Medicine — Thyroid Disease, NMC MBBS licence examination syllabus (Nepal Medical Council).
Thyroid disease — 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. In primary hypothyroidism, the expected pattern is:
A. TSH low, T4 low
B. TSH HIGH, T4 LOW
C. TSH high, T4 high
D. TSH normal, T4 low
ANSWER: B — TSH high, T4 low.
Why: the failing gland produces less hormone, so negative
feedback on the pituitary is reduced and TSH rises. In primary
disease, TSH always moves OPPOSITE to the thyroid hormone.
LEARNING POINT: this counterintuitive direction is the
commonest source of error in thyroid questions.
Q2. Which finding indicates that thyrotoxicosis is due to
GRAVES' disease specifically?
A. Weight loss
B. Tachycardia
C. PROPTOSIS and lid retraction
D. Heat intolerance
ANSWER: C — the eye signs.
Why: eye disease, pretibial myxoedema and acropachy occur in
Graves' and not in toxic multinodular goitre or toxic adenoma.
The other options occur in thyrotoxicosis of any cause.
LEARNING POINT: eye signs name the cause without a scan.
Level 3–4 — application and clinical reasoning
Q3. A woman with fatigue and cold intolerance has TSH LOW
and free T4 LOW. The correct interpretation is:
A. Hyperthyroidism — start an antithyroid drug
B. SECONDARY (pituitary) hypothyroidism
C. Subclinical hyperthyroidism
D. Normal results
ANSWER: B.
Why: TSH and T4 are moving TOGETHER, which localises the
problem to the pituitary. A failing pituitary cannot raise TSH
despite a low thyroid hormone, so the low TSH is deceptive.
LEARNING POINT: assess and replace CORTISOL before starting
thyroxine, or an adrenal crisis may be precipitated.
Q4. A 74-year-old presents with new atrial fibrillation,
weight loss and low mood, appearing withdrawn rather than
agitated. The most important test is:
A. Thyroid function tests
B. Echocardiogram alone
C. Psychiatric assessment alone
D. No test needed
ANSWER: A — thyroid function tests.
Why: APATHETIC thyrotoxicosis in older patients lacks the
classic restlessness and may present chiefly as atrial
fibrillation, weight loss and low mood. It is a readily
missed and readily treated cause of new AF.
LEARNING POINT: check thyroid function in any new atrial
fibrillation.
Q5. A patient on an antithyroid drug develops fever and a
severe sore throat. The correct action is:
A. Continue the drug and prescribe an antibiotic
B. STOP the drug and obtain an urgent full blood count
C. Increase the antithyroid dose
D. Reassure — this is a common viral illness
ANSWER: B.
Why: fever and sore throat on an antithyroid drug suggest
AGRANULOCYTOSIS, a potentially fatal complication. Treating it
as a routine infection without a blood count misses it.
LEARNING POINT: every patient starting an antithyroid drug
must be warned to do exactly this.
Level 5 — exception-based
Q6. Which treatment for hyperthyroidism is CONTRAINDICATED
in pregnancy?
A. Antithyroid drugs
B. Beta-blockers for symptom control
C. RADIOIODINE
D. Surgery in the second trimester
ANSWER: C — radioiodine.
Why: radioiodine crosses the placenta and would ablate the
fetal thyroid. It is contraindicated in pregnancy and
breastfeeding.
LEARNING POINT: management in pregnancy always requires
specialist input and trimester-specific reference ranges.
Q7. Why is levothyroxine started at a low dose and increased
slowly in an elderly patient with ischaemic heart disease?
A. The drug is poorly absorbed in the elderly
B. Raising the metabolic rate abruptly increases
myocardial oxygen demand and may precipitate angina
C. It causes hypertension
D. Elderly patients need lower final doses
ANSWER: B.
Why: correcting hypothyroidism increases cardiac work. Doing
so abruptly in a heart with limited coronary reserve can
provoke angina or an arrhythmia.
LEARNING POINT: start low, go slow — the final dose may still
be a full replacement dose.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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