NRE Aug 2023 by Medicall

NRE Step 1 Solved Past Paper - 06 August 2023

The National Registration Examination (NRE), formerly National Licensing Examination (NLE), is the gateway for medical graduates in Pakistan to obtain their license to practice. Conducted under PMDC (Pakistan Medical and Dental Council), this rigorous exam tests the competency of medical professionals in various disciplines.

The NRE Step 1 exam from 06 August 2023 by NUMS featured high-yield clinical MCQs spanning internal medicine, pharmacology, surgery, pathology, pediatrics, and OB/GYN collected by Medicall App. This post presents detailed explanations for each question to guide future aspirants.

Why Past Papers Are Essential for Preparation?

🔹 Recognizing Repeated Questions - Many questions recur with slight modifications.

🔹 Building Clinical Judgment - Case-based MCQs help improve diagnostic skills.

🔹 Optimizing Time Management - Practicing past papers improves speed and accuracy.

🔹 Identifying High-Yield Topics - Knowing frequently tested areas helps focus study efforts.

Detailed Breakdown of the NRE 06 August 2023 Paper (few)

📌 1. Internal Medicine & Neurology

A 65-year-old patient with progressive memory loss, visual deficits, and confabulation.
- Diagnosis: Alzheimer’s Disease.
- Explanation: The triad of old age, progressive memory loss, and confabulation suggests Alzheimer’s, especially in the absence of alcohol use (Korsakoff’s syndrome).
A child with seizures shows 3-Hz spike-wave pattern on EEG. Best drug?
- Answer: Ethosuximide.
- Explanation: Absence seizures (petit mal) are diagnosed by 3-Hz spike-wave on EEG; Ethosuximide is the drug of choice.

📌 2. Surgery & Trauma

A patient develops hoarseness post-thyroidectomy.
- Diagnosis: Recurrent Laryngeal Nerve Injury.
- Explanation: This nerve controls vocal cord movement and is at risk during thyroid surgeries.
A man with shoulder trauma develops sensory loss over the deltoid region.
- Diagnosis: Axillary Nerve Injury.
- Explanation: Shoulder dislocation or surgical neck fractures commonly injure the axillary nerve.

📌 3. Pediatrics & Infectious Diseases

A neonate with cyanosis within 24 hours of birth.
- Diagnosis: Transposition of the Great Arteries (TGA).
- Management: Prostaglandin E1 infusion to keep the ductus arteriosus open.
A child with fever, sore throat, and petechial rash, later developing hematuria.
- Diagnosis: Post-Streptococcal Glomerulonephritis (PSGN).
- Explanation: Follows streptococcal throat infection and presents with hypertension, hematuria, and proteinuria.

📌 4. Pharmacology & Drug Mechanisms

Which anticoagulant requires monitoring using PT/INR?
- Answer: Warfarin.
- Explanation: Warfarin affects the extrinsic pathway (Factor VII), requiring PT/INR monitoring.
A patient with SVT (Supraventricular Tachycardia) needs urgent treatment.
- Answer: IV Adenosine.
- Explanation: Adenosine slows AV node conduction, terminating paroxysmal SVT.

📌 5. Obstetrics & Gynecology

A pregnant woman at 10 weeks develops malodorous green vaginal discharge.
- Diagnosis: Trichomoniasis.
- Explanation: Trichomonas vaginalis presents with frothy yellow-green discharge and motile pear-shaped organisms.
Painless vaginal bleeding at 36 weeks gestation.
- Diagnosis: Placenta Previa.
- Explanation: Painless third-trimester bleeding occurs when the placenta partially or completely covers the cervical os.

📌 6. Cardiology & Pulmonology

Most common cause of cyanotic heart disease in children?
- Answer: Tetralogy of Fallot.
- Key Features: PROVe – Pulmonary stenosis, RV hypertrophy, Overriding aorta, VSD.
Most common cause of respiratory distress in premature neonates?
- Answer: Neonatal Respiratory Distress Syndrome (NRDS).
- Pathophysiology: Surfactant deficiency leads to alveolar collapse.

Clinical Case Scenarios from NRE 06 August 2023 (few)

📌 Case 1: A 70-year-old diabetic male presents with fever, dysuria, and CVA tenderness.

Diagnosis: Pyelonephritis.
Management: IV antibiotics (Ceftriaxone).

📌 Case 2: A 30-year-old woman presents with hematuria and painless bladder mass.

Diagnosis: Bladder Cancer.
Next Step: Cystoscopy with biopsy.

📌 Case 3: A 25-year-old male with LUQ pain post-MVA, BP 90/60, tachycardia.

Diagnosis: Splenic Rupture.
Management: Emergency laparotomy if unstable.

Most Repeated MCQs - NRE 06 August 2023

✅ Best initial test for Myocardial Infarction? ECG.

✅ Most common pathogen in diabetic foot infection? Staphylococcus aureus.

✅ Treatment of choice for Status Epilepticus? IV Lorazepam.

✅ Most common site for diverticulitis in the elderly? Sigmoid Colon.

✅ First-line treatment for severe anaphylaxis? IM Epinephrine.

Top Study Strategies for NRE Success

📌 Solve multiple past papers - Spot repeated MCQs and concepts.

📌 Master high-yield clinical scenarios - Many questions are case-based.

📌 Use mnemonics & active recall - Helps retain pharmacology & pathology.

📌 Time yourself during practice - Ensures speed & accuracy.

📌 Stay updated with PMDC guidelines - Policies may change over time.

Why MedsCrack is the Best for NRE Prep?

✔️ Authentic Recalled Questions - Available.

✔️ Detailed Explanations - No unnecessary fluff, just high-yield content.

✔️ Free Study Materials - available for everyone

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اے ہمارے ربّ !جو قُصور ہم سے ہوئے ہیں ان سے درگزر فرما، جو برائیاں ہم میں ہیں انھیں دور کردے اور ہمارا خاتمہ نیک لوگوں کے ساتھ کر
Our Lord, so forgive us our sins and remove from us our misdeeds and cause us to die among the righteous. 3:193

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