Environmental Health — Practice Questions

Community Medicine — Environmental and Occupational Health, NMC MBBS licence examination syllabus (Nepal Medical Council).

Environmental and occupational health — 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. Exposure limits and water quality thresholds come from national standards.

Level 1–2 — recall and understanding

Q1. Chronic obstructive pulmonary disease in a woman who has NEVER smoked should prompt you to ask about: A. Family history only B. COOKING FUEL and household air pollution C. Alcohol intake D. Dietary salt ANSWER: B. Why: solid fuel burned indoors on an open or poorly vented stove is a major cause of COPD in never-smoking women, who spend hours daily beside it. LEARNING POINT: equating COPD with smoking systematically misses the group most affected.

Q2. In the hierarchy of control for occupational hazards, personal protective equipment is: A. The FIRST and most effective measure B. The LAST resort, after elimination, substitution and engineering controls C. Never appropriate D. Equivalent to engineering controls ANSWER: B — the last resort. Why: PPE protects one person at a time, only while correctly worn and maintained. Elimination and substitution remove the hazard for everyone and depend on nobody's behaviour. LEARNING POINT: the instinctive answer is the wrong one, which is why it is examined.

Level 3–4 — application and reasoning

Q3. A worker's wheeze improves markedly on days off and during a week away, returning within a day of resuming work. This suggests: A. Poor inhaler technique B. OCCUPATIONAL ASTHMA C. Seasonal allergy D. Anxiety ANSWER: B. Why: improvement away from work with recurrence on return is close to diagnostic. Continued exposure risks permanent fixed airflow obstruction. LEARNING POINT: ask this question of anyone with adult-onset asthma, and ask about affected colleagues.

Q4. A man from a village using tubewell water has pigmentation changes and thickened KERATOSES on palms and soles. You should consider: A. Psoriasis only B. CHRONIC ARSENIC exposure — and test the water source C. Vitiligo D. Fungal infection ANSWER: B. Why: pigmentation change with palmar and plantar keratoses is the characteristic cutaneous picture of chronic arsenic exposure. Arsenic is tasteless and odourless and cannot be detected without testing. LEARNING POINT: consider the whole community — others drink the same water.

Q5. Stone-cutting workers develop breathlessness. The employer supplies cloth masks. The best assessment is: A. Adequate — PPE has been provided B. INADEQUATE — control should begin with dust suppression and extraction, and TB must be excluded C. Adequate if masks are worn constantly D. Only ergonomic assessment is needed ANSWER: B. Why: PPE is the last resort, and cloth masks do not protect against respirable silica. Engineering controls such as wet cutting and extraction protect everyone. LEARNING POINT: silica exposure substantially increases tuberculosis risk — exclude TB actively.

Level 5 — exception-based

Q6. Why can providing a tubewell sometimes create a new health problem? A. Groundwater always contains bacteria B. It may solve MICROBIOLOGICAL contamination while introducing CHEMICAL contamination such as arsenic C. Tubewells cannot be maintained D. It reduces water consumption ANSWER: B. Why: moving from contaminated surface water to groundwater addresses faecal contamination but may expose a community to naturally occurring arsenic or fluoride. LEARNING POINT: safe water means TESTED water — for chemistry as well as microbiology.

Q7. Why does a silica-exposed worker with chronic cough need TUBERCULOSIS actively excluded? A. Silicosis is caused by TB B. Silica exposure substantially INCREASES TB RISK, and the two can coexist C. TB always precedes silicosis D. They cannot occur together ANSWER: B. Why: silicosis and tuberculosis share a strong association, and the radiological and clinical pictures overlap. Assuming one excludes the other is a recognised error. LEARNING POINT: exclude TB actively rather than attributing symptoms to dust exposure alone.

Syllabus points

Recall and understanding questions
Application and reasoning questions
Exception-based questions

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