The Pakistan-specific facts foreign-trained doctors miss in the NRE

Why this matters for your result

PM&DC's syllabus lists community medicine with a Pakistan health system focus, forensic medicine under Pakistani law, and endemic diseases such as typhoid, tuberculosis, malaria, dengue and hepatitis in the medicine and community content. Medicine and allied alone carries about 52 of 200 items, and the stems are written for a Pakistani hospital, rural health centre or basic health unit. A Chinese or Russian curriculum, for example, may teach different national schedules and guidelines. That is our inference about curricula, not a PM&DC statement. The syllabus is the authority on what is examinable. This page is our reading of it.

1. Immunisation: the Pakistan EPI schedule

EPI Pakistan was launched in 1978 with BCG, polio, DPT and measles. WHO's Pakistan page records later additions: hepatitis B in 2002, Hib in 2009, pneumococcal conjugate vaccine (PCV) in 2012, inactivated polio vaccine (IPV) in 2015 and rotavirus in 2017. Typhoid conjugate vaccine (TCV) was introduced in Sindh in 2019, in Punjab and Islamabad in 2021, and nationwide in 2022. The MR (measles-rubella) vaccine replaced measles vaccine in 2021. All EPI vaccines are free at government facilities.

The schedule table comes from secondary sources, because the EPI site did not load when we checked. Copy the card from epi.gov.pk before relying on it. Do not memorise the timing of a booster or the number of rotavirus doses unless you have seen them on the current card.

Typhoid conjugate vaccine facts that are well supported: a single dose, WHO-prequalified, usable from 6 months, with protection of at least four years and about 97% effectiveness against XDR typhoid in the Hyderabad outbreak setting, according to the Coalition Against Typhoid's 2026 Pakistan fact sheet. The same sheet gives a 2023 Global Burden of Disease estimate of 242,370 typhoid cases and 3,946 deaths in Pakistan, 86% of cases in under-15s.

How it is tested: a stem describing an infant's vaccination history and asking which vaccine is due, or which vaccine is contraindicated, or what the cold chain rule is for a specific vaccine.

2. Typhoid and XDR typhoid

Extensively drug-resistant Salmonella Typhi (H58) emerged in Hyderabad, Sindh, in 2016. It is resistant to chloramphenicol, ampicillin, co-trimoxazole, fluoroquinolones and third-generation cephalosporins, and is treated with azithromycin or a carbapenem (confirm against WHO's typhoid fact sheet). The point for an exam: a Pakistani stem with a febrile patient and a culture result will not expect ciprofloxacin or ceftriaxone as the answer when resistance is stated.

3. Tuberculosis

WHO lists Pakistan among the high-burden countries. The standard drug-susceptible regimen is 2HRZE followed by 4HR, six months in all. WHO-endorsed four-month regimens exist: for children aged 3 months to 16 years with non-severe TB, 2HRZ(E)/2HR, and for adults and adolescents aged 12 and over with pulmonary TB, 2HPMZ/2HPM (isoniazid, rifapentine, moxifloxacin, pyrazinamide). DOTS means directly observed therapy, short course. The National TB Control Programme delivers through the public sector. Under current WHO policy a rapid molecular test such as GeneXpert, which also detects rifampicin resistance, is the first test for presumptive TB (confirm in WHO module 4 and Pakistani NTP guidance).

How it is tested: drug of choice, side effects and monitoring (hepatotoxicity, peripheral neuropathy and pyridoxine, optic neuritis with ethambutol), what to do for a contact, and what an MDR result changes.

4. Hepatitis B and C

Hepatitis C viraemic prevalence in Pakistan is estimated at about 4.3%, roughly 9.75 million viraemic people as of January 2021, and the 2008 national serosurvey found anti-HCV in 4.8%. The Prime Minister's Programme for Prevention and Control of Hepatitis began in 2005, and provincial hepatitis control programmes from 2010 provided free screening, diagnosis and treatment by 2011. Direct-acting antivirals replaced interferon, and sustained virological response rose from 64% to 96% by 2017. Only about half of blood donations were screened for HCV in the planning document we used. WHO's 2030 targets are an 80% fall in new infections, 90% diagnosed, 80% treated and a 65% fall in mortality.

Drug names and regimen length vary by genotype and cirrhosis status, and we could not confirm a Pakistani national regimen. Use WHO's hepatitis C guidelines for regimen questions and do not memorise week counts from forum posts.

5. Polio

Pakistan and Afghanistan are the only countries where wild poliovirus type 1 remains endemic, according to the Global Polio Eradication Initiative. Surveillance relies on acute flaccid paralysis (AFP) reporting and environmental sampling; campaigns include national and sub-national immunisation days and fractional IPV rounds. The Pakistan programme is coordinated by the National Emergency Operations Centre (NEOC).

How it is tested: the definition of AFP, the stool samples needed (two samples taken at least 24 hours apart within 14 days of onset, standard WHO practice; confirm in the NEOC protocol), and the difference between OPV and IPV.

6. Malaria

Plasmodium vivax is predominant in Pakistan, with P. falciparum second. Confirm with microscopy or a rapid diagnostic test before treating. Uncomplicated falciparum malaria is treated with artemether-lumefantrine. Vivax is treated with chloroquine plus primaquine, after a G6PD check. Severe malaria is treated with intravenous artesunate (WHO guidelines for malaria; confirm in the National Malaria Control Programme guidance).

7. Dengue and CCHF

Dengue is transmitted by Aedes aegypti. WHO warning signs are abdominal pain, persistent vomiting, mucosal bleeding, lethargy, liver enlargement and a rising haematocrit with falling platelets. Use paracetamol for fever and avoid NSAIDs and aspirin. Pakistan has had outbreaks in Punjab (2011), Khyber Pakhtunkhwa and Karachi.

Crimean-Congo haemorrhagic fever is endemic in Balochistan and Khyber Pakhtunkhwa. It is transmitted by the Hyalomma tick and by contact with the blood of infected animals, and cases rise around Eid ul Adha. Ribavirin is used (WHO fact sheet; confirm in provincial guidance).

8. Maternal and child health

• Postpartum haemorrhage: WHO recommends oxytocin 10 IU intramuscularly as first-line prophylaxis, and tranexamic acid 1 g intravenously within three hours of birth for treatment.
• Eclampsia: magnesium sulphate is the anticonvulsant of choice.
• Diarrhoea: low-osmolarity ORS plus zinc, 20 mg a day for 10 to 14 days (10 mg a day under six months).
• Pneumonia (IMCI): fast breathing is 60 or more breaths a minute under 2 months, 50 or more at 2 to 11 months, and 40 or more at 1 to 5 years.
• Leading causes of maternal death: postpartum haemorrhage, hypertensive disorders, sepsis and obstructed labour. The national maternal mortality ratio is quoted differently across sources, so do not memorise a single figure.

The Lady Health Worker Programme began in 1994: female community health workers delivering maternal and child health, family planning and EPI support in rural and peri-urban areas. The number of households per worker is not confirmed in the sources we used, so do not rely on one.

9. Drug regulation

The Drug Regulatory Authority of Pakistan (DRAP) was established under the DRAP Act 2012. It registers drugs, regulates prices and runs pharmacovigilance. The National Essential Medicines List guides the public-sector formulary. Expect a stem about who registers a drug, or what an essential medicine is, in the pharmacology and community medicine sections.

10. Poisoning and medicolegal law

Organophosphate poisoning is common in agricultural Pakistan. Treat with atropine, titrated to drying of bronchial secretions, and pralidoxime. Aluminium phosphide, sold as the "wheat pill", has high mortality and no specific antidote (WHO pesticide poisoning guidance; confirm local practice).

In medicolegal practice, injuries are classified under the Pakistan Penal Code, which includes hurt and the Qisas and Diyat provisions. Postmortem examination is requested by police under the Code of Criminal Procedure and carried out by an authorised medicolegal officer. Consent and confidentiality follow the PM&DC Code of Ethics. Check section numbers in the Pakistan Code before memorising them.

A one-page revision sheet

How to study this content

1. Read the official page. EPI card, NTP guideline, WHO fact sheet. One page each.
2. Write your own one-line summaries. The act of writing fixes them.
3. Do questions in the matching domain. See community medicine, forensic medicine and toxicology and medicine and allied.
4. Review weekly. Local facts fade fast if you only meet them once.

The high-yield topics guide ranks these against the rest of the syllabus, and the study plan shows where to place them in your weeks.