Psychiatry — Mood and Anxiety Disorders, NMC MBBS licence examination syllabus (Nepal Medical Council).
Depression and anxiety — 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 is MOST specific to a depressive episode,
as opposed to ordinary sadness?
A. Feeling tearful
B. ANHEDONIA — loss of interest or pleasure
C. Worrying about the future
D. Poor sleep on some nights
ANSWER: B — anhedonia.
Why: many people feel low for understandable reasons, but far
fewer lose the capacity to enjoy anything at all. Duration,
pervasiveness and loss of function also separate the two.
LEARNING POINT: anhedonia is one of the two screening
questions for exactly this reason.
Q2. A classic biological feature of depression is:
A. Difficulty falling asleep only
B. EARLY MORNING WAKENING with diurnal variation
C. Sleeping normally
D. Increased libido
ANSWER: B.
Why: early morning wakening with mood worst in the mornings
is characteristic. Appetite and weight change, loss of libido
and psychomotor change belong to the same group.
LEARNING POINT: biological features support the diagnosis and
suggest a more severe episode.
Level 3–4 — application and clinical reasoning
Q3. A 26-year-old with moderate depression describes a
two-week period two years ago of elevated mood, reduced
need for sleep and uncharacteristic overspending. The
correct action is:
A. Start an antidepressant alone
B. Recognise probable BIPOLAR disorder and refer for
specialist assessment
C. Reassure and review in six months
D. Start two antidepressants
ANSWER: B.
Why: that period describes a manic or hypomanic episode,
making this bipolar rather than unipolar depression.
Antidepressant monotherapy risks precipitating a switch into
mania.
LEARNING POINT: always ask about past elevated mood before
treating depression.
Q4. A 58-year-old smoker with hypertension has a first
episode of chest tightness, palpitations and fear of
dying, lasting 20 minutes. The correct approach is:
A. Diagnose panic attack and reassure
B. INVESTIGATE the physical differential first
C. Start an anxiolytic
D. Refer to psychiatry
ANSWER: B.
Why: panic symptoms are genuinely physical and overlap with
acute coronary syndrome, arrhythmia and thyrotoxicosis. A
first episode in an older patient with cardiac risk factors
must be investigated. Anxiety is a normal response to
frightening chest symptoms.
LEARNING POINT: panic is diagnosed once alternatives are
excluded.
Q5. A patient stops her antidepressant after 10 days saying
it does not work. The best explanation is:
A. The drug has failed and should be changed
B. The effect on mood takes WEEKS — the delay should have
been explained before prescribing
C. The dose was too low
D. She needs a second antidepressant
ANSWER: B.
Why: absence of response at 10 days is expected, not evidence
of failure. Premature discontinuation is one of the commonest
reasons antidepressant treatment fails.
LEARNING POINT: warn patients about the delay BEFORE
prescribing, and arrange early review.
Level 5 — exception-based
Q6. Which organic condition most closely mimics depression
and should be excluded?
A. HYPOTHYROIDISM
B. Hypertension
C. Osteoarthritis
D. Gastritis
ANSWER: A — hypothyroidism.
Why: fatigue, low mood, psychomotor slowing, weight change and
poor concentration are shared, and hypothyroidism is easily
tested for and treatable. Anaemia, chronic disease and
substance use are also considered.
LEARNING POINT: physical history and examination are part of a
psychiatric assessment.
Q7. Why does the period shortly after starting an
antidepressant warrant particular attention to risk?
A. The drug causes depression initially
B. Energy and psychomotor retardation may improve BEFORE
mood and hopelessness do
C. The drug is ineffective at first
D. Risk falls immediately on starting treatment
ANSWER: B.
Why: recovering energy while hopelessness persists is a
recognised concern, which is one reason early review is
arranged. Risk assessment is covered fully in the risk
assessment chapter.
LEARNING POINT: improvement is not uniform across symptoms.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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