Paediatrics — Respiratory Illness in Children, NMC MBBS licence examination syllabus (Nepal Medical Council).
Paediatric respiratory — 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. Stridor in a child indicates obstruction of the:
A. Bronchioles
B. UPPER airway — larynx or trachea
C. Alveoli
D. Pleural space
ANSWER: B — the upper airway.
Why: stridor is harsh and predominantly inspiratory, loudest
over the neck. Wheeze is musical and predominantly expiratory,
heard over the chest, and comes from the lower airways.
LEARNING POINT: the noise localises the obstruction, which is
the first step in the differential.
Q2. Which feature most suggests EPIGLOTTITIS rather than
croup?
A. Barking cough
B. DROOLING with a muffled voice and rapid onset
C. Preceding coryza
D. Hoarse voice
ANSWER: B.
Why: epiglottitis develops over hours with drooling (because
swallowing hurts), a muffled voice, toxicity and little cough.
Croup is gradual with a barking cough and hoarse voice.
LEARNING POINT: never examine the throat when epiglottitis is
suspected.
Level 3–4 — application and clinical reasoning
Q3. A child in a severe asthma attack stops wheezing, the
chest becomes quiet and he becomes drowsy. This means:
A. He is improving
B. LIFE-THREATENING deterioration — too little air is
moving to generate wheeze
C. The diagnosis was wrong
D. He is asleep
ANSWER: B.
Why: wheeze requires air movement. A silent chest with
drowsiness in an exhausted child indicates impending
respiratory failure.
LEARNING POINT: getting quieter is not the same as getting
better — escalate urgently.
Q4. A 4-year-old has stridor over a few hours, high fever,
drooling and sits leaning forward. The correct immediate
action is:
A. Examine the throat with a tongue depressor
B. Lie him flat and take blood
C. Keep him CALM with a parent and summon senior airway
help
D. Send him for a lateral neck X-ray alone
ANSWER: C.
Why: these features suggest epiglottitis. Examining the
throat, cannulating, or lying the child flat can precipitate
complete airway obstruction. He has adopted the position that
keeps his airway open.
LEARNING POINT: definitive examination happens where the
airway can be secured.
Q5. A 2-year-old had a sudden choking episode while eating
peanuts, and now has persistent cough with unilateral
wheeze. The chest X-ray is normal. You should:
A. Treat as a viral illness
B. Refer for BRONCHOSCOPY
C. Repeat the X-ray in a month
D. Reassure
ANSWER: B — bronchoscopy.
Why: most inhaled objects are food and are not radio-opaque,
so a normal film excludes nothing. A clear choking history in
a previously well child is powerful evidence.
LEARNING POINT: missed foreign bodies present later as
recurrent or non-resolving pneumonia in the same lobe.
Level 5 — exception-based
Q6. Why is bacteriological confirmation of tuberculosis often
unsuccessful in young children?
A. The organism is different
B. Children rarely produce sputum and their disease is
PAUCIBACILLARY
C. Tests are unavailable
D. Children clear the infection quickly
ANSWER: B.
Why: young children swallow rather than expectorate, and carry
few organisms. A negative result therefore does not exclude
TB, and diagnosis rests on contact history, persistent cough,
weight loss, fever and imaging.
LEARNING POINT: screen child contacts of any adult with
pulmonary TB.
Q7. In a wheezy child, which single question best assesses
severity at the bedside?
A. How long has the wheeze lasted?
B. Can the child FEED and TALK?
C. Is there a family history of asthma?
D. What colour is the sputum?
ANSWER: B.
Why: inability to feed or complete sentences reflects the work
of breathing directly. Other severity signs include marked
recession, drowsiness, cyanosis and a silent chest.
LEARNING POINT: a child too breathless to feed is a child in
trouble.
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.