NLE June 2022 by Medicall

NLE Step 1 Solved Past Paper – 27 June 2022

The National Registration Examination (NRE), previously called NLE (National Licensing Examination), is a crucial medical licensing exam in Pakistan, conducted by the Pakistan Medical and Dental Council (PMDC). This test ensures that medical graduates meet the competency standards necessary to practice medicine safely.

The NRE Step 1 exam from 27 June 2022 (Morning Shift) consisted of recall-based MCQs collected from students, covering major disciplines including internal medicine, surgery, pediatrics, obstetrics & gynecology, pharmacology, and pathology. Below is a comprehensive review of the questions, their explanations, and high-yield topics to help future candidates prepare effectively.

Why Study Past Papers?

🔹 Identifying High-Yield Topics – Spotting frequently asked subjects saves time and improves efficiency.

🔹 Exam Pattern Recognition – Understanding how questions are framed helps tackle tricky options.

🔹 Practicing Under Timed Conditions – Simulating real exam pressure enhances time management.

🔹 Building Clinical Reasoning Skills – Learning from previous cases strengthens diagnostic thinking.

Breakdown of 27 June 2022 Exam Topics (few)

📌 1. Internal Medicine & Endocrinology

A 53-year-old housewife presents with shortness of breath, weight loss, warm hands, and an irregular pulse.
- Diagnosis: Hyperthyroidism – Increased metabolic rate leads to weight loss, heat intolerance, and tachycardia.
- Reference: Pathoma, Pg. 161.
A dehydrated patient with severe diarrhea and lab findings of hyponatremia, hypokalemia, and hyperchloremia.
- Diagnosis: Metabolic Acidosis due to loss of HCO3 from excessive diarrhea.
- Reference: Davidson, Pg. 445.

📌 2. Pharmacology & Drug Mechanisms

A patient on ATT presents with big toe pain, hyperuricemia is noted.
- Culprit Drug: Pyrazinamide – A strong urate retention agent causing gout-like symptoms.
- Reference: Katzung, Pg. 71.
Which drug is used for acute SVT?
- First-Line Treatment: IV Adenosine – Slows AV nodal conduction.
- Reference: First Aid, Pg. 304.

📌 3. Surgery & Trauma

Post-thyroidectomy patient develops hoarseness and difficulty swallowing.
- Cause: Recurrent Laryngeal Nerve Injury.
- Reference: Robbins, Pg. 491.
A patient with lucid interval post-head injury who later deteriorates.
- Diagnosis: Epidural Hematoma (Lens-shaped on CT).
- Reference: Gray's Neuroanatomy, Pg. 70.

📌 4. Pediatrics & Neonatology

A neonate with cyanosis and no cardiac murmur.
- Diagnosis: Transposition of Great Arteries (TGA) – Requires Prostaglandin E1 infusion.
- Reference: Goljan, Pg. 173.
A 6-month-old child with projectile vomiting, visible gastric peristalsis, and an ‘olive’ mass in the epigastrium.
- Diagnosis: Hypertrophic Pyloric Stenosis.
- Reference: Bailey & Love, Pg. 128.

📌 5. Obstetrics & Gynecology

A woman at 13 weeks gestation presents with dyspnea, pinpoint rash, and mental confusion post-RTA.
- Diagnosis: Fat Embolism Syndrome due to long bone fractures.
- Reference: Robbins, Pg. 112.
A multiparous woman presents with painless vaginal bleeding at 36 weeks gestation.
- Diagnosis: Placenta Previa – Urgent obstetric assessment needed.
- Reference: Oxford OBG Handbook, Pg. 46.

📌 6. Cardiovascular & Hematology

A child presents with excessive bleeding post-circumcision, positive family history, and prolonged APTT.
- Diagnosis: Hemophilia A (Factor VIII Deficiency).
- Reference: BRS Pathology, Pg. 195.
A hypertensive male with ankle edema, anorexia, and metabolic acidosis (ABG: pH 7.3, HCO3 16).
- Diagnosis: Chronic Kidney Disease (CKD).
- Reference: Harsh Mohan, Pg. 99.

📌 7. Neurology & Psychiatry

A 40-year-old man with resting tremors, bradykinesia, and rigidity.
- Diagnosis: Parkinson’s Disease.
- Reference: CMDT, Pg. 1024.
A teenager with sudden jerky limb movements, history of sore throat, and elevated ESR.
- Diagnosis: Sydenham's Chorea (Rheumatic Fever Complication).
- Reference: Davidson, Pg. 516.

Common Clinical Cases in 27 June 2022 (few)

📌 Case 1: A 25-year-old female with severe lower abdominal pain and tachycardia.

Diagnosis: Ruptured Ectopic Pregnancy.
Immediate Step: Emergency laparoscopic surgery.

📌 Case 2: A 65-year-old male with dyspnea post-thyroidectomy, stridor, and sudden respiratory distress.

Diagnosis: Tracheomalacia.
Management: Immediate airway support.

📌 Case 3: A child with fever, cough, conjunctivitis, and maculopapular rash starting behind the ears.

Diagnosis: Measles.
Key Feature: Koplik’s Spots.

Most Repeated MCQs in 27 June 2022

✅ Most common cause of pneumonia in HIV patients? Strep pneumoniae.

✅ Best test for thalassemia? Hb Electrophoresis.

✅ Most common cyanotic heart disease in children? Tetralogy of Fallot.

✅ Best test for diagnosing pulmonary embolism? CT Pulmonary Angiography (CTPA).

✅ Most common malignant transformation in burn scars? Marjolin’s Ulcer.

Final Study Tips for NRE Success

📌 Revise past papers extensively – Many MCQs repeat with slight modifications.

📌 Master clinical presentations – Many questions are case-based.

📌 Use flashcards and mnemonics – Helps in quick recall.

📌 Time your mock exams – Helps in pacing yourself on the actual test day.

Why MedsCrack is Your Best Source for NRE Prep?

✔️ Authentic Recalled Questions – Repeated ones.

✔️ Concise, Exam-Focused Explanations – No unnecessary details.

✔️ Easy-to-Access Study Materials – available everytime available

🚀 Want to ace the NRE?

open

تو نے یہ سب کچھ بےمقصد تو پیدا نہیں کیا ہے تو پاک ہے (اس سے کہ کوئی عبث کام کرے) پس تو ہمیں دوزخ کے عذاب سے بچا !
Our Lord! You have not created ˹all of˺ this without purpose. Glory be to You! Protect us from the torment of the Fire. 3:191

NLE June 2022 solved by Medicall is as follows