill each cluster until the discriminator fires without thinking — then move to the next.

CARDIAC & ECG CLUSTER (20 questions in bank)

• Q13: Down's syndrome + CHD = ASD (ostium primum).
• Q29: Warfarin blocks vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX, and X.
• Q39: Crushing chest pain + radiating + ST elevation = inferior STEMI.
• Q41: Irregularly irregular + absent P waves = atrial fibrillation.
• Q42: Syncope on exertion + radiating to carotids = aortic stenosis.
• Q43: Progressive dyspnea + orthopnea + EF 30% = HFrEF.
• Q46: Young woman + rapid regular narrow complex = AVNRT.
• Q47: Apical murmur radiating to axilla = mitral regurgitation.
• Q48: Chest pain + improves sitting forward = pericarditis.
• Q49: AF + stroke = cardioembolic.
• Q50: Click + louder with Valsalva = HCM.
• Q57: Large pneumothorax = chest tube insertion.
• Q67: Weight loss + heat intolerance + AF + suppressed TSH = Graves disease.
• Q72: Episodic HTN + headache + palpitations + elevated VMA = pheochromocytoma.
• Q89: Rheumatic heart + prolonged fever = subacute endocarditis.
• Q90: AF + progressive dyspnea = mitral stenosis.
• Q92: Rusty sputum + lobar consolidation = classic pneumococcal pneumonia.
• Q94: Post-surgical immobility + sudden dyspnea + tachycardia + hypoxia = pulmonary embolism.
• Q97: Peaked T waves + widened QRS = cardiotoxic hyperkalemia; IV calcium stabilizes the myocardium first.
• Q150: Harsh systolic murmur in infant = VSD (most common CHD).

RENAL & GLOMERULAR CLUSTER (27 questions in bank)

• Q7: PCT reabsorbs 65-70% of filtered Na+ and water.
• Q8: Angiotensin II is the primary stimulus for aldosterone.
• Q21: Ferrous sulfate + tetracyclines = absorption antagonism.
• Q22: Uricosuric drug for gout = probenecid.
• Q32: ACE inhibitors are teratogenic in pregnancy (fetal renal damage); methyldopa is the safest first-line option.
• Q35: Outbreak definition depends on disease and context.
• Q37: Measles R0 = 12-18 (highly infectious).
• Q45: Age 50 + bilateral R stenosis = atherosclerotic.
• Q51: Epigastric + back + elevated amylase/lipase = pancreatitis.
• Q55: Bilious emesis after gastric bypass = efferent loop obstruction.
• Q62: Hematuria + proteinuria + rash = IgA nephropathy.
• Q63: Oliguria + muddy brown casts = ATN.
• Q64: HTN + hematuria + proteinuria + anti-GBM = Goodpasture.
• Q66: Flank pain + hematuria + renal mass = renal cell carcinoma.
• Q103: Active variceal bleeding = vasoconstrictor (terlipressin) plus endoscopic band ligation.
• Q114: Metformin is first-line in type 2 diabetes — weight-neutral with low hypoglycemia risk.
• Q115: ACE inhibitors reduce intraglomerular pressure and proteinuria — renoprotective in diabetic nephropathy.
• Q128: Symptomatic hemorrhoids = rubber band ligation.
• Q130: Acute pancreatitis = NPO + IV fluids.
• Q137: Hematuria + bladder tumor = bladder cancer.
• Q143: Complete ACL tear in active patient = reconstruction.
• Q151: Hematuria + oliguria + post-strep = PSGN.
• Q154: Fever + rash + conjunctivitis = Kawasaki disease.
• Q156: Abdominal mass + hematuria in child = Wilms tumor.
• Q163: IVIG within 10 days plus high-dose aspirin reduces coronary aneurysm risk in Kawasaki disease.
• Q164: Edema + heavy proteinuria + hypoalbuminemia + hyperlipidemia without hematuria in a young child = nephrotic syndrome, usually minimal change disease.
• Q166: HTN + proteinuria + edema = preeclampsia.

NERVE INJURY CLUSTER (3 questions in bank)

• Q3: Diaphragm motor innervation = phrenic nerve (C3-C5).
• Q23: Thyroidectomy + hoarseness + dyspnea = recurrent laryngeal nerve injury.
• Q41: Irregularly irregular + absent P waves = atrial fibrillation.

TOXINS & ANTIDOTE CLUSTER (5 questions in bank)

• Q19: Organophosphate + muscarinic symptoms = atropine.
• Q27: N-acetylcysteine replenishes glutathione and prevents hepatic necrosis in paracetamol poisoning.
• Q28: Miosis + respiratory depression + depressed consciousness = opioid overdose; naloxone is the antagonist.
• Q29: Warfarin blocks vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX, and X.
• Q97: Peaked T waves + widened QRS = cardiotoxic hyperkalemia; IV calcium stabilizes the myocardium first.

PAEDIATRIC AIRWAY & LUNG CLUSTER (29 questions in bank)

• Q12: PKU = phenylalanine hydroxylase deficiency.
• Q13: Down's syndrome + CHD = ASD (ostium primum).
• Q14: Kwashiorkor = edema + fatty liver + low albumin.
• Q15: Acute osteomyelitis in child = Staphylococcus aureus.
• Q23: Thyroidectomy + hoarseness + dyspnea = recurrent laryngeal nerve injury.
• Q25: Benzodiazepine ingestion in child = charcoal + supportive care.
• Q58: Cough + sputum + wheezing = chronic bronchitis.
• Q104: Moderate acute asthma (PEF 50–75%) with ability to speak = inhaled short-acting beta-agonist first.
• Q107: Childhood absence epilepsy with 3 Hz spike-and-wave = ethosuximide first-line.
• Q112: Isolated thrombocytopenia after a viral illness in a well child with normal hemoglobin and WBC = immune thrombocytopenia.
• Q145: Fever + irritability + bulging fontanelle = meningitis.
• Q146: Neonatal jaundice + 15 mg/dL = phototherapy.
• Q147: Respiratory distress + scaphoid abdomen = congenital diaphragmatic hernia.
• Q148: 28-week preemie + RDS = hyaline membrane disease.
• Q149: Bark-like cough + stridor + nighttime = croup.
• Q150: Harsh systolic murmur in infant = VSD (most common CHD).
• Q151: Hematuria + oliguria + post-strep = PSGN.
• Q152: Failure to thrive + diarrhea + distension = celiac disease.
• Q153: Limp + hip pain in young child = transient synovitis.
• Q154: Fever + rash + conjunctivitis = Kawasaki disease.
• Q155: Bedwetting + frequency = UTI (must rule out first).
• Q156: Abdominal mass + hematuria in child = Wilms tumor.
• Q158: Purpuric rash on buttocks/legs in child = HSP.
• Q159: Infant with coryza progressing to tachypnea, recession, and diffuse crackles in winter = bronchiolitis (RSV).
• Q161: Colicky episodic pain with red currant jelly stool in an infant = intussusception.
• Q162: Generalized seizure under 5 years with rapid fever, lasting under 15 minutes, no focal features, full recovery = simple febrile seizure.
• Q164: Edema + heavy proteinuria + hypoalbuminemia + hyperlipidemia without hematuria in a young child = nephrotic syndrome, usually minimal change disease.
• Q184: Child + sneezing + clear discharge + folds = allergic rhinitis.
• Q188: Hearing loss + recurrent ear infections = otitis media with effusion.

OBSTETRIC NUMBER CLUSTER (27 questions in bank)

• Q11: EFA deficiency in TPN = dermatitis, growth failure.
• Q16: COCP mechanism = inhibit ovulation via progestin.
• Q32: ACE inhibitors are teratogenic in pregnancy (fetal renal damage); methyldopa is the safest first-line option.
• Q36: BCG + Hepatitis B at birth.
• Q71: Polyuria + polydipsia + low C-peptide = Type 1 DM.
• Q89: Rheumatic heart + prolonged fever = subacute endocarditis.
• Q93: Chronic constitutional symptoms + upper lobe cavitation = pulmonary tuberculosis.
• Q99: Symmetric small-joint polyarthritis with morning stiffness over 1 hour = rheumatoid arthritis.
• Q106: Ascending flaccid paralysis after infection with albuminocytologic dissociation = Guillain-Barré syndrome.
• Q112: Isolated thrombocytopenia after a viral illness in a well child with normal hemoglobin and WBC = immune thrombocytopenia.
• Q117: Age over 50 + bilateral girdle stiffness without true weakness + high ESR = polymyalgia rheumatica.
• Q129: Ruptured ectopic = emergency salpingectomy.
• Q148: 28-week preemie + RDS = hyaline membrane disease.
• Q151: Hematuria + oliguria + post-strep = PSGN.
• Q165: First prenatal visit at 12 weeks = confirm gestational age with ultrasound.
• Q166: HTN + proteinuria + edema = preeclampsia.
• Q167: Active labor at 38 weeks = allow to progress.
• Q168: Positive test + intrauterine + spotting = threatened abortion.
• Q169: Preterm labor at 32 weeks = betamethasone + tocolysis + magnesium.
• Q170: Severe nausea + vomiting + weight loss = hyperemesis gravidarum.
• Q171: FHR 170 = tachycardia, continue monitoring first.
• Q179: Positive β-hCG above the discriminatory zone with an empty uterus = ectopic pregnancy until proven otherwise.
• Q180: Painless bleeding with placenta over the internal os = placenta previa; digital examination can trigger catastrophic hemorrhage.
• Q181: Universal screening for gestational diabetes is the OGTT at 24–28 weeks, when placental anti-insulin hormones peak.
• Q182: Persistent sadness + anhedonia + sleep disturbance = MDD.
• Q184: Child + sneezing + clear discharge + folds = allergic rhinitis.
• Q187: Persistent dysphonia in a voice user with bilateral vocal cord swellings at the junction of the anterior and middle thirds = vocal cord nodules.

ANTIBIOTIC & INFECTION CLUSTER (9 questions in bank)

• Q6: Conus medullaris ends at L1/L2.
• Q21: Ferrous sulfate + tetracyclines = absorption antagonism.
• Q26: Acute anaphylaxis = epinephrine (first-line).
• Q38: Sensitivity = true positives / all diseased = 85/100 = 85%.
• Q93: Chronic constitutional symptoms + upper lobe cavitation = pulmonary tuberculosis.
• Q103: Active variceal bleeding = vasoconstrictor (terlipressin) plus endoscopic band ligation.
• Q105: Turbid CSF with neutrophils, low glucose, and high protein = acute bacterial meningitis.
• Q120: Beck triad — hypotension, raised JVP, muffled heart sounds — with pulsus paradoxus = cardiac tamponade.
• Q145: Fever + irritability + bulging fontanelle = meningitis.

ENDOCRINE GLAND CLUSTER (13 questions in bank)

• Q23: Thyroidectomy + hoarseness + dyspnea = recurrent laryngeal nerve injury.
• Q68: Hyperpigmentation + hypotension + hyponatremia + elevated ACTH = Addison disease.
• Q69: Thyroid nodule + follicular cells = follicular neoplasm.
• Q70: Galactorrhea + amenorrhea + elevated prolactin = prolactinoma.
• Q83: Sudden weakness + slurred speech + no hemorrhage = ischemic stroke.
• Q91: Moon face + purple striae + weight gain = Cushing syndrome.
• Q95: Hyperglycemia + ketoacidosis + Kussmaul breathing in type 1 diabetes = DKA.
• Q111: High TSH with low free T4 = primary hypothyroidism (thyroid gland failure).
• Q114: Metformin is first-line in type 2 diabetes — weight-neutral with low hypoglycemia risk.
• Q115: ACE inhibitors reduce intraglomerular pressure and proteinuria — renoprotective in diabetic nephropathy.
• Q121: Acral growth + coarse features + bitemporal hemianopia from a pituitary mass = acromegaly (GH excess, raised IGF-1).
• Q138: Claudication = peripheral arterial disease.
• Q181: Universal screening for gestational diabetes is the OGTT at 24–28 weeks, when placental anti-insulin hormones peak.

3 prediction items were rebuilt from truncated recall stems. Their four-option logic is pattern-weighted inference rather than a verbatim recall — treat them as topic placeholders, not as exact repeats.

• Q5: During a laparoscopic cholecystectomy, the surgeon identifies the triangle of Calot before clipping any structures. Which of the following d...
• Q12: A 6-week-old infant is brought for poor feeding and developmental delay. He has fair skin, eczema, and a musty odor to his urine. Newborn sc...
• Q196: In a forensic identification case, the examiner classifies the fingerprints of an unknown deceased person. Which is the most prevalent finge...

Otherwise the bank is clean: 200/200 items carry stem, options, answer, discriminator, distractor reasoning and recognition variant; no schema or integrity flags remain from the Sep 13 sweep.

This paper is a rehearsal, not a reading exercise. Treat it like the real thing once, then mine it for weeks.

• 1. Timed single pass: 200 questions, 3 hours, no phone, no notes. 90 seconds per question maximum — mark and move. The recalled papers repeatedly show execution failure, not knowledge failure.
• 2. Score by subject using the Answer Key (DOCX or HTML twin). Compare your subject-level misses against Section 1 — a miss inside Medicine or Surgery costs more than a miss in Psychiatry.
• 3. Error-log every miss: date, source (Prediction 2026), Q number, subject, discriminator you missed, trap type, one-line future alert. This feeds the battle plan — the log decides what you revise, not the syllabus order.
• 4. Drill the Section 4 clusters every week until the discriminators are instant. Cluster drills are how confusion becomes reflex.
• 5. Use the Non-Negotiable 100 and NRE50 cycles as the drill engine; use this prediction exam as the periodic full-scale rehearsal. Macro map and micro drill — together they close the gap.