Medicine — GI Bleeding and Dyspepsia, NMC MBBS licence examination syllabus (Nepal Medical Council).
GI bleeding and dyspepsia — 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. Melaena indicates bleeding from:
A. The colon
B. An UPPER gastrointestinal source, of significant volume
C. Haemorrhoids
D. The urinary tract
ANSWER: B.
Why: blood must be digested to become black, tarry and
offensive, which requires both time in the gut and a
substantial volume.
LEARNING POINT: conversely, a very brisk upper bleed can
present as fresh red rectal blood.
Q2. Which is an ALARM feature in dyspepsia requiring urgent
endoscopy?
A. Symptoms worse after spicy food
B. DYSPHAGIA
C. Symptoms for two weeks in a young patient
D. Relief with antacids
ANSWER: B — dysphagia.
Why: alarm features are dysphagia, weight loss, persistent
vomiting, GI bleeding or anaemia, an epigastric mass,
progressive symptoms and new dyspepsia in an older patient.
LEARNING POINT: dysphagia is never treated empirically.
Level 3–4 — application and clinical reasoning
Q3. A patient vomits a large volume of blood. He is pale with
a pulse of 118 and systolic 112. The initial haemoglobin
is NORMAL. This means:
A. Blood loss has been minimal
B. NOTHING — haemoglobin falls late in acute haemorrhage
C. The bleeding has stopped
D. The sample was taken incorrectly
ANSWER: B.
Why: in acute haemorrhage whole blood is lost, so
concentration falls only as plasma volume is restored. His
tachycardia and appearance are the real information.
LEARNING POINT: judge severity by physiology, not by the first
haemoglobin.
Q4. A 72-year-old with melaena says he takes "no medicines".
His family later report he buys painkillers weekly and
takes daily low-dose aspirin. This illustrates that:
A. The history was deliberately misleading
B. Patients often do not count OVER-THE-COUNTER drugs as
medicines — ask specifically
C. Aspirin does not cause ulcers
D. NSAIDs always cause pain first
ANSWER: B.
Why: over-the-counter analgesics, low-dose aspirin and
traditional remedies are frequently not reported. NSAID ulcers
in older patients are often painless until they bleed.
LEARNING POINT: ask specifically about them in every
patient.
Q5. A 66-year-old man has iron deficiency anaemia with no
visible bleeding and no bowel symptoms. The correct
management is:
A. Iron replacement and dietary advice alone
B. Iron replacement AND investigation of the
gastrointestinal tract
C. Reassurance
D. Repeat the blood count in one year
ANSWER: B.
Why: in a man of any age, or a post-menopausal woman,
unexplained iron deficiency anaemia is gastrointestinal blood
loss until proven otherwise. Occult bleeding is invisible by
definition.
LEARNING POINT: iron alone corrects the number and hides the
cause.
Level 5 — exception-based
Q6. Why does finding haemorrhoids NOT explain a patient's
rectal bleeding?
A. Haemorrhoids never bleed
B. Haemorrhoids are so common that most people with
colorectal cancer also have them
C. They only bleed after surgery
D. They cause melaena instead
ANSWER: B.
Why: a coexisting benign finding excludes nothing. Change in
bowel habit, blood mixed in the stool, weight loss and iron
deficiency anaemia all point elsewhere.
LEARNING POINT: abdominal and rectal examination in every
case, and investigate when red flags are present.
Q7. In upper gastrointestinal bleeding, a raised urea with a
normal creatinine reflects:
A. Acute kidney injury
B. ABSORBED BLOOD PROTEIN from the gut
C. Dehydration only
D. Laboratory error
ANSWER: B.
Why: digested blood is absorbed as protein and metabolised to
urea, so the urea rises disproportionately to the creatinine.
It supports an upper source.
LEARNING POINT: it is a supportive clue, not a substitute for
resuscitation and endoscopy.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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