NRE Step 1 Medicine MCQs
12 sample questions from the 985 Medicine questions in NRE-1 Prep. Choose an answer to see why it is right and why each other option is wrong.
Practise all 985 Medicine questions in NRE-1 Prep
Sample Medicine questions
1. An ABG shows pH 7.29, PaCO₂ 70 mmHg and bicarbonate 33 mmol/L. What is the pattern?
Answer: Chronic CO₂ retention, acute rise. High CO₂ with acidosis and raised bicarbonate: chronic retention with an acute rise.
- Metabolic acidosis: Bicarbonate is high.
- Normal: No.
- Respiratory alkalosis: pH is low.
- Metabolic alkalosis: pH is low.
2. After NG tube insertion, the aspirate pH is 6.5. What should be done?
Answer: Don't feed. pH 5.5 or below confirms gastric placement; otherwise X-ray.
- Put the end in water: Unreliable.
- Feed slowly: Unsafe.
- Start feeding: Not confirmed in the stomach.
- Whoosh test: Unreliable.
3. A 2-year-old unvaccinated child in a Karachi slum has had measles for 5 days. He now has fast breathing, chest indrawing and fever returning after the rash appeared. Which complication is most likely?
Answer: Secondary bacterial pneumonia. Measles is caused by a paramyxovirus; prodrome of cough, coryza, conjunctivitis and Koplik spots, then a maculopapular rash spreading from behind the ears downwards on about day 4. Pneumonia (viral giant-cell or secondary bacterial) is the commonest cause of death; others are diarrhoea, otitis media, croup, encephalitis (acute), corneal ulceration with vitamin A deficiency, and SSPE (7–10 years later). WHO recommends vitamin A on two consecutive days for all children with measles (200 000 IU if ≥ 12 months). Return of fever after the rash is a red flag for a bacterial complication.
- Subacute sclerosing panencephalitis: SSPE develops years later.
- Koplik spot ulceration: Koplik spots are a prodromal sign only.
- Acute rheumatic fever: Rheumatic fever follows streptococcal throat infection.
4. A 45-year-old with gallstone pancreatitis has, 48 hours after admission, persistent hypotension and rising creatinine despite fluids. What defines this as severe acute pancreatitis?
Answer: Organ failure > 48 hours. Revised Atlanta classification: mild — no organ failure or complications; moderately severe — transient organ failure (< 48 h) or local complications; severe — persistent organ failure > 48 h. Diagnosis needs 2 of 3: typical pain, lipase/amylase > 3× normal, imaging. Management: goal-directed fluids (Ringer’s lactate), analgesia, early enteral feeding, ERCP within 24–72 h for cholangitis, cholecystectomy in the same admission for mild gallstone pancreatitis. Antibiotics only for infected necrosis.
- Amylase > 3× upper limit: Amylase level is diagnostic, not a severity marker.
- Pain radiating to the back: Back pain is a typical feature, not a marker of severity.
- Gallstones on ultrasound: Gallstones are the cause, not a severity measure.
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5. A 40-year-old man has a first episode of uncomplicated-looking cystitis confirmed on culture. What is appropriate after treatment?
Answer: Investigate the urinary tract. UTIs in men are considered complicated; consider prostatitis, outflow obstruction, stones or structural abnormalities. Treat for 7 days (14 days if prostatitis suspected), and arrange ultrasound of the urinary tract and post-void residual (± PSA after infection settles). Women with uncomplicated cystitis need 3–5 days of nitrofurantoin or fosfomycin without imaging.
- No further action: UTI in men is uncommon and needs investigation.
- Long-term prophylaxis immediately: Investigation should come before prophylaxis.
- Cranberry juice only: Cranberry juice has no evidence in men.
6. An 82-year-old admitted with pneumonia becomes acutely confused at night, inattentive and agitated, then drowsy by day. What is the first priority?
Answer: Find and treat the cause. Delirium is an acute fluctuating disturbance of attention and awareness due to a medical cause: infection, drugs (anticholinergics, opioids, benzodiazepines), dehydration, electrolytes, urinary retention, constipation, hypoxia, pain, alcohol withdrawal. Manage with non-pharmacological measures (orientation, family, glasses/hearing aids, sleep hygiene) and treat causes. Low-dose haloperidol only for severe distress or risk. Avoid benzodiazepines except in alcohol withdrawal.
- Start donepezil: Donepezil is a dementia drug.
- Restrain physically: Restraint worsens delirium.
- Give haloperidol as first step: Haloperidol is used only if the patient is distressed or dangerous.
7. A 22-year-old has 8 months of hearing voices commenting on his actions, believing his thoughts are being broadcast and social withdrawal. He uses no drugs. What is first-line treatment?
Answer: Risperidone. Schizophrenia: positive symptoms (hallucinations — third-person running commentary; delusions; thought insertion/withdrawal/broadcast — Schneider first-rank), negative symptoms (withdrawal, flat affect, alogia), lasting > 1 month (ICD-11). Treat with antipsychotic (e.g. risperidone, olanzapine, aripiprazole) plus psychosocial interventions and family support. Clozapine for treatment-resistant illness (after 2 failed antipsychotics) with neutrophil monitoring. Monitor metabolic side effects.
- Sertraline: Sertraline does not treat psychosis.
- Lithium: Lithium is for bipolar disorder.
- Diazepam: Diazepam is not an antipsychotic.
8. A patient has low calcium, high phosphate and low PTH six months after neck surgery. What is the diagnosis?
Answer: Hypoparathyroidism. Hypocalcaemia with low PTH = hypoparathyroidism (post-surgical — commonest, autoimmune, DiGeorge, magnesium deficiency, infiltration). With high PTH: vitamin D deficiency (phosphate low), CKD (phosphate high), pseudohypoparathyroidism (PTH resistance, phosphate high; Albright hereditary osteodystrophy — short stature, short 4th/5th metacarpals). Treat hypoparathyroidism with calcium and activated vitamin D (alfacalcidol/calcitriol); recombinant PTH for refractory cases.
- Vitamin D deficiency: Vitamin D deficiency gives low phosphate and high PTH.
- CKD: CKD gives high PTH.
- Pseudohypoparathyroidism: Pseudohypoparathyroidism gives high PTH.
9. A man bitten while sleeping on the floor in rural Sindh wakes with abdominal pain, ptosis, difficulty swallowing and progressive weakness. There is minimal local swelling. 20WBCT is normal. What is most important?
Answer: Antivenom + ventilation. Common krait bites occur at night on people sleeping on the floor; often painless with no local signs. Neurotoxic envenoming: ptosis, ophthalmoplegia, bulbar palsy, descending paralysis, respiratory failure; abdominal pain. Give polyvalent antivenom, airway protection and mechanical ventilation as needed; neostigmine trial (more effective for cobra). Prevention: sleep on cots/under bed nets.
- Tourniquet and incision: Tourniquets and incisions are harmful.
- Vitamin K and FFP: This is a neurotoxic bite, not haemotoxic.
- Antibiotics and tetanus only: Antibiotics and tetanus cover do not treat neurotoxicity.
10. An elderly woman with untreated hypothyroidism is found drowsy in winter; temperature 32 °C, HR 44, Na 122, glucose 3.4, hypoventilating. What is given along with IV levothyroxine?
Answer: IV hydrocortisone. Myxoedema coma: decompensated severe hypothyroidism (precipitated by cold, infection, sedatives, stopping thyroxine) — hypothermia, bradycardia, hyponatraemia, hypoglycaemia, hypoventilation, altered consciousness. ICU: IV levothyroxine (± liothyronine), IV hydrocortisone (until adrenal insufficiency excluded), passive rewarming, ventilatory support, treat hyponatraemia cautiously, glucose, treat infection.
- Rapid active external rewarming: Rapid rewarming risks vasodilatory collapse.
- Hypertonic saline bolus first: Hypertonic saline is not first unless she is seizing.
- IV propylthiouracil: PTU is a hyperthyroid drug.
11. A 60-year-old has platelets 1100 × 10⁹/L on repeated tests, erythromelalgia (burning red fingers) and a JAK2 V617F mutation; Hb and WCC normal; iron studies normal. What is the management for this high-risk patient?
Answer: Aspirin + hydroxycarbamide. Essential thrombocythaemia: myeloproliferative neoplasm — sustained platelets > 450; JAK2 (~55%), CALR, MPL mutations; exclude reactive thrombocytosis (iron deficiency, infection, inflammation, malignancy, post-splenectomy). Risks: thrombosis, bleeding (acquired von Willebrand with very high counts), erythromelalgia, transformation to myelofibrosis/AML. High risk (age > 60, prior thrombosis, JAK2): aspirin + cytoreduction (hydroxycarbamide; interferon in pregnancy/young; anagrelide).
- Elective splenectomy: Splenectomy worsens thrombocytosis.
- Platelet transfusion: Platelet transfusion is the wrong direction.
- Oral iron supplements: She is not iron deficient.
12. A 28-year-old has had auditory hallucinations and persecutory delusions for 6 months; during this time he had a 6-week manic episode, and the psychotic symptoms persisted for 3 weeks after mood returned to normal. What is the diagnosis?
Answer: Schizoaffective disorder. Schizoaffective disorder: an uninterrupted illness with a major mood episode (depressive or manic) concurrent with schizophrenia criterion A symptoms, plus delusions or hallucinations for ≥ 2 weeks in the absence of a mood episode, and mood symptoms present for the majority of the illness. Bipolar/depressive disorder with psychotic features: psychosis occurs only during mood episodes. Schizophrenia: mood episodes brief relative to illness. Treatment: antipsychotic plus mood stabiliser (bipolar type) or antidepressant (depressive type), psychosocial support.
- Bipolar disorder with psychotic features: Psychosis only during mood episodes.
- Schizophrenia alone: Mood episode is prominent and concurrent.
- Delusional disorder: Non-bizarre delusions, no prominent hallucinations.
Topics covered
Gastroenterology, Pulmonology, Neurology, CVS, Endocrinology, Infection & infectious diseases, Haematology, Rheumatology, Nephrology, Infectious diseases, Cardiology, Dermatology, Psychiatry, Toxicology, Hepatology, Acute gout, Critical care, Stroke, Sepsis, Hypertensive emergency, Pyelonephritis, Guillain–Barré syndrome, DKA and HHS, Acute asthma, COPD flare (acute exacerbation), Community-acquired pneumonia, TIA (transient ischaemic attack), Dengue fever, Anaphylaxis, Status epilepticus, Upper GI bleed, Chest pain, Organophosphate poisoning, Snake bite, Wheat pill (aluminium phosphide) poisoning, Meningitis and encephalitis, Typhoid (enteric fever), Acute coronary syndrome (heart attack), Atrial fibrillation, Acute kidney injury (AKI)
Frequently asked questions
How many NRE Step 1 Medicine questions are in the bank?
There are 985 Medicine questions in NRE-1 Prep, each with an explanation for every option.
Are these past paper questions?
No. Every question is original, written by us and mapped to the published PMDC NRE syllabus.
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