Master Medicine & Allied
for PMDC NLE Step 1
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Focus on a systematic approach: ABCs (Airway, Breathing, Circulation), Vitals, History, Physical Exam. Key differentials for common symptoms (e.g., chest pain, dyspnea). Understand common risk factors: Hypertension, Diabetes, Dyslipidemia, Smoking, Obesity. Prioritize life-threatening conditions.
Clinical Presentation
- Acute Coronary Syndromes (ACS): Crushing substernal chest pain, radiation to left arm/jaw, dyspnea, diaphoresis, nausea. Atypical presentations common in women, elderly, diabetics.
- Heart Failure (Acute Decompensated): Progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), bilateral pitting edema, crackles/rales, S3 gallop, elevated JVP.
- Atrial Fibrillation (AFib): Palpitations, irregular irregular pulse, fatigue, dyspnea, chest discomfort, or often asymptomatic.
- Asthma/COPD Exacerbation: Worsening dyspnea, wheezing, cough, chest tightness, increased sputum production/purulence.
- Pneumonia: Fever, productive cough, pleuritic chest pain, dyspnea, chills. Elderly may present with confusion or weakness.
- Pulmonary Embolism (PE): Sudden onset dyspnea, pleuritic chest pain, cough, hemoptysis, syncope. May have signs of DVT (leg swelling, pain).
- Peptic Ulcer Disease (PUD): Epigastric pain (burning, gnawing), often relieved by food (duodenal ulcer) or worsened by food (gastric ulcer). Nausea, bloating, melena/hematemesis if bleeding.
- Acute Pancreatitis: Severe, constant epigastric pain radiating to the back, nausea, vomiting. Relieved by leaning forward.
- Acute Kidney Injury (AKI): Oliguria/anuria, generalized weakness, altered mental status, edema, nausea. Symptoms often nonspecific.
- Diabetic Ketoacidosis (DKA): Polyuria, polydipsia, polyphagia, nausea, vomiting, abdominal pain, Kussmaul respirations (deep, rapid), fruity breath odor, altered mental status.
- Hypoglycemia: Tremors, palpitations, anxiety, sweating, hunger, confusion, dizziness, slurred speech, seizures, coma.
- Acute Ischemic Stroke: Sudden onset focal neurological deficit (unilateral weakness/numbness, aphasia, visual field defects, facial droop). Time is brain!
- Bacterial Meningitis: Fever, severe headache, nuchal rigidity (stiff neck), photophobia, altered mental status. Kernig's/Brudzinski's signs may be positive.
- Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection. Fever/hypothermia, tachycardia, hypotension, tachypnea, altered mental status, elevated lactate.
Diagnosis (Gold Standard / Key Initial Test)
ACS: ECG (STEMI), Cardiac Troponins (NSTEMI/UA). Heart Failure: Echocardiogram (EF, chamber size/function), BNP/NT-proBNP. AFib: ECG. Pneumonia: Chest X-ray. PE: CT Pulmonary Angiogram (CTPA). V/Q scan if renal dysfunction or contrast allergy. Cirrhosis: Liver biopsy (definitive), but clinical/radiological findings often suffice. Acute Pancreatitis: Serum Lipase/Amylase (>3x upper limit of normal). AKI: Serum Creatinine elevation (absolute or relative to baseline). DKA: Glucose >250 mg/dL, pH <7.3, Bicarbonate <18 mEq/L, Ketones in urine/serum. Acute Ischemic Stroke: Non-contrast CT Head (to rule out hemorrhage before thrombolysis). Bacterial Meningitis: Lumbar Puncture (CSF analysis: high protein, low glucose, high WBCs, Gram stain). Sepsis: Blood cultures, serum lactate.
Management (First Line)
ACS: MONA (Morphine, Oxygen, Nitrates, Aspirin), P2Y12 inhibitor, reperfusion (PCI or Fibrinolysis). Heart Failure (Acute Decompensated): IV Diuretics (Furosemide), Oxygen, Vasodilators (Nitroglycerin). AFib (Rate Control): Beta-blockers (e.g., Metoprolol) or Calcium Channel Blockers (e.g., Diltiazem). (Rhythm control: Cardioversion, antiarrhythmics). Pneumonia: Empiric antibiotics (e.g., Macrolide or Doxycycline for outpatient, Beta-lactam + Macrolide/Fluoroquinolone for inpatient). PE: Anticoagulation (LMWH, Fondaparinux, or UFH). Thrombolysis for massive PE with hemodynamic instability. Acute Pancreatitis: Aggressive IV fluids, NPO (bowel rest), pain control (opioids). Hyperkalemia: IV Calcium Gluconate (cardiac stabilization), IV Insulin + Glucose, Salbutamol, Loop diuretics, Sodium Polystyrene Sulfonate (Kayexalate). DKA: IV fluids (Normal Saline), IV regular insulin drip, Potassium replacement. Hypoglycemia: Oral glucose (conscious), IV Dextrose (unconscious). Acute Ischemic Stroke: IV tPA (Alteplase) within 4.5 hours of symptom onset (if no contraindications); Mechanical thrombectomy for large vessel occlusion (up to 24 hours). Bacterial Meningitis: Empiric IV antibiotics (e.g., Ceftriaxone + Vancomycin), Dexamethasone. Sepsis: "Hour-1 Bundle" - IV fluids (30mL/kg crystalloid), broad-spectrum antibiotics (after cultures), vasopressors for hypotension.
Exam Red Flags
- Chest pain + Hypotension/Bradycardia: Inferior MI (RCA involvement), consider RV infarct.
- Sudden, severe "tearing" chest or back pain, wide pulse pressure, difference in BP between arms: Aortic Dissection.
- New neurological deficit in an anticoagulated patient: Intracranial Hemorrhage until proven otherwise – CT Head STAT.
- Unconscious patient with diabetes: ALWAYS treat for hypoglycemia first (IV Dextrose) if blood glucose unknown.
- Acute abdominal pain with rigid abdomen: Perforation of a hollow viscus. Surgical emergency.
- Pulmonary Embolism with hemodynamic instability (hypotension): Consider thrombolysis or embolectomy.
- Status Epilepticus (seizure >5 minutes or recurrent without recovery): Treat immediately with benzodiazepines (e.g., Lorazepam, Midazolam).
- Any infection with signs of organ dysfunction (e.g., AKI, hypotension, altered mental status): Sepsis, manage aggressively.
- Fever + Headache + Neck Stiffness: Meningitis – empiric antibiotics and consider LP.
Sample Practice Questions
A 22-year-old female, known to have Type 1 Diabetes Mellitus, is brought to the emergency department by her family. She has been experiencing polyuria, polydipsia, lethargy, and diffuse abdominal pain for the past 24 hours. Her breath has a distinct fruity odor. Vitals: BP 90/60 mmHg, HR 110 bpm, RR 28/min. Labs reveal blood glucose 550 mg/dL, pH 7.15, HCO3 8 mEq/L, and positive urine ketones.
A 40-year-old female presents to the emergency department with severe, sudden onset epigastric pain radiating to her back. The pain started after a heavy meal and is associated with multiple episodes of nausea and vomiting. She denies any history of alcohol abuse but reports a history of recurrent episodes of right upper quadrant pain, previously diagnosed as gallstones. On examination, she has tenderness in the epigastric region, and bowel sounds are diminished. Her temperature is 38.2°C, blood pressure 110/70 mmHg, and pulse 98 bpm. Laboratory tests reveal markedly elevated serum amylase and lipase levels. Which of the following is the most likely diagnosis?
A 32-year-old male presents with a 4-day history of high-grade fever, severe headache, retro-orbital pain, and generalized body aches (myalgia and arthralgia). He recently returned from a trip to Karachi, an area known for vector-borne diseases. He reports some nausea but no vomiting or diarrhea. On examination, he has a diffuse erythematous macular rash over his trunk and limbs. His vital signs are stable. A rapid diagnostic test for malaria is negative.
Ready to see the answers?
Unlock All AnswersPMDC NLE Step 1
- ✓ 50+ Medicine & Allied Questions
- ✓ AI Tutor Assistance
- ✓ Detailed Explanations
- ✓ Performance Analytics