Snakebite — Practice Questions

Medicine — Snakebite and Environmental Emergencies, NMC MBBS licence examination syllabus (Nepal Medical Council).

Snakebite and environmental emergencies — 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. Antivenom dosing and species-specific guidance come from the national snakebite management guideline.

Level 1–2 — recall and understanding

Q1. Correct first aid for snakebite includes: A. Applying a tight tourniquet above the bite B. REASSURE, IMMOBILISE the limb and TRANSPORT urgently C. Incising and sucking the wound D. Applying ice and a herbal poultice ANSWER: B. Why: tourniquets cause limb ischaemia and can release a bolus of venom when removed. Incision, suction, ice and poultices either do nothing or cause harm. LEARNING POINT: the only effective treatment is antivenom in hospital — delay is a major cause of death.

Q2. The characteristic FIRST sign of neurotoxic envenoming is: A. Bleeding gums B. PTOSIS C. Haematuria D. Local necrosis ANSWER: B — ptosis. Why: neurotoxic envenoming produces a descending paralysis beginning with the eyelids, then eye movements, swallowing and speech, and finally the respiratory muscles. LEARNING POINT: look for it deliberately — it is easy to miss.

Level 3–4 — application and clinical reasoning

Q3. A man has ptosis, diplopia and difficulty swallowing after a bite, but the bite site looks almost normal. This means: A. He is unlikely to be envenomed B. He has SYSTEMIC ENVENOMING — minimal local signs mean nothing C. He has an unrelated neurological illness D. Antivenom is not indicated ANSWER: B. Why: neurotoxic bites, particularly at night indoors, may be almost painless with minimal local signs. Judging severity by the bite site is a recognised route to a preventable death. LEARNING POINT: he needs antivenom and preparation for airway support.

Q4. Before starting an antivenom infusion, you must: A. Give prophylactic antibiotics B. Have ADRENALINE and resuscitation equipment at the bedside C. Obtain a species identification D. Wait for laboratory clotting results ANSWER: B. Why: antivenom carries a real risk of anaphylaxis, so the means to treat it must be immediately available before the infusion begins. LEARNING POINT: antivenom is indicated for systemic envenoming, not for every bite.

Q5. A labourer collapses in hot weather, is very hot and is CONFUSED. The correct management is: A. Paracetamol and rest in the shade B. IMMEDIATE AGGRESSIVE PHYSICAL COOLING — this is heat stroke C. Oral fluids alone D. Observation for two hours ANSWER: B. Why: altered mental state distinguishes heat stroke from heat exhaustion and makes it a medical emergency. Antipyretics do not work because the hypothalamic set point is normal. LEARNING POINT: check the glucose and watch for rhabdomyolysis, AKI and coagulopathy.

Level 5 — exception-based

Q6. Why can a patient with complete flaccid paralysis from neurotoxic envenoming still recover fully? A. The venom does not reach the brain B. The paralysis is REVERSIBLE, so a ventilated patient survives until the venom is cleared or neutralised C. Paralysis is always mild D. Antivenom is unnecessary ANSWER: B. Why: death is from respiratory muscle paralysis, not brain injury. Ventilatory support carries the patient through until recovery. LEARNING POINT: such a patient may be fully AWARE while unable to move — speak to them.

Q7. A trekker develops ATAXIA and confusion at altitude. The priority is: A. Rest at the same altitude B. IMMEDIATE DESCENT C. Increase fluid intake only D. Continue ascending slowly ANSWER: B — immediate descent. Why: ataxia with confusion suggests high altitude cerebral oedema. Descent is the definitive treatment; oxygen and drugs are adjuncts that buy time. LEARNING POINT: breathlessness AT REST suggests high altitude pulmonary oedema — also requiring descent.

Syllabus points

Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions

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