Childhood infections — 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.
Level 1–2 — recall and understanding
Q1. In a febrile child, which is the BEST guide to the
severity of illness?
A. The height of the temperature
B. How the child LOOKS and BEHAVES
C. The duration of the fever
D. The parents' level of anxiety
ANSWER: B.
Why: temperature correlates poorly with serious illness. A
child who is alert, drinking and playing between fevers is
usually well; a drowsy, floppy child who is not feeding is
not, whatever the thermometer says.
LEARNING POINT: "not feeding" is among the most reliable
danger signs in a young child.
Q2. Oral rehydration solution works because:
A. It kills the causative organism
B. Sodium absorption in the small intestine is COUPLED TO
GLUCOSE and keeps working despite inflammation
C. It stops the diarrhoea directly
D. It replaces lost red cells
ANSWER: B.
Why: glucose-coupled sodium transport continues to function
in an inflamed, secreting gut, so glucose in the solution
drives absorption of salt and water.
LEARNING POINT: also give zinc, and continue feeding.
Level 3–4 — application and clinical reasoning
Q3. A febrile, drowsy, mottled 5-year-old has spots that do
not fade under glass. The correct FIRST action is:
A. Arrange a lumbar puncture
B. Give ANTIBIOTICS IMMEDIATELY
C. Take blood cultures and await results
D. Transfer before treating
ANSWER: B — antibiotics immediately.
Why: fever with a non-blanching rash in an unwell child is
meningococcal disease until proven otherwise, and delay to the
first antibiotic dose is what worsens outcome.
LEARNING POINT: investigations and transfer follow treatment
here, never the other way round.
Q4. A 4-month-old born preterm attends for immunisation with
a runny nose, no fever, and is taking antibiotics for a
skin infection. The correct action is:
A. Defer until the antibiotics are finished
B. Defer because he was premature
C. VACCINATE TODAY per the national schedule
D. Restart the whole schedule
ANSWER: C — vaccinate today.
Why: minor illness without fever, current antibiotic use and
prematurity are all FALSE contraindications. Preterm infants
are vaccinated by actual age and benefit particularly.
LEARNING POINT: missed doses are resumed, never restarted.
Q5. An 18-month-old with diarrhoea is lethargic, has sunken
eyes, cannot drink, and the skin pinch retracts very
slowly. Management is:
A. Oral rehydration solution at home
B. INTRAVENOUS rehydration
C. An antimotility drug
D. Withhold feeds for 24 hours
ANSWER: B — intravenous rehydration.
Why: these are signs of SEVERE dehydration, and a child who
cannot drink cannot be rehydrated orally. Antimotility drugs
are avoided in children, and feeding should continue.
LEARNING POINT: ORS is for mild and moderate dehydration;
severe dehydration needs intravenous fluid.
Level 5 — exception-based
Q6. Which finding indicates SEVERE pneumonia in a child and
mandates referral rather than home treatment?
A. Fever
B. CHEST INDRAWING
C. Cough for three days
D. A runny nose
ANSWER: B — chest indrawing.
Why: fast breathing identifies pneumonia; chest indrawing
marks it as severe. Grunting, cyanosis and inability to drink
are also signs of severity.
LEARNING POINT: counting the respiratory rate needs no
equipment, which is why it anchors community case management.
Q7. Why does rubella matter clinically, given that the
childhood illness is usually mild?
A. It commonly causes encephalitis in children
B. Infection in PREGNANCY causes congenital rubella
syndrome
C. It always becomes chronic
D. It causes liver failure
ANSWER: B.
Why: rubella is a mild illness in the child but a
teratogenic infection in pregnancy, capable of causing
deafness, cardiac defects and eye abnormalities in the fetus.
LEARNING POINT: some vaccines protect the recipient mainly in
order to protect somebody else.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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