Obstetrics and Gynaecology — Antenatal Care and Gynaecology, NMC MBBS licence examination syllabus (Nepal Medical Council).
Antenatal care and gynaecology — 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. Folic acid supplementation to prevent neural tube
defects should be started:
A. At the first antenatal visit
B. BEFORE conception
C. In the second trimester
D. After 20 weeks
ANSWER: B — before conception.
Why: the neural tube closes within the first few weeks of
pregnancy, frequently before pregnancy is recognised.
Supplementation begun at the booking visit has missed the
period it was designed to protect.
LEARNING POINT: this is why folic acid advice belongs in
family planning consultations.
Q2. Which contraceptive consideration is a contraindication
to combined hormonal contraception?
A. Migraine WITHOUT aura
B. Migraine WITH aura
C. Age 25 and smoking
D. Regular menstrual cycles
ANSWER: B — migraine with aura.
Why: aura carries an increased stroke risk that combined
hormonal contraception compounds. Migraine without aura does
not carry the same restriction.
LEARNING POINT: take the migraine history precisely — the
presence of aura changes the answer.
Level 3–4 — application and clinical reasoning
Q3. A woman with well-controlled epilepsy discovers she is
pregnant and stops her antiepileptic. The correct advice
is:
A. She was right to stop immediately
B. Urgent specialist review — uncontrolled seizures are
more dangerous than most alternatives
C. Restart at double the dose
D. Stop all medication permanently
ANSWER: B — urgent specialist review.
Why: uncontrolled seizures risk trauma and hypoxia for both
mother and fetus. Abrupt unilateral withdrawal is more
dangerous than a planned medication decision.
LEARNING POINT: never stop essential treatment in pregnancy
without specialist input — ideally the discussion happens
before conception.
Q4. A 60-year-old, six years post-menopausal, has light
vaginal bleeding and feels well. The correct action is:
A. Reassure — light bleeding is not significant
B. Urgent investigation to exclude endometrial carcinoma
C. Topical oestrogen and review in six months
D. Repeat only if it recurs
ANSWER: B — urgent investigation.
Why: post-menopausal bleeding is endometrial carcinoma until
proven otherwise. Atrophy is common but may only be
diagnosed after malignancy has been excluded.
LEARNING POINT: light bleeding and feeling well do not lower
the priority.
Q5. Asymptomatic bacteriuria detected on routine antenatal
screening should be:
A. Left untreated, as in non-pregnant adults
B. Treated with antibiotics
C. Repeated in the third trimester only
D. Treated only if the woman develops symptoms
ANSWER: B — treated.
Why: in pregnancy, asymptomatic bacteriuria progresses to
pyelonephritis far more often and is associated with preterm
birth, so it is treated even without symptoms — unlike in
non-pregnant adults.
LEARNING POINT: pregnancy changes the answer to a question
that seems settled elsewhere.
Level 5 — exception-based
Q6. Why is rhesus status checked early in every pregnancy?
A. To predict fetal blood group
B. Because a rhesus-negative woman may be sensitised,
affecting FUTURE pregnancies
C. To determine the mode of delivery
D. To calculate anaemia risk
ANSWER: B.
Why: sensitisation after exposure to rhesus-positive fetal
blood produces antibodies that affect subsequent
pregnancies. Anti-D prophylaxis prevents that.
LEARNING POINT: an intervention given to one patient largely
for the benefit of a future one.
Q7. A woman on rifampicin for tuberculosis uses the
combined oral contraceptive pill. The correct advice is:
A. No change needed
B. Rifampicin induces enzymes and reduces contraceptive
efficacy — use an alternative or additional method
C. Double the pill dose
D. Stop the rifampicin
ANSWER: B.
Why: rifampicin is a potent CYP450 inducer and accelerates
metabolism of contraceptive hormones, so efficacy falls.
Alternative or additional contraception is required.
D: stopping effective TB treatment is not an option.
LEARNING POINT: the same interaction appears in the
tuberculosis chapter — worth recognising from both sides.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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