NLE 31 March 2022 by Medicall
NLE Step 1 Solved Past Paper – 31 March 2022
The National Registration Examination (NRE), formerly National Licensing Examination (NLE), is an essential licensing exam for medical graduates in Pakistan, conducted under the Pakistan Medical and Dental Council (PMDC). This exam ensures that doctors have the clinical knowledge and skills required for safe and effective medical practice.
The 31 March 2022 NRE Step 1 (Morning Shift) Exam included recall-based MCQs from students, collected by Medicall App , covering high-yield subjects such as internal medicine, pharmacology, pathology, pediatrics, surgery, and OB/GYN. Below is a detailed breakdown of all the questions, along with explanations to help future candidates prepare effectively.
Why Are Past Papers Critical for Preparation?
✅ Understanding Exam Trends – Repeated exposure to similar questions improves familiarity with exam patterns.
✅ Time Management Practice – Practicing full-length papers under timed conditions helps improve efficiency.
✅ Identifying High-Yield Topics – Many subjects, such as cardiology, endocrinology, and pharmacology, have a high rate of repetition.
✅ Building Exam Confidence – Solving past papers reduces stress and improves exam-day performance.
Subject-Wise Breakdown of the 31 March 2022 Exam
📌 1. Internal Medicine & Infectious Diseases
- Osmotic Diuretics Mechanism of Action: Primarily acts on the proximal convoluted tubule (PCT) and descending loop of Henle to inhibit water reabsorption.
- Marfan Syndrome: A tall, thin man with long arms, lens dislocation, and sudden chest pain – think aortic dissection.
- Acute Myocardial Infarction Death at 6 Days: Ventricular free wall rupture → Cardiac tamponade.
- Normal Pressure Hydrocephalus: Presents with urinary incontinence, gait disturbances, and cognitive impairment.
📌 2. Pharmacology & Drug Mechanisms
- Class III Antiarrhythmic Drug: Amiodarone, used for atrial and ventricular arrhythmias.
- Rapid Treatment for SVT: IV Adenosine slows AV nodal conduction and is the first-line therapy.
- Side Effect of Spironolactone: Gynecomastia due to anti-androgenic effects.
- Anticoagulant of Choice for DVT: Low molecular weight heparin (LMWH).
📌 3. Surgery & Trauma Cases
- Hoarseness Post-Thyroidectomy: Suggests Recurrent Laryngeal Nerve Injury.
- Best Fluid for Hypovolemic Shock: Ringer’s lactate for initial resuscitation.
- Head Injury with Biconvex Hemorrhage: Epidural hematoma (MMA rupture).
- Postoperative Fever on Day 2-3: Most commonly due to atelectasis.
📌 4. Pediatrics & Neonatology
- Neonatal Cyanosis Within 24 Hours: Transposition of Great Arteries (TGA).
- Failure to Thrive, Hepatosplenomegaly, and Anemia: Thalassemia Major.
- Nephrotic Syndrome in Children: Minimal Change Disease.
- Hemophilia A: Prolonged APTT, normal PT, X-linked recessive inheritance.
📌 5. Obstetrics & Gynecology
- PCOS Management: Metformin for insulin resistance.
- Placenta Previa vs. Abruption: Painless bleeding = Previa, painful bleeding = Abruption.
- Management of Eclampsia: IV Magnesium Sulfate to prevent seizures.
- Amenorrhea with Webbed Neck & Short Stature: Turner Syndrome (45XO).
📌 6. Cardiovascular & Hematology
- STEMI in a Facility Without PCI: Thrombolytic therapy (Alteplase).
- Diagnosis of ALL in a Child: Pancytopenia, blast cells on smear, lymphadenopathy.
- Blood Loss vs. Anaphylactic Shock: Anaphylaxis involves massive vasodilation and increased capillary permeability.
📌 7. Neurology & Psychiatry
- Stroke Management Within 3 Hours: IV tPA (Tissue Plasminogen Activator).
- Parkinson’s Disease Symptoms: Resting tremor, bradykinesia, cogwheel rigidity.
- Diagnosis of Social Anxiety Disorder: Excessive fear of public speaking, avoidance behavior.
Clinical Case Scenarios from 31 March 2022 Paper (few)
📌 Case 1: A 55-Year-Old Male with Chest Pain A male presents with severe chest pain radiating to his left arm. ECG reveals ST-elevation in leads II, III, and aVF. Immediate treatment is oxygen, aspirin, and PCI/thrombolysis.
📌 Case 2: A Neonate with Cyanosis & No Cardiac Murmur A newborn shows profound cyanosis within hours after birth. Echocardiography confirms Transposition of the Great Arteries (TGA). Prostaglandin infusion is administered to maintain ductal patency.
📌 Case 3: A 40-Year-Old Female with Hoarseness Post-Surgery A patient develops hoarseness after thyroidectomy. Laryngoscopy reveals unilateral vocal cord paralysis, indicating Recurrent Laryngeal Nerve Injury.
Most Frequently Repeated MCQs – 31 March 2022
✅ Best Diagnostic Test for Diabetic Nephropathy? Microalbuminuria.
✅ Commonest Site for Bone Marrow Aspiration? Iliac Crest.
✅ Most Common Cause of Painless Hematuria in Elderly? Bladder Cancer.
✅ Treatment of Epiglottitis in Children? Endotracheal Intubation.
✅ Management of Hypertension in Pregnancy? Methyldopa.
Effective Strategy for NRE Preparation
🔹 Step 1: Solve past papers in a simulated exam environment.
🔹 Step 2: Identify weak areas and reinforce key concepts.
🔹 Step 3: Use standard textbooks like Davidson’s Medicine, Bailey & Love, First Aid USMLE etc
🔹 Step 4: Create flashcards and mnemonics for rapid revision.
🔹 Step 5: Join study groups and online discussions.
Why MedsCrack is the Best for NRE Past Papers?
✔️ Genuine Recalled Questions – Authenticated by medical students.
✔️ Exam-Focused Explanations – Covers high-yield clinical concepts.
✔️ Free & Accessible – No charges to access.
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