Community Medicine — Health Systems and Patient Safety, NMC MBBS licence examination syllabus (Nepal Medical Council).
Health systems and patient safety — 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. Details of Nepal's health system structure and financing come from current national policy documents.
Level 1–2 — recall and understanding
Q1. A clinical audit is distinguished from research because it:
A. Generates new knowledge about what works
B. COMPARES current practice against an EXISTING STANDARD
C. Requires ethical approval in all cases
D. Is always published
ANSWER: B.
Why: audit measures practice against a standard that already
exists and aims to improve local care. Research asks what the
standard should be.
LEARNING POINT: without a change and re-measurement it is a
survey, not an audit.
Q2. "Catastrophic health expenditure" refers to:
A. The cost of running a hospital
B. OUT-OF-POCKET payment that impoverishes a household
C. National health spending
D. The cost of new technology
ANSWER: B.
Why: paying at the point of care can force families to sell
assets or borrow, and also deters them from seeking care at
all.
LEARNING POINT: prepayment and pooling protect against this;
user fees do not.
Level 3–4 — application and reasoning
Q3. A drug error occurs with look-alike ampoules on an
understaffed night shift. The nurse is disciplined and
retrained. Six months later the same error recurs. This
shows:
A. The nurse was not retrained properly
B. A PERSON APPROACH was applied to a SYSTEM problem
C. Errors are unavoidable
D. More discipline is needed
ANSWER: B.
Why: the packaging and staffing were unchanged, so the
conditions producing the error remained. Removing the person
did not remove the trap.
LEARNING POINT: blame also guarantees the next error goes
unreported.
Q4. A team measures guideline compliance, finds it poor,
presents the results, and does nothing further. This is:
A. A completed audit
B. A SURVEY — the audit loop did not close
C. Research
D. Quality improvement
ANSWER: B.
Why: an audit requires a change to be implemented and
practice re-measured to determine whether it worked.
LEARNING POINT: identify WHY the guideline is not followed
before designing the change.
Q5. A man with a chronic condition stops attending and is
labelled non-compliant. He lives four hours away and pays
for drugs and travel himself. The label is:
A. Accurate and useful
B. MISLEADING — this is an access and financing problem
C. Correct because he chose to stop
D. Irrelevant to his care
ANSWER: B.
Why: cost and distance are among the strongest determinants of
whether treatment continues, and the label stops anyone from
addressing the actual barrier.
LEARNING POINT: ask about cost and distance explicitly and
record the real reason.
Level 5 — exception-based
Q6. A "just culture" differs from a blame-free culture
because:
A. It punishes all errors
B. Honest error is treated as a system problem, but
RECKLESSNESS remains the individual's responsibility
C. It has no accountability at all
D. It applies only to senior staff
ANSWER: B.
Why: both halves are necessary. A culture with no
accountability is as unsafe as one with no psychological
safety.
LEARNING POINT: the duty to be honest with the patient
afterwards is a separate obligation — see the ethics
chapter.
Q7. Why do surgical safety checklists reduce harm?
A. They teach the team new clinical knowledge
B. They make OMISSIONS VISIBLE in a busy setting where
everyone assumes someone else has checked
C. They slow the operation down
D. They replace clinical judgement
ANSWER: B.
Why: the failures they catch are usually omissions rather than
knowledge gaps — the wrong side, a missing consent, an
unavailable implant.
LEARNING POINT: a checklist is a safety net, not a substitute
for a culture where people can speak up.
Syllabus points
Recall and understanding questions
Application and reasoning questions
Exception-based questions
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