Obstetrics and Gynaecology — Obstetric Emergencies, NMC MBBS licence examination syllabus (Nepal Medical Council).
Obstetric emergencies — NMC-style practice questions
Practice questions written for this chapter. These are not past NMC papers.
📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter.
Level 1–2 — recall and understanding
Q1. Which is the commonest cause of postpartum
haemorrhage?
A. Retained tissue B. Uterine atony
C. Genital tract trauma D. Coagulopathy
ANSWER: B — uterine atony ("tone").
Why: the uterus stops bleeding by contracting. Failure to
contract is by far the commonest cause, which is why the
first actions are fundal massage, emptying the bladder and
uterotonics.
LEARNING POINT: the four Ts — Tone, Tissue, Trauma,
Thrombin — in order of frequency.
Q2. The drug of choice for preventing and treating
eclamptic seizures is:
A. Diazepam B. Phenytoin
C. Magnesium sulphate D. Levetiracetam
ANSWER: C — magnesium sulphate.
Why: it is more effective than conventional anticonvulsants
for eclamptic seizures and also reduces the risk of
recurrence.
LEARNING POINT: monitor reflexes, respiration and urine
output for magnesium toxicity; calcium gluconate is the
antidote.
Level 3–4 — application and clinical reasoning
Q3. A woman at 33 weeks has painless bright red bleeding
with a soft, non-tender uterus. The next step is:
A. Digital vaginal examination to assess the cervix
B. Urgent ultrasound to locate the placenta; NO digital
examination
C. Immediate artificial rupture of membranes
D. Discharge with advice
ANSWER: B.
Why: painless bleeding with a soft uterus suggests placenta
praevia, and digital examination risks provoking catastrophic
haemorrhage. Ultrasound localises the placenta safely.
LEARNING POINT: one of the few absolute prohibitions in
clinical practice.
Q4. Twenty minutes after forceps delivery there is heavy
bleeding. The uterus is FIRM and well contracted, and
two uterotonic doses have had no effect. The most
likely cause is:
A. Uterine atony
B. Genital tract trauma or retained tissue
C. Amniotic fluid embolism
D. Normal lochia
ANSWER: B — trauma or retained tissue.
Why: a firm uterus excludes atony as the explanation.
Instrumental delivery makes a vaginal or cervical tear
likely.
LEARNING POINT: feeling the uterus tells you which of the
four Ts you are dealing with.
Q5. A woman at 34 weeks has epigastric pain and vomiting,
BP 160/106, proteinuria, platelets 82 and raised ALT.
The diagnosis is:
A. Gastritis
B. HELLP syndrome
C. Cholecystitis
D. Hyperemesis gravidarum
ANSWER: B — HELLP syndrome.
Why: haemolysis, elevated liver enzymes and low platelets in
the context of hypertension and proteinuria. Epigastric pain
arises from hepatic capsular stretch.
A: the misdiagnosis this question targets.
LEARNING POINT: epigastric pain in a pregnant woman is
pre-eclampsia until proven otherwise.
Level 5 — exception-based
Q6. A 26-year-old woman presents with abdominal pain and
syncope. Pulse 120, BP 94/58. She states she is
"probably not pregnant". The essential investigation is:
A. Abdominal X-ray
B. Pregnancy test
C. Serum amylase only
D. Urinalysis only
ANSWER: B — pregnancy test.
Why: ruptured ectopic pregnancy presents with pain, shock and
intraperitoneal bleeding, and patient report is not a
substitute for a test. It is a rapidly fatal and treatable
diagnosis.
LEARNING POINT: pregnancy test in ANY woman of reproductive
age with abdominal pain or collapse.
Q7. A woman had an uncomplicated delivery two days ago and
now has a severe headache and a seizure at home. The
most likely diagnosis is:
A. Eclampsia is impossible after delivery
B. Postpartum eclampsia
C. Migraine
D. Epilepsy of new onset
ANSWER: B — postpartum eclampsia.
Why: eclampsia can occur after delivery, sometimes several
days later. Delivery removes the placenta but does not
immediately end the disease process.
LEARNING POINT: monitoring and patient warning continue after
delivery, not up to it.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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