Obstetrics and Gynaecology — Gynaecology, NMC MBBS licence examination syllabus (Nepal Medical Council).
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. A 24-year-old presents with acute pelvic pain. The FIRST
investigation is:
A. Pelvic ultrasound
B. PREGNANCY TEST
C. Full blood count
D. Urine culture
ANSWER: B — pregnancy test.
Why: ectopic pregnancy is the diagnosis that kills, and it is
missed when the possibility is not entertained. The test is
done in every woman of reproductive age with pelvic pain,
whatever she says about the likelihood.
LEARNING POINT: ectopic bleeding is concealed, so shock can
precede any visible blood loss.
Q2. Post-menopausal bleeding should be regarded as:
A. Vaginal atrophy until proven otherwise
B. ENDOMETRIAL CARCINOMA until proven otherwise
C. Normal if a single light episode
D. Due to hormone therapy if she takes it
ANSWER: B.
Why: atrophy is the commonest cause but is a diagnosis of
EXCLUSION. A single light episode does not reduce the risk,
and malignancy must be excluded first.
LEARNING POINT: the same discipline applies to post-coital
bleeding, which needs cervical assessment.
Level 3–4 — application and clinical reasoning
Q3. A couple have not conceived in two years. The woman has
had eight months of investigation; her husband has had
none. The most appropriate next step is:
A. Continue investigating the woman
B. Arrange SEMEN ANALYSIS
C. Refer directly for assisted conception
D. Advise waiting another year
ANSWER: B — semen analysis.
Why: a male factor contributes in a large proportion of
couples, and semen analysis is simple, cheap and
non-invasive. Investigating only the woman delays diagnosis
and, where infertility is socially blamed on women, is unjust.
LEARNING POINT: subfertility is assessed in the COUPLE.
Q4. A woman with suspected pelvic inflammatory disease has
equivocal findings and swab results are days away. You
should:
A. Wait for the results before treating
B. TREAT EMPIRICALLY NOW and treat the partner
C. Treat only if she becomes febrile
D. Reassure and review in a week
ANSWER: B.
Why: clinical diagnosis is imprecise and the consequences of
undertreatment — tubal infertility, ectopic pregnancy, chronic
pain — are permanent. The threshold to treat is deliberately
low.
LEARNING POINT: treating the partner prevents reinfection.
Q5. A 27-year-old with PCOS has had no period for eight
months. Besides fertility, the concern is:
A. Nothing — it is harmless
B. Unopposed oestrogen raising ENDOMETRIAL CANCER risk,
plus metabolic risk
C. Immediate osteoporosis
D. Ovarian rupture
ANSWER: B.
Why: without regular endometrial shedding, prolonged unopposed
oestrogen raises endometrial cancer risk. PCOS also carries
raised type 2 diabetes and cardiovascular risk.
LEARNING POINT: inducing regular withdrawal bleeds is
protective, and lifestyle management is first-line.
Level 5 — exception-based
Q6. Why can cervical cancer be prevented by VACCINATION?
A. The vaccine treats early cancer
B. Persistent high-risk HPV infection is a NECESSARY
cause, so preventing infection prevents the cancer
C. It boosts general immunity
D. It replaces the need for screening
ANSWER: B.
Why: because the cancer cannot occur without persistent
high-risk HPV, blocking the infection blocks the pathway.
Screening remains complementary — it detects the treatable
pre-cancerous stage in those already exposed.
LEARNING POINT: vaccination works best BEFORE exposure.
Q7. A woman has sudden severe unilateral pelvic pain with
vomiting and a known ovarian cyst. The concern is:
A. Pelvic inflammatory disease
B. OVARIAN TORSION
C. Urinary tract infection
D. Endometriosis
ANSWER: B — ovarian torsion.
Why: sudden severe unilateral pain with vomiting, especially
with a known cyst, suggests torsion of the ovarian pedicle.
The blood supply is compromised, so delay costs the ovary.
LEARNING POINT: this is time-critical in the same way as
testicular torsion — and a pregnancy test is still required.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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