Medicine — Geriatric Medicine, NMC MBBS licence examination syllabus (Nepal Medical Council).
Geriatric medicine — 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. Frailty instruments and blood pressure thresholds come from local practice.
Level 1–2 — recall and understanding
Q1. An 84-year-old independent last week is admitted unable
to stand and mildly confused, labelled a "social
admission". This label is:
A. An adequate working diagnosis
B. AN UNFINISHED ASSESSMENT — an acute cause must be
sought
C. Correct if she lives alone
D. Appropriate pending social work review
ANSWER: B.
Why: someone independent a week ago who cannot manage today
has an acute problem — infection, drugs, retention,
constipation, pain, fracture or myocardial infarction.
LEARNING POINT: the label closes the inquiry exactly when it
should open.
Q2. In serious infection in an older person:
A. Fever is always present
B. FEVER AND LEUCOCYTOSIS ARE OFTEN ABSENT
C. Confusion excludes infection
D. Hypothermia excludes sepsis
ANSWER: B.
Why: the inflammatory response is blunted with age, so a
hypothermic confused older patient may be profoundly septic —
the same reversal seen in the newborn.
LEARNING POINT: treat the clinical picture, not the
temperature.
Level 3–4 — application and clinical reasoning
Q3. A man has fallen three times since an antihypertensive
was added, and takes a night sedative. The most useful
immediate steps are:
A. Physiotherapy referral alone
B. Measure LYING AND STANDING blood pressure and REVIEW
THE DRUGS
C. Brain imaging
D. Bed rest
ANSWER: B.
Why: falls are multifactorial and drugs are the most
modifiable factor. Antihypertensives and sedatives are
strongly associated with falls, and postural hypotension is
easily demonstrated and often missed.
LEARNING POINT: physiotherapy helps but does not remove the
cause.
Q4. A woman is given a drug, becomes constipated, receives a
laxative, becomes confused, receives a sedative, then
falls. This sequence is:
A. Unavoidable
B. A PRESCRIBING CASCADE — each symptom treated as a new
disease
C. Correct management
D. Due to age alone
ANSWER: B.
Why: each new symptom was treated as a new diagnosis rather
than as a possible drug effect, and each addition created the
next problem.
LEARNING POINT: review the whole chart from the beginning and
stop rather than add.
Q5. An independent 82-year-old who walks to market daily is
refused a routine treatment as "too old". This is:
A. Appropriate
B. INAPPROPRIATE — frailty and function, not age,
determine reserve
C. Correct if she lives alone
D. Correct above 80
ANSWER: B.
Why: frailty is loss of physiological reserve and is not a
synonym for age. Her described function suggests she is not
frail, and the decision is hers to make with proper
information.
LEARNING POINT: never withhold treatment on the basis of age
alone.
Level 5 — exception-based
Q6. Why is prolonged bed rest particularly harmful to older
inpatients?
A. It causes boredom
B. DECONDITIONING is rapid and takes far longer to
reverse
C. It has no significant effect
D. It reduces delirium
ANSWER: B.
Why: muscle lost over days in bed takes weeks to regain, and
immobility also brings delirium, pressure ulcers, infection
and venous thromboembolism.
LEARNING POINT: get patients up and dressed, and restore
glasses and hearing aids.
Q7. A confused older patient has a positive urine dipstick.
This means:
A. Urinary infection is confirmed as the cause
B. It does NOT prove urinary infection is causing the
confusion — keep searching
C. No further assessment is needed
D. Antibiotics alone will resolve it
ANSWER: B.
Why: asymptomatic bacteriuria is common in older people, and
attributing confusion to it stops the search for the real
cause — which may be drugs, retention, constipation, pain or
myocardial infarction.
LEARNING POINT: a plausible finding is not the same as the
explanation.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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