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.
Level 1–2 — recall and understanding
Q1. In a shocked child, hypotension indicates:
A. Early compensated shock
B. A pre-terminal sign of decompensation
C. Mild dehydration
D. Normal physiology for age
ANSWER: B — a pre-terminal sign.
Why: children maintain blood pressure through tachycardia and
vasoconstriction until compensation fails. Once it does,
arrest follows quickly.
LEARNING POINT: act on heart rate, perfusion and alertness —
not on a falling blood pressure.
Q2. Oral rehydration salts work because:
A. Water alone is absorbed passively
B. Glucose-coupled sodium co-transport continues to
function in secretory diarrhoea
C. They reduce gut motility
D. They sterilise the bowel
ANSWER: B.
Why: the sodium-glucose co-transporter keeps working even
when the gut is secreting fluid, so giving both together
drives sodium absorption and water follows.
LEARNING POINT: this is why ORS must contain both — plain
water does not achieve it.
Level 3–4 — application and clinical reasoning
Q3. A 3-year-old with diarrhoea has heart rate 170,
capillary refill 4 seconds, cool peripheries and
lethargy. Blood pressure is normal for age. The correct
interpretation is:
A. Stable — the blood pressure is normal
B. Compensated shock requiring urgent treatment
C. Mild dehydration for home ORS
D. Anxiety
ANSWER: B — compensated shock.
Why: tachycardia, prolonged capillary refill, cool peripheries
and lethargy indicate significant circulatory compromise. The
normal blood pressure reflects intact compensation, not a
well child.
LEARNING POINT: waiting for hypotension in a child means
waiting for arrest.
Q4. A 4-year-old with fever has a few non-blanching purple
spots on the legs. He is irritable but talking. The
immediate action is:
A. Await lumbar puncture results before treating
B. Give parenteral antibiotics immediately
C. Oral antibiotics and review tomorrow
D. Reassure — he is talking
ANSWER: B — immediate parenteral antibiotics.
Why: a non-blanching rash with fever is meningococcal disease
until proven otherwise, and it can progress to death within
hours. Treatment precedes investigation and transfer.
LEARNING POINT: how well the child currently looks does not
buy time in this diagnosis.
Q5. A 2-year-old with diarrhoea is alert, irritable,
drinking eagerly, with slightly sunken eyes and a slow
skin pinch. The best management is:
A. Intravenous fluids and admission
B. Supervised oral rehydration with ORS and zinc
C. Antibiotics and antimotility agents
D. Withhold feeding until the diarrhoea stops
ANSWER: B — supervised ORS.
Why: alert and drinking indicates "some dehydration", which
is treated orally. Intravenous fluid is reserved for severe
dehydration, shock or inability to drink.
D: feeding is continued throughout.
LEARNING POINT: a cannula in a child who can drink adds risk
without benefit.
Level 5 — exception-based
Q6. An 18-month-old with bronchiolitis has been working
hard to breathe for hours. He becomes quieter with less
recession, and his heart rate falls from 180 to 90.
This indicates:
A. Clinical improvement
B. Exhaustion and impending respiratory arrest
C. Effective bronchodilator response
D. Sleep
ANSWER: B — exhaustion.
Why: reduced respiratory effort with a falling heart rate in a
previously distressed infant means the child is tiring.
Bradycardia in children is driven by hypoxia and precedes
arrest.
LEARNING POINT: the apparent settling IS the emergency.
Q7. A sick child is prescribed hypotonic maintenance fluid
and becomes drowsy with a falling serum sodium. The
mechanism is:
A. Excess sodium administration
B. Free water retention with high ADH activity causing
hyponatraemia and cerebral oedema
C. Dehydration
D. Hyperglycaemia
ANSWER: B.
Why: sick children have high antidiuretic hormone activity and
retain free water. Hypotonic fluid then lowers the serum
sodium, and rapid hyponatraemia causes cerebral oedema.
LEARNING POINT: use isotonic maintenance fluid and monitor
sodium — this error has killed children.
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.