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PMDC NRE study materials
PMDC NRE study resources

PMDC NRE practice questions

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Question 1NRE Step-I

Under the PMDC National Registration Examination framework, which body is responsible for conducting the NRE for graduates of medical and dental colleges in Pakistan?

  1. Provincial health departments
  2. Pakistan Medical and Dental Council Correct answer.
  3. College of Physicians and Surgeons Pakistan
  4. Higher Education Commission

Explanation

The Pakistan Medical and Dental Council is the statutory regulator that conducts the National Registration Examination as part of its licensing function for medical and dental graduates. The other bodies have different mandates: HEC regulates higher education, CPSP runs postgraduate fellowship training, and provincial departments manage public health services.

Question 2NRE Step-I

A candidate passes the NRE but has not yet completed the mandatory house job. What is the standard PMDC requirement before full permanent registration is granted?

  1. Six months of rural service posting
  2. Completion of a supervised one-year house job Correct answer.
  3. Submission of two research publications
  4. Passing a separate clinical skills OSCE

Explanation

PMDC requires a supervised rotating house job of one year after the final professional examination before full registration is issued. Research publications, additional OSCEs, and rural postings are not prerequisites for initial full registration under the standard pathway.

Question 3NRE Step-I

During the NRE, a candidate is found copying from another candidate. Which consequence is most consistent with PMDC examination regulations?

  1. Warning letter with no effect on the result
  2. Transfer to a different examination centre
  3. Automatic re-sit of the paper at no cost
  4. Cancellation of the result and possible debarment from future attempts Correct answer.

Explanation

Unfair means in PMDC examinations typically lead to cancellation of the candidate's result and possible debarment for a defined period. A free re-sit, a mere warning, or a centre transfer does not reflect the disciplinary framework for examination misconduct.

Question 4NRE Step-I

Which document primarily sets out the competencies and curriculum standards that Pakistani medical colleges must follow, thereby shaping NRE content?

  1. HEC Undergraduate Education Policy
  2. PMDC National Framework for Medical Education Correct answer.
  3. CPSP Training Manual
  4. WHO Global Competency Model

Explanation

PMDC issues the national curriculum framework that defines graduate competencies for MBBS and BDS programs, and NRE content aligns with these competencies. HEC policy covers general higher education, WHO guidance is advisory, and CPSP manuals concern postgraduate training.

Question 5NRE Step-I

A foreign medical graduate wishes to practise in Pakistan. Which step is required in addition to passing the NRE?

  1. Exemption from the house job requirement
  2. Direct issuance of a specialist licence
  3. Automatic recognition of any WHO-listed medical school
  4. Verification and equivalence of the foreign qualification by PMDC Correct answer.

Explanation

Foreign qualifications must be verified and assessed for equivalence by PMDC before registration, in addition to passing the NRE. WHO listing alone does not confer automatic recognition, house job exemptions are not automatic, and specialist licences require separate postgraduate certification.

Question 6NRE Step-I

In the context of the NRE, what does the term 'structured clinical examination' most likely refer to?

  1. An oral viva conducted by a single examiner
  2. A written multiple-choice paper on basic sciences
  3. A standardized station-based assessment of clinical skills Correct answer.
  4. A portfolio review of logbook entries

Explanation

A structured clinical examination uses standardized stations with defined checklists to assess clinical skills objectively. A written MCQ paper tests knowledge, a single-examiner viva lacks standardization, and a portfolio review evaluates documented experience rather than live clinical performance.

Question 7NRE Step-I

Which principle best explains why the NRE uses a standard-setting procedure to determine the pass mark rather than a fixed percentage chosen arbitrarily?

  1. To ensure a predetermined proportion of candidates always passes
  2. To simplify scoring logistics for the examining body
  3. To align the pass mark with international tuition fees
  4. To link the pass standard to the minimum competence required for safe practice Correct answer.

Explanation

Standard-setting ties the passing score to the level of competence needed for safe independent practice, making the decision defensible and criterion-referenced. It is not designed to fix a pass rate, simplify logistics, or relate to fees.

Question 8NRE Step-I

A candidate repeatedly fails the NRE. Under typical PMDC rules, what limitation may apply to further attempts?

  1. Automatic passing on the third attempt
  2. Unlimited attempts with no conditions
  3. Permanent disqualification after the first failure
  4. A cap on the number of permitted attempts with possible additional requirements Correct answer.

Explanation

PMDC regulations generally limit the number of attempts and may impose additional conditions after repeated failures. Unlimited attempts, automatic passing, and permanent disqualification after one failure do not reflect the balanced regulatory approach.

Question 9NRE Step-I

Which of the following best describes the purpose of the NRE in the overall licensing pathway?

  1. To rank candidates for postgraduate scholarship allocation
  2. To verify that a graduate meets the minimum knowledge and skill standard before registration Correct answer.
  3. To certify specialist competence in a chosen discipline
  4. To replace the university final professional examination

Explanation

The NRE functions as a gatekeeping assessment confirming that graduates meet the minimum competence standard for registration. It is not a ranking tool for scholarships, does not replace university examinations, and does not certify specialist competence.

Question 10NRE Step-I

A candidate with dyslexia requests extra time in the NRE. What is the most appropriate procedural step?

  1. Apply for reasonable accommodation through the official PMDC process with supporting documentation Correct answer.
  2. Arrange extra time informally with the invigilator on exam day
  3. Skip the examination and request a waiver
  4. Have a relative read the questions aloud

Explanation

Reasonable accommodations are granted through a formal application supported by documentation so that the assessment remains fair and standardized. Informal arrangements, waivers, and third-party reading without approval compromise examination integrity.

Question 11NRE Step-I

Which basic science discipline is most directly tested by questions on pharmacokinetics such as drug half-life and volume of distribution?

  1. Physiology
  2. Pharmacology Correct answer.
  3. Pathology
  4. Anatomy

Explanation

Pharmacokinetics, including half-life and volume of distribution, is a core component of pharmacology. Anatomy concerns structure, physiology concerns normal function, and pathology concerns disease processes.

Question 12NRE Step-I

In community medicine, which measure best quantifies the proportion of a population that has a disease at a specific point in time?

  1. Case fatality rate
  2. Point prevalence Correct answer.
  3. Relative risk
  4. Incidence rate

Explanation

Point prevalence measures the proportion of a population with a condition at a single point in time. Incidence rate measures new cases over time, case fatality measures deaths among cases, and relative risk compares risk between exposed and unexposed groups.

Question 13NRE Step-I

A patient presents with acute central chest pain and ST elevation on ECG. Which immediate management step is most appropriate in the emergency setting?

  1. Reassure and arrange review in one week
  2. Order an outpatient stress test
  3. Activate the acute coronary syndrome pathway for reperfusion Correct answer.
  4. Prescribe oral antibiotics and discharge

Explanation

ST-elevation myocardial infarction requires immediate activation of the reperfusion pathway, whether primary PCI or thrombolysis, within guideline timeframes. Antibiotics, outpatient stress testing, and delayed review are inappropriate for an acute emergency.

Question 14NRE Step-I

Which ethical principle is primarily engaged when a doctor respects a competent adult patient's refusal of a recommended procedure?

  1. Beneficence
  2. Non-maleficence
  3. Autonomy Correct answer.
  4. Justice

Explanation

Autonomy reflects respect for the patient's right to make informed decisions about their own care, including refusal. Beneficence concerns acting in the patient's interest, non-maleficence concerns avoiding harm, and justice concerns fair distribution of resources.

Question 15NRE Step-I

A researcher wants to test a new antihypertensive against placebo with random assignment and double blinding. Which study design is being described?

  1. Case-control study
  2. Randomized controlled trial Correct answer.
  3. Ecological study
  4. Cross-sectional survey

Explanation

Random assignment plus blinding and a control arm define a randomized controlled trial, the strongest design for establishing causal treatment effects. Case-control and cross-sectional designs are observational, and ecological studies analyse group-level data.

Question 16NRE Step-I

Which statement about the structure of the NRE is most accurate based on PMDC examination policy?

  1. It assesses integrated basic, behavioural, and clinical sciences through a standardized format Correct answer.
  2. It consists only of an oral interview with examiners
  3. It covers only preclinical subjects
  4. It is identical in content to the university final professional examination

Explanation

The NRE uses a standardized format covering integrated basic, behavioural, and clinical sciences to confirm graduate competence. It is not a viva-only examination, is not restricted to preclinical subjects, and is distinct from university final examinations.

Question 17NRE Step-I

A candidate's NRE result is withheld pending an investigation into alleged impersonation. Which principle best supports this action?

  1. Reducing administrative workload
  2. Rewarding high-scoring candidates
  3. Protecting the integrity and validity of the licensing assessment Correct answer.
  4. Maximizing the number of candidates registered

Explanation

Withholding a result during an integrity investigation protects the validity and credibility of the licensing assessment. Administrative convenience, registration targets, and rewarding scores do not justify withholding results.

Question 18NRE Step-I

Which statistical concept describes the probability of obtaining the observed result, or a more extreme one, if the null hypothesis is true?

  1. Effect size
  2. Power
  3. p-value Correct answer.
  4. Confidence interval

Explanation

The p-value quantifies the probability of the observed or more extreme data under the null hypothesis. A confidence interval estimates a parameter range, power is the probability of detecting a true effect, and effect size measures the magnitude of a difference.

Question 19NRE Step-I

A 30-year-old woman has fatigue, weight gain, cold intolerance, and a raised TSH with low free T4. Which diagnosis is most likely?

  1. Nephrotic syndrome
  2. Hyperthyroidism
  3. Primary hypothyroidism Correct answer.
  4. Iron deficiency anaemia

Explanation

The combination of fatigue, weight gain, cold intolerance, raised TSH, and low free T4 is characteristic of primary hypothyroidism. Hyperthyroidism would show low TSH and high T4, while nephrotic syndrome and iron deficiency anaemia do not produce this thyroid profile.

Question 20NRE Step-I

Which route of drug administration completely avoids first-pass hepatic metabolism?

  1. Rectal (upper rectum)
  2. Intravenous Correct answer.
  3. Sublingual
  4. Oral

Explanation

Intravenous administration delivers drug directly into the systemic circulation, avoiding hepatic first-pass metabolism entirely. Oral drugs undergo substantial first-pass metabolism, and sublingual and upper rectal routes partially bypass but do not completely eliminate first-pass effects.

Question 21NRE Step-I

In a case-control study, 200 cases with lung cancer and 200 controls without it are compared for smoking history. Which measure of association is most appropriate?

  1. Odds ratio Correct answer.
  2. Attributable risk
  3. Relative risk
  4. Incidence rate ratio

Explanation

Case-control studies begin with outcome status, so incidence cannot be measured directly and the odds ratio is the appropriate measure of association. Relative risk and incidence rate ratio require cohort data, and attributable risk depends on incidence in exposed and unexposed groups.

Question 22NRE Step-I

A doctor discloses a patient's HIV status to the patient's employer without consent and without a legal obligation. Which ethical and legal breach has occurred?

  1. Conflict of interest
  2. Negligence in diagnosis
  3. Breach of confidentiality Correct answer.
  4. Failure of informed consent for treatment

Explanation

Sharing identifiable health information without consent or legal justification breaches the duty of confidentiality owed to patients. Informed consent concerns treatment authorization, negligence concerns standard of care, and conflict of interest concerns improper secondary interests.

Question 23NRE Step-I

Which feature most reliably distinguishes a screening test from a diagnostic test in community medicine?

  1. Screening is always more expensive than diagnosis
  2. Screening is applied to asymptomatic populations to detect early disease Correct answer.
  3. Screening confirms the final diagnosis definitively
  4. Screening requires hospital admission

Explanation

Screening applies a simple test to asymptomatic people to identify those needing further evaluation, whereas diagnosis confirms disease in symptomatic or screen-positive individuals. Cost, admission, and definitive confirmation are not defining features of screening.

Question 24NRE Step-I

A patient with major depressive disorder is started on an SSRI. Which adverse effect is most characteristic during the initial weeks of therapy?

  1. Acute renal failure
  2. Permanent hearing loss
  3. Immediate severe hypertension
  4. Transient nausea and gastrointestinal upset Correct answer.

Explanation

SSRIs commonly cause transient gastrointestinal upset and nausea in the early weeks as serotonergic effects adjust. Severe hypertension is more typical of monoamine oxidase inhibitors, and hearing loss or acute renal failure are not characteristic SSRI effects.

Question 25NRE Step-I

In interpreting a screening test, which situation describes a false negative result?

  1. A healthy person is classified as diseased by the test
  2. A diseased person is correctly identified by the test
  3. A healthy person is correctly identified by the test
  4. A diseased person is classified as disease-free by the test Correct answer.

Explanation

A false negative occurs when a person who truly has the disease tests negative, reducing sensitivity. A healthy person testing positive is a false positive, and the two remaining options describe true positives and true negatives.

Question 26NRE Step-I

Under PMDC policy, which body is responsible for conducting the National Registration Examination (NRE) for medical graduates?

  1. The Higher Education Commission
  2. The Pakistan Medical and Dental Council Correct answer.
  3. The College of Physicians and Surgeons Pakistan
  4. The provincial health department

Explanation

The NRE is a licensing examination administered under the authority of the Pakistan Medical and Dental Council, which regulates registration of medical practitioners. CPSP conducts postgraduate fellowship training, HEC oversees higher education generally, and provincial health departments deliver public health services rather than licensing examinations.

Question 27NRE Step-I

A medical graduate trained abroad wishes to practise in Pakistan. Which requirement is most consistent with PMDC registration policy?

  1. Completing a fellowship in a clinical specialty
  2. Obtaining a licence from a foreign medical council only
  3. Passing the NRE and holding a recognised primary medical qualification Correct answer.
  4. Submitting a research thesis without any examination

Explanation

Registration for foreign-trained graduates requires a recognised primary qualification plus success in the NRE, which verifies that the candidate meets the national standard. A thesis, specialty fellowship, or a foreign licence alone does not establish eligibility for licensure in Pakistan.

Question 28NRE Step-I

A patient with suspected acute bacterial meningitis is being assessed. Which cerebrospinal fluid finding most strongly supports a bacterial rather than viral cause?

  1. Opening pressure within the normal range
  2. Lymphocyte predominance with normal glucose
  3. Normal protein with clear appearance
  4. Neutrophil predominance with low glucose Correct answer.

Explanation

Bacterial meningitis typically produces a neutrophilic pleocytosis with low CSF glucose and raised protein, reflecting bacterial proliferation and consumption of glucose. Viral meningitis more often shows lymphocyte predominance with normal glucose, so the other patterns point away from bacterial infection.

Question 29NRE Step-I

A 55-year-old man has crushing chest pain and ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

  1. Left main coronary artery
  2. Left anterior descending artery
  3. Left circumflex artery
  4. Right coronary artery Correct answer.

Explanation

ST elevation in the inferior leads II, III, and aVF localises the infarct to the inferior wall, which is most often supplied by the right coronary artery. LAD occlusion produces anterior changes, circumflex occlusion tends to affect the lateral wall, and left main disease causes widespread anterior or global ischaemia.

Question 30NRE Step-I

In a randomised trial, which feature most reliably reduces selection bias when allocating participants to treatment groups?

  1. Blinding of outcome assessors
  2. Analysis by intention to treat
  3. Concealment of the allocation sequence from recruiters Correct answer.
  4. Use of a placebo in the control arm

Explanation

Selection bias arises when recruiters can foresee or influence the next allocation, so concealing the allocation sequence until the moment of assignment prevents this. Placebo use, assessor blinding, and intention-to-treat analysis address other biases such as performance, detection, and attrition bias.

Question 31NRE Step-I

A screening programme is introduced for a disease with low prevalence. Which effect does this have on the positive predictive value of the screening test?

  1. It has no effect on the positive predictive value
  2. It increases the positive predictive value
  3. It increases the sensitivity of the test
  4. It decreases the positive predictive value Correct answer.

Explanation

Positive predictive value depends on prevalence as well as on sensitivity and specificity. When prevalence falls, a larger share of positive results are false positives, so the positive predictive value decreases even if the test characteristics are unchanged. Sensitivity and specificity are intrinsic properties and are not altered by prevalence.

Question 32NRE Step-I

A patient with chronic kidney disease has a raised potassium and peaked T waves on ECG. Which treatment most rapidly stabilises the myocardium?

  1. Intravenous insulin with glucose
  2. Inhaled salbutamol
  3. Intravenous calcium gluconate Correct answer.
  4. Oral sodium polystyrene sulfonate

Explanation

Intravenous calcium antagonises the membrane effects of hyperkalaemia and protects the myocardium within minutes, making it the first step when ECG changes are present. Insulin with glucose, salbutamol, and potassium binders lower serum potassium but act more slowly and do not immediately protect the heart.

Question 33NRE Step-I

Which mechanism best explains why a drug with a high hepatic extraction ratio has low oral bioavailability?

  1. High plasma protein binding
  2. Slow dissolution in the stomach
  3. Reduced renal tubular secretion
  4. Extensive first-pass metabolism in the liver Correct answer.

Explanation

Drugs with a high extraction ratio are cleared efficiently by the liver, so a large fraction of an oral dose is metabolised during its first pass before reaching the systemic circulation. Renal secretion, protein binding, and dissolution affect exposure but not the first-pass loss that defines low oral bioavailability for such drugs.

Question 34NRE Step-I

A 25-year-old woman has heat intolerance, tremor, weight loss, and a diffuse goitre with suppressed TSH and raised free T4. Which diagnosis is most likely?

  1. Pituitary adenoma
  2. Subacute thyroiditis
  3. Graves disease Correct answer.
  4. Hashimoto thyroiditis

Explanation

The combination of thyrotoxic symptoms, diffuse goitre, suppressed TSH, and raised free T4 points to Graves disease, an autoimmune hyperthyroidism. Hashimoto thyroiditis usually causes hypothyroidism, subacute thyroiditis is painful and often transient, and a pituitary adenoma would raise TSH rather than suppress it.

Question 35NRE Step-I

In a case-control study of smoking and bladder cancer, which measure of association is most appropriate to calculate?

  1. Relative risk
  2. Odds ratio Correct answer.
  3. Prevalence ratio
  4. Incidence rate

Explanation

Case-control studies sample on outcome status, so incidence and therefore relative risk cannot be estimated directly; the odds ratio is the appropriate measure of association. Incidence rate and prevalence ratio require cohort or cross-sectional sampling frames where denominators are known.

Question 36NRE Step-I

A doctor shares a patient's clinical details with a colleague outside the treating team for non-clinical discussion without consent. Which principle is most directly breached?

  1. Justice
  2. Confidentiality Correct answer.
  3. Veracity
  4. Beneficence

Explanation

Confidentiality obliges doctors to protect patient information and share it only for legitimate clinical purposes or with consent or legal authority. Beneficence concerns promoting welfare, justice concerns fair distribution, and veracity concerns truthfulness, none of which is the primary issue in unauthorised disclosure.

Question 37NRE Step-I

A 60-year-old man has progressive dyspnoea, a raised JVP, hepatomegaly, and bilateral ankle oedema. Which finding on echocardiography most directly supports a diagnosis of heart failure with reduced ejection fraction?

  1. Mild mitral regurgitation with normal ventricular function
  2. Left ventricular ejection fraction of 30% Correct answer.
  3. Normal chamber dimensions with normal filling pressures
  4. Left ventricular ejection fraction of 60% with concentric hypertrophy

Explanation

Heart failure with reduced ejection fraction is defined by a left ventricular ejection fraction of 40% or less together with clinical features of congestion. A normal ejection fraction with hypertrophy suggests preserved ejection fraction, and normal filling pressures or isolated mild regurgitation do not fit the reduced-ejection-fraction category.

Question 38NRE Step-I

Which statement best describes the role of a structured clinical examination within the NRE?

  1. It is used only for candidates seeking specialty training
  2. It measures basic science knowledge through multiple-choice items
  3. It assesses clinical reasoning and communication through standardised tasks and scoring Correct answer.
  4. It replaces the written component of the examination entirely

Explanation

A structured clinical examination uses standardised tasks, simulated patients, and predefined scoring to assess clinical skills, reasoning, and communication consistently across candidates. It complements rather than replaces written assessment and is not restricted to specialty applicants, nor is it a basic science item format.

Question 39NRE Step-I

A candidate with a documented visual impairment requests a larger font in the NRE. Which action is most appropriate?

  1. Advise the candidate to withdraw from the examination
  2. Grant a reasonable accommodation following documented procedures Correct answer.
  3. Allow unlimited extra time without documentation
  4. Refuse because all candidates must sit identical papers

Explanation

Reasonable accommodation adjusts the examination conditions so that candidates with documented disabilities can demonstrate their ability without altering the standard being assessed. Refusing accommodation is discriminatory, withdrawal is unnecessary, and unlimited time without documentation undermines fairness and the validity of the assessment.

Question 40NRE Step-I

A candidate fails the NRE on several occasions. Which statement best reflects the typical regulatory approach to repeated attempts?

  1. Only the first attempt is ever counted
  2. Attempts are unlimited with no conditions
  3. Failure permanently bars any future registration
  4. A limit on attempts may apply, after which additional requirements are imposed Correct answer.

Explanation

Regulators commonly cap the number of attempts or attach additional conditions after repeated failures to balance fairness to candidates with protection of the public. Unlimited attempts with no conditions, permanent exclusion, or counting only the first attempt do not reflect typical licensing policy.

Question 41NRE Step-I

Which principle best explains the use of a standard-setting procedure to determine the NRE pass mark?

  1. It derives the cut score from expected competence rather than a fixed quota Correct answer.
  2. It ensures a predetermined proportion of candidates always pass
  3. It fixes the pass mark at a round percentage for administrative ease
  4. It allows the pass mark to vary with the number of candidates sitting

Explanation

Standard setting links the cut score to the level of knowledge and skill expected of a minimally competent candidate, so the pass mark reflects competence rather than a fixed percentage or quota. Fixing a round percentage, predetermining a pass proportion, or varying the mark with candidate numbers would not be criterion-referenced standard setting.

Question 42NRE Step-I

In a cross-sectional survey, which measure describes the proportion of a population with diabetes at a given time?

  1. Attack rate
  2. Incidence rate
  3. Point prevalence Correct answer.
  4. Case fatality rate

Explanation

Point prevalence is the proportion of a population that has a condition at a specified moment, which is what a cross-sectional survey estimates. Incidence measures new cases over time, case fatality measures deaths among cases, and attack rate describes illness in an outbreak cohort.

Question 43NRE Step-I

A 70-year-old woman has a hip fracture after a minor fall. Which investigation is most appropriate to assess for osteoporosis as the underlying cause?

  1. Serum calcium and phosphate only
  2. Bone scan
  3. Dual-energy X-ray absorptiometry Correct answer.
  4. Plain radiograph of the lumbar spine

Explanation

Dual-energy X-ray absorptiometry measures bone mineral density and is the standard test for diagnosing osteoporosis and guiding treatment after a fragility fracture. Serum calcium and phosphate screen for secondary causes but do not quantify density, plain radiographs are insensitive for bone loss, and bone scans assess focal lesions rather than density.

Question 44NRE Step-I

Which statement best describes the relationship between sensitivity and specificity of a diagnostic test?

  1. Specificity is the proportion of diseased patients correctly identified
  2. Sensitivity depends on disease prevalence
  3. Raising the cut-off to increase specificity generally lowers sensitivity Correct answer.
  4. They always change in the same direction when the cut-off is altered

Explanation

Sensitivity and specificity are inversely related when the diagnostic threshold moves: a stricter cut-off detects fewer diseased people but correctly excludes more healthy ones. Neither measure depends on prevalence, and specificity refers to correctly identifying those without disease, not those with it.

Question 45NRE Step-I

A patient with major depressive disorder starts an SSRI. Which adverse effect is most characteristic during the first two weeks of therapy?

  1. Transient nausea and anxiety Correct answer.
  2. Immediate improvement of mood
  3. Severe hypertension requiring emergency treatment
  4. Marked weight gain

Explanation

SSRIs often cause transient nausea, headache, and increased anxiety early in treatment before the therapeutic effect develops over several weeks. Mood improvement is delayed rather than immediate, hypertensive crisis is associated with monoamine oxidase inhibitors and tyramine, and marked weight gain tends to occur with longer-term use.

Question 46NRE Step-I

A screening test returns a negative result for a person who actually has the disease. What is this result called?

  1. False positive
  2. True positive
  3. False negative Correct answer.
  4. True negative

Explanation

A false negative occurs when a test fails to detect disease that is present, which reduces sensitivity and may delay diagnosis. A true positive correctly detects disease, a true negative correctly excludes it, and a false positive wrongly flags a healthy person.

Question 47NRE Step-I

A 45-year-old man has a body mass index of 34 and a fasting glucose of 6.4 mmol/L. Which diagnosis is most appropriate according to standard criteria?

  1. Normal glucose tolerance
  2. Prediabetes Correct answer.
  3. Gestational diabetes
  4. Type 1 diabetes

Explanation

A fasting plasma glucose between 5.6 and 6.9 mmol/L, together with obesity, is consistent with prediabetes, which warrants lifestyle intervention and monitoring. Type 1 diabetes usually presents with marked hyperglycaemia and ketosis, gestational diabetes applies in pregnancy, and the value is above the normal range.

Question 48NRE Step-I

Which route of administration avoids first-pass hepatic metabolism entirely?

  1. Oral
  2. Rectal
  3. Sublingual
  4. Intravenous Correct answer.

Explanation

Intravenous administration delivers drug directly into the systemic circulation, so no absorption phase or hepatic first-pass effect occurs. Oral and rectal routes involve absorption into the portal circulation, and sublingual absorption drains into the systemic circulation but is not the route that avoids first pass entirely by definition.

Question 49NRE Step-I

A 30-year-old woman has a positive pregnancy test and sudden lower abdominal pain with vaginal bleeding. Which diagnosis must be excluded first?

  1. Ectopic pregnancy Correct answer.
  2. Cervical ectropion
  3. Ovarian cyst
  4. Endometrial polyp

Explanation

A positive pregnancy test with abdominal pain and bleeding raises immediate concern for ectopic pregnancy, which can rupture and cause life-threatening haemorrhage. Polyps, simple ovarian cysts, and cervical ectropion do not typically present with this combination in early pregnancy.

Question 50NRE Step-I

Which statistical concept describes the probability of obtaining the observed result, or a more extreme one, if the null hypothesis were true?

  1. Effect size
  2. Confidence interval
  3. p-value Correct answer.
  4. Statistical power

Explanation

The p-value is calculated under the assumption that the null hypothesis holds and quantifies how compatible the observed data are with that assumption. A confidence interval estimates a range for the parameter, power is the probability of detecting a true effect, and effect size quantifies the magnitude of a difference.