Medicine — The Unconscious Patient, NMC MBBS licence examination syllabus (Nepal Medical Council).
The unconscious patient — 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. All doses come from local protocol.
Level 1–2 — recall and understanding
Q1. Which investigation must be performed in EVERY unconscious
patient, without exception?
A. CT head
B. BLOOD GLUCOSE
C. Lumbar puncture
D. Toxicology screen
ANSWER: B — blood glucose.
Why: hypoglycaemia is instantly reversible, rapidly fatal if
missed, requires no laboratory and takes seconds. Every other
investigation can wait behind it.
LEARNING POINT: give thiamine alongside glucose in dependence
or malnutrition — but never withhold the glucose.
Q2. Pinpoint pupils with a slow respiratory rate in an
unconscious patient suggest:
A. Raised intracranial pressure
B. OPIOID toxicity
C. Hyperglycaemia
D. Meningitis
ANSWER: B — opioid toxicity.
Why: this is a reversible cause with an available antidote,
and the examination is typically symmetrical without focal
signs.
LEARNING POINT: a fixed DILATED pupil suggests compression
instead, and needs urgent imaging and neurosurgical
input.
Level 3–4 — application and clinical reasoning
Q3. An unconscious patient has a falling conscious level, a
new fixed dilated right pupil, rising blood pressure and
bradycardia. You should:
A. Perform a lumbar puncture to exclude meningitis
B. Treat as RAISED INTRACRANIAL PRESSURE — urgent imaging
and neurosurgical referral
C. Lower the blood pressure urgently
D. Await spontaneous improvement
ANSWER: B.
Why: these three findings together indicate rising
intracranial pressure with impending herniation. Lumbar
puncture could precipitate herniation.
LEARNING POINT: do NOT lower that blood pressure — it is
compensating to maintain cerebral perfusion.
Q4. An elderly febrile unconscious woman has NO neck
stiffness. The team defers antibiotics pending CT and
lumbar puncture. This is:
A. Correct — meningitis is unlikely without neck stiffness
B. INCORRECT — neck stiffness is often absent, and
antibiotics must not be delayed
C. Correct if she has no rash
D. Correct in patients over 70
ANSWER: B.
Why: neck stiffness is frequently absent in infants, the
elderly and the deeply unconscious. Delay to the first
antibiotic dose is what worsens outcome in bacterial
meningitis.
LEARNING POINT: take cultures, give antibiotics, then
image.
Q5. A man is brought in unconscious smelling of alcohol. The
correct approach is:
A. Allow him to sleep it off in the recovery position
B. Airway, oxygen and CHECK THE GLUCOSE, then examine
fully
C. Await sobriety before assessment
D. Immediate CT head only
ANSWER: B.
Why: alcohol on the breath explains nothing. Hypoglycaemia,
head injury, hypothermia and infection are all commoner in
dependent drinkers and are all missed by this assumption.
LEARNING POINT: give thiamine with the glucose if he is
dependent or malnourished.
Level 5 — exception-based
Q6. Which examination finding best distinguishes a STRUCTURAL
from a METABOLIC cause of coma?
A. The depth of coma
B. ASYMMETRY — of pupils, movement, tone or reflexes
C. The respiratory rate alone
D. The presence of fever
ANSWER: B — asymmetry.
Why: metabolic and toxic causes depress the whole brain, so
signs are usually symmetrical with pupils preserved. A
structural lesion produces focal signs and asymmetry.
LEARNING POINT: this single observation determines whether the
next step is urgent imaging or a metabolic screen.
Q7. Why should lumbar puncture be avoided when raised
intracranial pressure is suspected?
A. It is technically difficult
B. It can precipitate HERNIATION
C. It gives no useful information
D. It causes infection
ANSWER: B.
Why: removing cerebrospinal fluid below a pressure gradient
can allow brain tissue to shift downwards, with catastrophic
consequences.
LEARNING POINT: in suspected meningitis, give antibiotics
first and image before lumbar puncture where there are signs
of raised pressure.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
Create a free account to tick topics off, take notes as you read, watch the video lessons and get a day-by-day study plan built around your exam date.