PM&DC does not publish a list of frequently tested topics, and nobody outside the exam office can truthfully give you one. What you can do is rank topics by evidence you can see: the blueprint weight of the domain, how heavily the syllabus words that topic, and whether it is specific to Pakistan. On that basis, spend your first half of study time on medicine and allied (about 52 items) and surgery and allied (about 48 items), put the Pakistani infections, trauma and acute abdomen at the top of each, and treat community medicine and forensic medicine as small but cheap marks. This ranking is our judgement, not a leak or a PM&DC statement.
How we rank topics
We use three signals and nothing else. We do not use recalled questions.
| Signal | Why it counts | Where it comes from |
|---|---|---|
| Domain weight | More items means more marks per hour of study | PM&DC 2024 syllabus blueprint (basic-science figures scaled by us to 60 items) |
| Syllabus emphasis | Topics named in the syllabus or its appendices are examinable | PM&DC 2024 syllabus text, and the subtopic lists in our domain pages |
| Pakistan specificity | Local topics are the ones foreign curricula skip, so they are where marks are lost | Syllabus content and national programmes; see local guidelines |
A fourth signal, "how often have candidates said it came up", is deliberately missing. Such reports are unreliable and may also come from copied items. If a topic is in the blueprint and you know it well, you do not need a rumour.
Tier 1: the 100 items in medicine and surgery
Half the paper sits in two domains. A candidate scoring 70% in these two and 50% elsewhere would reach 60% overall. The reverse, 70% in basics and 50% in medicine and surgery, would not.
Medicine and allied (about 52 items)
- Pakistani infections: typhoid including XDR, tuberculosis (pulmonary, extrapulmonary, MDR), malaria (vivax and falciparum, severe malaria), dengue with warning signs and fluids, CCHF, hepatitis B and C, cirrhosis and hepatocellular carcinoma, HIV and sepsis.
- Cardiology: acute coronary syndrome, heart failure, rheumatic heart disease and valve disease, arrhythmias, hypertension.
- Respiratory: pneumonia, COPD, asthma, pulmonary embolism, interstitial lung disease, lung cancer.
- Gastroenterology and liver: peptic ulcer, GI bleeding, inflammatory bowel disease, hepatic encephalopathy, pancreatitis.
- Renal and electrolytes: CKD, AKI, nephrotic and nephritic syndromes, acid-base and electrolyte disorders.
- Endocrine: diabetes, DKA, hypoglycaemia, thyroid, adrenal, pituitary.
- Neurology, haematology, rheumatology, poisoning, psychiatry, dermatology: stroke, epilepsy, meningitis; anaemias, thalassaemia, leukaemias; RA, SLE, vasculitis; organophosphate and other poisonings; common psychiatric emergencies; leishmaniasis and scabies.
Surgery and allied (about 48 items)
- Emergency surgery: trauma and the ATLS primary survey, head and chest injury, shock and haemorrhage control, burns, acute abdomen (appendicitis, perforation, obstruction).
- Hepatobiliary and pancreas: gallstones, cholangitis, liver abscess, pancreatitis and spleen.
- Colorectal and hernias: colorectal cancer, diverticulitis, haemorrhoids, fistula, inguinal and femoral hernias.
- Vascular and endocrine surgery: arterial disease, aneurysm, DVT, thyroid and parathyroid.
- Urology and orthopaedics: stones, BPH, prostate and renal tumours; fractures, bone and joint infection, bone tumours and orthopaedic emergencies.
- Peri-operative care: pre-operative assessment, anaesthesia, fluids, surgical site infection, consent and ethics.
For depth on each, use Medicine and allied and Surgery and allied.
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Tier 2: clinical specialties and applied basic sciences
| Domain | Approx. items | Highest-yield topics (our ranking) |
|---|---|---|
| Obstetrics and gynaecology | 14 | Pre-eclampsia and eclampsia, postpartum haemorrhage, antepartum haemorrhage, labour and partograph, obstructed labour, ectopic pregnancy, contraception |
| Paediatrics | 14 | Immunisation, neonatal jaundice and sepsis, diarrhoea and ORS with zinc, pneumonia and IMCI, severe acute malnutrition, thalassaemia, nephrotic syndrome |
| Applied pathology | 12 | Anaemias, leukaemias and lymphomas, neoplasia, hepatitis and liver pathology, microbiology of Pakistani pathogens, hypersensitivity |
| Applied anatomy | 12 | Neuroanatomy and lesion syndromes, brachial plexus and limb nerve injuries, inguinal canal and hernias, embryological anomalies |
| Ophthalmology and ENT | 12 | Red eye, glaucoma, diabetic retinopathy, cataract, otitis media, hearing loss, epistaxis, tonsillar disease |
| Applied physiology | 11 | Cardiac physiology and ECG, respiratory and V/Q mismatch, renal clearance and acid-base, endocrine physiology |
| Clinical pharmacology | 9 | Pharmacokinetics, antimicrobials, anti-TB drugs, antimalarials, cardiovascular drugs, drugs in pregnancy, adverse reactions and interactions |
Tier 3: small domains with cheap marks
| Domain | Approx. items | Why it is worth the time |
|---|---|---|
| Applied biochemistry | 6 | A short list of recurring themes: inborn errors, vitamins, lipids and enzymes, molecular techniques. Learn these as clinical pictures. |
| Community medicine and public health | 6 | Highly Pakistan-specific (EPI, LHW programme, TB, hepatitis, polio) plus epidemiology and biostatistics that can be learned from rules and calculations. |
| Forensic medicine and toxicology | 4 | Four items at most, but they depend on Pakistani law and common local poisons, which a foreign curriculum is unlikely to have taught. |
Cheap marks are not the same as unimportant marks. Ten items from tiers 3 and part of tier 2 can move a score from 58% to 63%.
The cross-cutting topics that show up in many domains
Some themes cross domain lines. A single piece of knowledge appears as a pathology question, a pharmacology question and a medicine question. Learn these once, thoroughly.
- Tuberculosis: pathology (granuloma), microbiology (Ziehl-Neelsen), pharmacology (HRZE adverse effects), medicine (extrapulmonary), community medicine (DOTS), paediatrics (childhood TB).
- Hepatitis B and C: virology, serology, treatment, cirrhosis complications, prevention programmes, blood-borne transmission in surgery.
- Malaria: parasitology, haemolysis, G6PD and primaquine, severe malaria and artesunate, vector control.
- Typhoid: Salmonella biology, complications such as ileal perforation, XDR treatment, TCV and EPI.
- Acid-base and electrolytes: physiology, biochemistry (anion gap), medicine (DKA, renal), surgery (post-operative fluids).
- Shock: physiology, pathology, surgery (haemorrhage), medicine (sepsis), obstetrics (PPH).
- Anaemia: pathology, biochemistry (haem synthesis), medicine, paediatrics (thalassaemia), obstetrics.
- Diabetes: biochemistry, physiology, pharmacology, medicine (DKA), surgery (diabetic foot), eye (retinopathy), obstetrics (gestational).
How to turn a topic into a revision card
A high-yield topic is only useful if you can retrieve it under time pressure. The method below takes about twenty minutes per topic. We use tuberculosis as the worked example because it appears in at least five domains.
| Card field | Tuberculosis example |
|---|---|
| One-line definition | Chronic granulomatous infection by Mycobacterium tuberculosis, with caseating granulomas |
| How it presents in Pakistan | Chronic cough, night sweats, weight loss; extrapulmonary forms (lymph node, pleural, abdominal, spinal) are examinable alongside pulmonary disease |
| Diagnosis | Rapid molecular test (GeneXpert) first, which also detects rifampicin resistance; smear and culture |
| Treatment | 2HRZE then 4HR for drug-susceptible disease; DOTS; know the four-month options |
| Traps | Pyridoxine with isoniazid; hepatotoxicity monitoring; ethambutol and the eye; rifampicin and drug interactions |
| Programme link | National TB Control Programme delivers DOTS through the public sector |
| Cross-domain | Pathology (granuloma), pharmacology (side effects), paediatrics (childhood TB), community medicine (case finding), surgery (spinal and abdominal TB) |
Build a card for each cross-cutting theme listed above. After you make a card, do 15 questions on the topic across domains. If you get more than three wrong, the card is incomplete; edit it.
What to deprioritise
Deprioritise does not mean skip. It means do not spend the first month on it.
- Memorising doses and rare syndromes. The syllabus's emphasis is on higher cognition: management decisions, interpretations, diagnoses.
- Long embryology and anatomy lists with no clinical hook. Anatomy is 12 items. Neuroanatomy lesions, nerve injuries and hernias will repay your time more than the origin of every branch.
- Rare tumours and obscure infections. Prioritise what is common in Pakistan.
- Anything only found in forum posts. If you cannot match it to the syllabus, set it aside.
A checklist you can test yourself against
For each line, ask whether you could answer a clinical vignette on it today, not whether you recognise the name. Mark it red, amber or green and update after each mock.
| Area | Check |
|---|---|
| Infections | XDR typhoid treatment; TB regimens and adverse effects; vivax malaria treatment and G6PD; dengue warning signs; hepatitis serology |
| Cardiology | ACS management; heart failure drug classes; rheumatic fever criteria; ECG patterns |
| Emergencies | ATLS primary survey; burns resuscitation; DKA management; upper GI bleeding |
| Acute abdomen | Appendicitis, perforation, obstruction, cholangitis, pancreatitis |
| Women and children | Eclampsia drug; PPH steps; neonatal jaundice; ORS and zinc; IMCI classification |
| Basics as clinical | Brainstem and cord lesions; nerve injuries; acid-base interpretation; enzyme and vitamin deficiency pictures |
| Local content | EPI schedule; LHW programme; DRAP; Pakistani medicolegal terms |
Sit a timed PMDC NRE Step I mock exam
Blueprint-weighted questions under exam timing, then a breakdown of your result by domain.
Marks per hour: a rough calculation
To see why the ranking looks the way it does, divide each domain's approximate items by the share of your study time it needs. The hours below are our own planning estimates for a candidate with average gaps, not measured data.
| Domain group | Items | Study hours (estimate) | Items per 10 hours |
|---|---|---|---|
| Medicine and surgery | 100 | 110 | 9.1 |
| Obstetrics, paediatrics, eye and ENT | 40 | 35 | 11.4 |
| Anatomy, physiology, pathology, pharmacology | 44 | 50 | 8.8 |
| Biochemistry, community medicine, forensic medicine | 16 | 10 | 16.0 |
The smallest domains give the most items per hour, which is why they are worth doing even though they are small. Medicine and surgery give fewer items per hour, but they are the only place where the absolute number of marks is large enough to decide the result, so they get the biggest block. Your own numbers will differ: a candidate with a very weak biochemistry background will find it costs far more than ten hours.
Using this ranking in your plan
Put Tier 1 first, Tier 2 second and Tier 3 in short daily slots from the start, because local facts need spaced repetition. The study plan shows where each block falls in an 8, 12 or 16-week schedule, and the overview shows the blueprint in one table. If your mock results disagree with this ranking, trust your mock results: they measure your gaps, which is what matters.
Frequently asked questions
What are the high-yield subjects for NRE Step I?
Medicine and allied (about 52 of 200 items) and surgery and allied (about 48 items) carry half the paper. Obstetrics and gynaecology and paediatrics have about 14 each, and the remaining basic and public-health domains share the rest.
Does PM&DC publish the most repeated topics?
No. PM&DC publishes a syllabus and blueprint, not topic frequency. Any list of repeated topics comes from candidate recall and should be treated with caution.
Which Pakistani diseases should I know best?
Typhoid including XDR, tuberculosis including MDR, malaria (vivax and falciparum), dengue, CCHF, hepatitis B and C, leishmaniasis, organophosphate poisoning and the national programmes that address them.
How many questions come from basic sciences?
Sixty of 200 (30%) according to the 2024 syllabus. They are written as clinical correlations. The split across the seven basic-science domains in our pages is a scaled estimate.
Is community medicine worth studying for only six questions?
Yes, because the content is Pakistan-specific (EPI, LHW programme, TB, hepatitis, polio) and can be learned from rules, programmes and calculations. Foreign curricula often skip it, so marks are lost by candidates who do not prepare.
How should I use a topic ranking?
Put Tier 1 (medicine and surgery) first, Tier 2 (specialties and applied basics) second, and Tier 3 (biochemistry, community medicine, forensic medicine) in short daily slots. Then adjust by your own mock results.
Which topics appear in more than one domain?
Tuberculosis, hepatitis B and C, malaria, typhoid, acid-base and electrolytes, shock, anaemia and diabetes each appear in several domains. Learn them thoroughly once.
Should I memorise drug doses?
Learn first-line drugs, key adverse effects and a small set of critical doses such as oxytocin 10 IU for PPH prophylaxis. The syllabus emphasises higher cognition, meaning decisions and interpretation, over rarely used doses.
Are there topics I can skip?
Nothing in the blueprint should be skipped entirely, but you can delay long embryology lists, rare tumours and obscure infections until your mock scores in the main domains are stable.
Why do you not list 'most repeated MCQs'?
We do not copy recalled questions or claim insider knowledge. Our ranking uses published weights and syllabus content, so you can check every line against the PM&DC document.