Medicine — Seizures and Headache, NMC MBBS licence examination syllabus (Nepal Medical Council).
Seizures and headache — 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 feature best distinguishes a generalised
convulsion from vasovagal syncope?
A. Brief jerking movements
B. PROLONGED POSTICTAL CONFUSION
C. Urinary incontinence
D. Collapse to the floor
ANSWER: B — prolonged postictal confusion.
Why: syncope recovers orientation within seconds to a minute.
Brief jerking and incontinence can occur in either, so they
discriminate poorly.
LEARNING POINT: ask how long until the person could hold a
normal conversation.
Q2. A headache reaching maximum intensity within seconds
should be treated as:
A. Migraine
B. Tension-type headache
C. SUBARACHNOID HAEMORRHAGE until excluded
D. Cluster headache
ANSWER: C.
Why: thunderclap onset is the defining feature. Migraine
builds over minutes to hours. Investigation is CT first, with
lumbar puncture after an interval if CT is negative and
suspicion remains.
LEARNING POINT: speed of onset is the highest-value question
in headache.
Level 3–4 — application and clinical reasoning
Q3. A 19-year-old collapsed while standing in a hot hall
after feeling hot and nauseated, jerked for a few seconds
while held upright, and was conversing normally within 30
seconds. The correct management is:
A. Start an antiepileptic drug
B. Reassurance, trigger advice and an ECG — this is
SYNCOPE
C. Urgent MRI brain
D. Long-term driving ban
ANSWER: B.
Why: upright posture, a clear prodrome, brief jerking and
rapid full recovery indicate vasovagal syncope with secondary
jerking. An ECG is done to exclude a cardiac cause.
LEARNING POINT: misdiagnosed epilepsy brings medication,
restrictions and stigma.
Q4. In status epilepticus, treatment is escalated:
A. Only if the first drug clearly fails after an hour
B. At fixed TIME POINTS according to protocol
C. Once an EEG confirms ongoing seizure
D. After imaging
ANSWER: B — by the clock.
Why: seizures become progressively harder to terminate and
more damaging as they continue. Escalation follows timed
protocol steps rather than clinical impression.
LEARNING POINT: check the glucose immediately, and look for
the precipitant throughout.
Q5. A 58-year-old has six weeks of headache, worse on waking
and on coughing, with vomiting. The priority is:
A. Simple analgesia and review
B. Fundoscopy and URGENT IMAGING
C. Migraine prophylaxis
D. Reassurance
ANSWER: B.
Why: headache worse on lying and straining, with vomiting and
a progressive course in an older patient, suggests raised
intracranial pressure and requires imaging.
LEARNING POINT: in this age group also consider giant cell
arteritis as a treatable cause of new headache.
Level 5 — exception-based
Q6. A woman 3 days postpartum has a generalised seizure.
Until proven otherwise this is:
A. Newly diagnosed epilepsy
B. ECLAMPSIA
C. Vasovagal syncope
D. A febrile convulsion
ANSWER: B — eclampsia.
Why: a seizure in pregnancy or the postpartum period is
eclampsia until excluded, and the treatment is magnesium
sulphate per obstetric protocol rather than the standard
epilepsy pathway.
LEARNING POINT: eclampsia can occur after delivery, not only
before it.
Q7. Which behaviour helps distinguish cluster headache from
migraine at the bedside?
A. The patient lies still in a dark room
B. The patient is RESTLESS and paces
C. The patient sleeps through the attack
D. The patient reports bilateral pain
ANSWER: B — restlessness and pacing.
Why: migraine is worsened by movement, so sufferers keep
still. Cluster headache causes agitation, with unilateral
autonomic features such as a red watering eye and ptosis.
LEARNING POINT: watching what the patient does with the pain
is genuinely diagnostic.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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