Psychiatry — Substance Use Disorders, NMC MBBS licence examination syllabus (Nepal Medical Council).
Substance use — 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. They test principles rather than unit limits or regimens, which follow national guidance.
Level 1–2 — recall and understanding
Q1. Dependence on a substance is BEST defined by:
A. The quantity consumed each week
B. A syndrome including compulsion, tolerance, withdrawal
and CONTINUED USE DESPITE HARM
C. Drinking every day
D. Having been arrested while intoxicated
ANSWER: B.
Why: dependence describes the relationship between the person
and the substance, not an amount. Persistence despite clear
evidence of harm is the most telling feature.
LEARNING POINT: someone can be seriously harmed without being
dependent, and that group responds best to brief
intervention.
Q2. Which is a recognised feature of DELIRIUM TREMENS?
A. Pinpoint pupils and slow breathing
B. Confusion with VIVID HALLUCINATIONS, tremor, fever and
autonomic instability
C. Isolated hypotension without confusion
D. A purely psychological craving
ANSWER: B.
Why: delirium tremens follows the earlier tremulous phase and
possible seizures, and carries significant mortality if
untreated.
LEARNING POINT: it is most often precipitated by unplanned
abstinence after hospital admission.
Level 3–4 — application and clinical reasoning
Q3. A man admitted after a fall becomes tremulous on day one,
then confused, febrile and hallucinating on day two. No
alcohol history was taken. The most likely cause is:
A. Sepsis alone
B. ALCOHOL WITHDRAWAL — delirium tremens
C. Head injury alone
D. A drug reaction
ANSWER: B.
Why: this time course after admission, beginning with tremor
and anxiety, is characteristic. Admission causes abrupt
unplanned abstinence in a dependent drinker.
LEARNING POINT: withdrawal and infection can coexist — exclude
and treat both, and give thiamine.
Q4. A 26-year-old has had two injuries this year while
drinking heavily at weekends, but has no tolerance,
withdrawal or difficulty abstaining. The best action is:
A. Reassure — he is not dependent
B. Deliver a BRIEF INTERVENTION
C. Refer for inpatient detoxification
D. Start medication for dependence
ANSWER: B.
Why: he has harmful use without dependence. Injury is a
serious harm, and this pattern responds particularly well to
brief intervention.
LEARNING POINT: absence of dependence is not absence of a
problem.
Q5. A woman with low mood drinks most evenings to help her
sleep. Starting an antidepressant without discussing the
alcohol is:
A. Appropriate — treat the depression first
B. INCOMPLETE — alcohol worsens mood and sleep and
perpetuates the symptoms
C. Correct if she agrees
D. Correct because alcohol is unrelated
ANSWER: B.
Why: alcohol is both a cause and a consequence of low mood
and disrupts sleep, so it sustains the very symptoms it is
being used to treat.
LEARNING POINT: reassess mood after a period of reduced use —
depression persisting after several weeks of abstinence is
more likely to be independent.
Level 5 — exception-based
Q6. A man who injects drugs and is "not ready to stop"
attends with an abscess. Deferring hepatitis B vaccination
until he achieves abstinence is:
A. Correct — vaccination is wasted otherwise
B. WRONG — harm reduction means reducing damage NOW
C. Correct if he refuses counselling
D. Correct policy in most services
ANSWER: B.
Why: vaccination, testing, clean equipment and overdose
awareness reduce risk immediately. Withholding them removes
his only contact with services and increases harm.
LEARNING POINT: abstinence is a goal, not a precondition for
care.
Q7. Why is alcohol withdrawal potentially FATAL?
A. It causes liver failure directly
B. Chronic suppression leaves the nervous system
over-excitable, producing seizures and delirium
tremens
C. It causes immediate cardiac arrest
D. It always causes gastrointestinal bleeding
ANSWER: B.
Why: the brain compensates for chronic depression of activity
by becoming more excitable. Abrupt removal of alcohol leaves
that compensation unopposed.
LEARNING POINT: this is why withdrawal is anticipated and
treated by protocol rather than simply observed.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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