NLE Dec 2021 by Medicall
December 2021 NLE Step 1-Solved Past Paper
The National Registration Examination (NRE), previously known as NLE (National Licensing Examination), is a critical licensing exam in Pakistan conducted by the Pakistan Medical and Dental Council (PMDC). It is a mandatory requirement for medical graduates to obtain a license for practicing medicine in Pakistan. The 02 December 2021 NRE Step 1 exam consisted of recalled MCQs from various students collected by Medicall App , covering high-yield topics essential for success in the exam.
Importance of Past Papers for NRE Preparation
Studying previous exam papers is a well-proven strategy to excel in the NRE exam. It allows candidates to:
✅ Familiarize themselves with the exam structure and common question patterns.
✅ Identify high-yield, frequently repeated topics.
✅ Improve time management skills by practicing under timed conditions.
✅ Develop clinical reasoning and decision-making abilities.
✅ Reduce exam anxiety by simulating real exam conditions.
Breakdown of December 2021 Exam
The exam included clinical scenarios, basic sciences, and system-based questions. Below is a detailed breakdown of the major topics covered:
📌 1. General Medicine & Infectious Diseases
- Pyogenic Liver Abscess: Most commonly caused by ascending cholangitis.
- Stagnant Hypoxia & Pedal Edema: Seen in cardiogenic shock due to decreased tissue perfusion.
- Hereditary Spherocytosis & Cholelithiasis: Due to hemolysis, leading to increased bilirubin and gallstone formation.
- Blood Transfusion & Infectious Disease Transmission: Hepatitis A is least likely to be transmitted through transfusion (fecal-oral route).
📌 2. Pharmacology & Drug Mechanisms
- Drug of Choice for Status Asthmaticus: IV steroids (not salbutamol or aminophylline) reduce inflammation and improve oxygenation.
- Anticoagulation for DVT Prevention: Low molecular weight heparin (LMWH) is preferred.
- Treatment for Anaphylactic Shock: IV Epinephrine is the first-line therapy.
- Drug for Hypertension in Pregnancy: Methyldopa is the safest choice.
📌 3. Surgery & Trauma Cases
- Best Fluid Choice for Hypovolemia Post-Trauma: Ringer’s lactate is preferred for resuscitation.
- Common Cause of Postoperative SOB: Pulmonary embolism due to immobilization.
- Management of Fractured Long Bone Healing: Giant cell reparative granuloma is NOT part of normal bone healing.
📌 4. Pediatrics & Neonatology
- Neonatal Cyanosis in First 24 Hours: Transposition of Great Arteries (TGA) is the most common cause.
- Failure to Thrive, Hepatosplenomegaly, and Microcytic Anemia: Suggests Thalassemia Major, confirmed by Hb electrophoresis.
- Nephrotic Syndrome in a Child: Presents with periorbital edema, proteinuria, and normal renal function.
📌 5. Obstetrics & Gynecology
- First Step in Treating Hypercalcemia in Pregnancy: IV fluids for hydration.
- Absolute Indication for C-section: Central placenta previa.
- Most Common Cause of Menorrhagia & Dysmenorrhea in Nulliparous Woman: Adenomyosis.
📌 6. Cardiovascular & Hematology
- Hypertrophic Cardiomyopathy (HCM): Diastolic dysfunction due to thickened ventricular walls.
- STEMI in an Elderly Patient Without PCI Facility: Thrombolytic therapy (Alteplase) is the best option.
- Diagnosis of ALL in a Child: High WBC, low platelets, neutropenia, and anemia.
📌 7. Neurology & Psychiatry
- Glasgow Coma Scale for Confusion, Pain Response, Eye Opening: Score = 9.
- Post-Stroke Management Within 3 Hours: IV tPA (Tissue Plasminogen Activator).
- GBS Post-Viral Infection: Lower limb paresis, absent reflexes, increased CSF protein.
Clinical Case Scenarios in December 2021 Paper
The exam included multiple case-based questions, testing clinical reasoning. Here are some key cases:
📌 Case 1: A 45-year-old male with sudden-onset chest pain A middle-aged male presents with crushing chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF. The immediate treatment includes aspirin, nitrates, and urgent PCI or thrombolysis.
📌 Case 2: A 2-day-old neonate presents with cyanosis and weak pulses A newborn shows profound cyanosis within 24 hours of birth. Echocardiography confirms Transposition of the Great Arteries (TGA). Emergency prostaglandin infusion is initiated to maintain ductal patency.
📌 Case 3: A 55-year-old smoker with progressive hoarseness A smoker presents with hoarseness for 3 months. Laryngoscopy reveals a vocal cord mass. Biopsy confirms laryngeal squamous cell carcinoma, requiring radiotherapy and surgical intervention.
December 2021 – Most Repeated MCQs
✅ Common site for Squamous Cell Carcinoma of the Esophagus? Upper and middle third.
✅ Best Diagnostic Test for Diabetic Nephropathy? Microalbuminuria.
✅ Most Common Cause of Bloody Nipple Discharge? Intraductal papilloma.
✅ Drug of Choice for Hypertension in Eclampsia? IV Magnesium Sulfate.
✅ Commonest Site for Bone Marrow Aspiration? Iliac crest.
Final Study Tips for NRE Exam Success
📍 Revise past papers extensively – many questions are repeated.
📍 Practice time management – Aim to solve 200 MCQs in less than 3 hours.
📍 Master high-yield topics like cardiology, OB/GYN, pediatrics, and internal medicine.
📍 Use standard textbooks such as Davidson’s Medicine, Bailey & Love’s Surgery, First Aid USMLE, and Goljan Pathology.
📍 Stay updated with PMDC exam patterns as question trends evolve.
Why Choose MedsCrack for NRE Past Papers?
✔️ Updated Past Papers
✔️ High-Yield Summaries – Covers concepts that frequently appear in exams.
✔️ Free and Accessible Anytime – Available for everyone at anytime..
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