Medicine — Cancer and Palliative Care, NMC MBBS licence examination syllabus (Nepal Medical Council).
Cancer and palliative care — 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 and opioid conversions come from national guidance.
Level 1–2 — recall and understanding
Q1. When prescribing an opioid for cancer pain, you should
ALWAYS also prescribe:
A. An antibiotic
B. A LAXATIVE
C. A sedative
D. An antihypertensive
ANSWER: B — a laxative.
Why: opioid-induced constipation is predictable, near
universal, and does NOT wear off with time. It causes pain,
nausea, confusion and distress.
LEARNING POINT: nausea and drowsiness usually settle within
days; constipation does not.
Q2. The principles of cancer pain control are:
A. As required, orally, at the lowest dose
B. BY THE MOUTH, BY THE CLOCK, BY THE LADDER
C. Injections only, when pain is severe
D. Avoid opioids until the final days
ANSWER: B.
Why: oral route where possible, REGULAR dosing rather than
as-required, and stepping up the analgesic ladder as needed —
with a breakthrough dose available on top.
LEARNING POINT: as-required alone leaves the patient chasing
pain that has already returned.
Level 3–4 — application and clinical reasoning
Q3. A man with known prostate cancer has worsening back pain
and heavy legs on the stairs. The correct action is:
A. Analgesia and clinic review in ten days
B. URGENT imaging and specialist referral the same day
C. Physiotherapy
D. Reassurance
ANSWER: B.
Why: back pain with leg weakness in a patient with a
bone-seeking cancer is spinal cord compression until excluded,
and function lost before treatment is usually not regained.
LEARNING POINT: ask specifically about sensory level and
bladder function.
Q4. A patient with advanced cancer becomes confused, thirsty
and constipated over two weeks. The team attributes this
to disease progression. A treatable cause to exclude is:
A. HYPERCALCAEMIA
B. Hypoglycaemia only
C. Anaemia only
D. Nothing — it is progression
ANSWER: A — hypercalcaemia.
Why: thirst, polyuria, constipation and confusion are the
classic picture, it is common in malignancy, and it is
treatable.
LEARNING POINT: attributing new symptoms to "the cancer"
without examining is how reversible problems are missed.
Q5. A woman on as-required morphine reports pain most of the
day and has not opened her bowels for five days. The best
management is:
A. Increase the as-required dose only
B. REGULAR dosing with a breakthrough dose, PLUS a
laxative
C. Stop the morphine
D. Add a sedative
ANSWER: B.
Why: regular dosing maintains background analgesia with
breakthrough available on top — the single change that most
improves cancer pain control. Constipation needs treating and
preventing.
LEARNING POINT: take all doses and conversions from national
guidance.
Level 5 — exception-based
Q6. Why is spinal cord compression treated within HOURS
rather than days?
A. The pain worsens quickly
B. FUNCTION LOST BEFORE TREATMENT IS USUALLY NOT REGAINED
C. Imaging is only available briefly
D. It resolves spontaneously after days
ANSWER: B.
Why: a patient still walking when treated often keeps
walking; one who has been paraplegic for days usually remains
so. The window is short and does not reopen.
LEARNING POINT: this is why "review tomorrow" is the critical
error.
Q7. Which statement about palliative care is correct?
A. It begins only when active treatment stops
B. It RUNS ALONGSIDE active treatment and can begin at
diagnosis
C. It is only provided by specialists
D. It excludes investigation of any kind
ANSWER: B.
Why: symptom control, communication and support are valuable
from diagnosis onwards, and where specialist services are
scarce they are delivered by ordinary clinicians.
LEARNING POINT: "nothing more can be done" is always false —
cure may be impossible, comfort never is.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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