NRE June 2024 by NRE Essence 2025

NRE Step 1 Solved Past Paper - June 2024

The National Registration Examination (NRE) is the mandatory licensing exam in Pakistan for medical graduates aiming to practice medicine legally. Administered by the Pakistan Medical and Dental Council (PMDC), the exam evaluates clinical knowledge, diagnostic skills, and medical decision-making to ensure safe and effective healthcare delivery.

The NRE Step 1 exam from 02 June 2024 is a recall-based assessment, with MCQs contributed by students who took the exam collected & solved in NRE Essence 2025 by Dr Asif Ali Khan. Following breakdown includes high-yield questions, explanations, and frequently repeated concepts to help future candidates prepare thoroughly.

Why Are NRE Past Papers Essential for Success?

✅ Recognizing Exam Trends - Questions often repeat with slight modifications.

✅ Developing Clinical Thinking - Case-based MCQs test real-world medical application.

✅ Time Management Skills - Solving past papers improves speed and efficiency.

✅ Mastering High-Yield Topics - Focus on frequently tested subjects.

✅ Boosting Exam Confidence - Familiarity with question styles reduces stress.

Exam Breakdown - NRE June 2024 (few)

📌 1. Internal Medicine & Neurology

A 60-year-old hypertensive male presents with sudden left-sided weakness and slurred speech.
- Diagnosis: Ischemic Stroke.
- First Step: Non-contrast CT Brain to rule out hemorrhage.
A patient complains of morning headaches, polyuria, and galactorrhea.
- Diagnosis: Prolactinoma (Pituitary Adenoma).
- Best Initial Test: Serum Prolactin Levels.
A middle-aged patient with numbness in both hands, worse at night.
- Diagnosis: Carpal Tunnel Syndrome.
- Most Affected Nerve: Median Nerve.

📌 2. Pharmacology & Drug Mechanisms

A patient on warfarin presents with bleeding. What is the antidote?
- Answer: Vitamin K & Fresh Frozen Plasma.
A young woman with acne is prescribed isotretinoin. What is the most important precaution?
- Answer: Pregnancy Test - Risk of Teratogenicity.
A hypertensive diabetic patient requires antihypertensive therapy. Which drug is preferred?
- Answer: ACE Inhibitors (e.g., Lisinopril) to protect kidneys from diabetic nephropathy.

📌 3. Surgery & Trauma

A patient presents with a progressively enlarging, non-tender thyroid nodule.
- Diagnosis: Thyroid Cancer.
- Best Initial Investigation: Fine-Needle Aspiration Cytology (FNAC).
A motorcyclist with LUQ pain post-accident and hypotension.
- Diagnosis: Splenic Rupture.
- Best Management: Emergency Laparotomy if unstable.

📌 4. Pediatrics & Neonatology

A neonate presents with failure to pass meconium within 48 hours.
- Diagnosis: Hirschsprung’s Disease.
- Next Step: Rectal Biopsy.
A child with recurrent infections, thrombocytopenia, and eczema.
- Diagnosis: Wiskott-Aldrich Syndrome.
- Pathophysiology: Defective cytoskeleton in WBCs and platelets.

📌 5. Obstetrics & Gynecology

A pregnant woman at 34 weeks with severe RUQ pain and hypertension.
- Diagnosis: HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets).
- Best Management: Immediate Delivery.
A 19-year-old with primary amenorrhea, webbed neck, and short stature.
- Diagnosis: Turner Syndrome (45XO).
- Best Diagnostic Test: Karyotyping.

📌 6. Cardiology & Pulmonology

A young male with syncope during exertion. ECG shows LVH with deep S waves in V1.
- Diagnosis: Hypertrophic Cardiomyopathy (HCM).
- Most Common Cause of Death: Sudden Cardiac Arrest due to Ventricular Arrhythmias.
A patient with long-term smoking history and chronic productive cough for 3 months.
- Diagnosis: Chronic Obstructive Pulmonary Disease (COPD).
- Best Initial Treatment: Bronchodilators (LABA + LAMA).

Frequently Asked Clinical Case Scenarios - June 2024 (few)

📌 Case 1: A 45-year-old diabetic with sudden-onset severe abdominal pain radiating to the back.

Diagnosis: Acute Pancreatitis.
Most Common Cause: Gallstones & Alcohol.

📌 Case 2: A 3-year-old child with stridor, barking cough, and steeple sign on X-ray.

Diagnosis: Croup (Laryngotracheobronchitis).
Management: Nebulized Epinephrine & Steroids.

📌 Case 3: A 70-year-old male with weight loss, jaundice, and painless palpable gallbladder.

Diagnosis: Pancreatic Cancer (Courvoisier’s Sign).
Best Imaging Modality: CT Abdomen.

Most Repeated MCQs - NRE June 2024 (few)

✅ Most common site of colorectal cancer? Rectosigmoid Junction.

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

✅ Most common cause of lower GI bleeding in the elderly? Diverticulosis.

✅ Antibiotic for Strep throat to prevent Rheumatic Fever? Penicillin V.

✅ Most common cyanotic congenital heart disease? Tetralogy of Fallot.

Proven Strategies for NRE Success

📌 Master Past Papers - Repeated questions are common.

📌 Develop Strong Clinical Reasoning - Case-based MCQs test real-world medical decision-making.

📌 Use Mnemonics & Flashcards - Simplify pharmacology & microbiology etc

📌 Time Yourself During Practice - Work on speed & accuracy.

📌 Follow PMDC Guidelines - Stay updated with medical protocols.

Why MedsCrack is Your Best Study Partner?

✔️ Authentic Recalled Questions - By medical graduates.

✔️ Exam-Focused Explanations - Straight to the point.

✔️ Free Study Materials - Accessible anytime.

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Our Lord, we have believed, so forgive us and have mercy upon us 23:109

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