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. Fluid volumes and correction regimens come from local protocol.
Level 1–2 — recall and understanding
Q1. BILIOUS (green) vomiting in an infant should be treated
as:
A. Reflux
B. INTESTINAL OBSTRUCTION until proven otherwise
C. Overfeeding
D. Normal in the first month
ANSWER: B.
Why: bile enters at the ampulla, so bilious vomit means the
obstruction lies distal to it. Malrotation with volvulus can
infarct the entire midgut within hours.
LEARNING POINT: this is an urgent surgical referral, never an
overnight observation.
Q2. The classic metabolic abnormality in pyloric stenosis is:
A. Metabolic acidosis with high potassium
B. HYPOCHLORAEMIC HYPOKALAEMIC METABOLIC ALKALOSIS
C. Respiratory alkalosis
D. Normal biochemistry
ANSWER: B.
Why: persistent vomiting of gastric contents loses hydrogen
and chloride ions, producing alkalosis with hypochloraemia and
hypokalaemia.
LEARNING POINT: correct fluids and electrolytes BEFORE
surgery — alkalosis risks post-operative apnoea.
Level 3–4 — application and clinical reasoning
Q3. A 3-week-old vomits green fluid but looks well with a
soft abdomen. The correct action is:
A. Observe overnight and review in the morning
B. URGENT surgical referral and imaging now
C. Change the feed
D. Discharge with advice
ANSWER: B.
Why: looking well is characteristic of EARLY midgut volvulus,
not evidence against it. Ischaemia develops within hours and
bowel loss can be catastrophic.
LEARNING POINT: keep nil by mouth, pass a nasogastric tube and
give fluids per protocol while arranging assessment.
Q4. A 9-month-old has episodes of drawing up his legs,
screaming and going pale, but plays normally between
episodes. He has vomited twice. This suggests:
A. Colic — discharge
B. INTUSSUSCEPTION
C. Gastroenteritis
D. Constipation
ANSWER: B.
Why: intermittent severe colic with pallor and an apparently
well interval is the classic pattern. The well interval is a
feature of the disease, not evidence against it.
LEARNING POINT: redcurrant jelly stool is a LATE sign — do not
wait for it.
Q5. A newborn whose mother had polyhydramnios froths at the
mouth and becomes cyanosed at the first feed. You should:
A. Feed more slowly
B. STOP FEEDING, attempt to pass a tube, and refer
urgently
C. Give oxygen and continue feeding
D. Reassure
ANSWER: B.
Why: this suggests oesophageal atresia. Continued feeding
risks aspiration and pneumonia, and inability to pass a tube
into the stomach supports the diagnosis.
LEARNING POINT: antenatal polyhydramnios should raise
suspicion BEFORE the first feed.
Level 5 — exception-based
Q6. Why is vigorous BAG-MASK ventilation avoided in suspected
congenital diaphragmatic hernia?
A. It causes pneumothorax only
B. It INFLATES THE HERNIATED BOWEL in the chest and
worsens lung compression
C. It is ineffective
D. It causes hypothermia
ANSWER: B.
Why: air forced into bowel that lies within the thorax
increases compression of the already hypoplastic lung.
Intubation is preferred where available.
LEARNING POINT: look for a scaphoid abdomen and bowel sounds
in the chest.
Q7. Why is an inguinal hernia in an infant repaired PROMPTLY
rather than watched?
A. It never resolves
B. The risk of INCARCERATION is far higher than in adults,
and it threatens both bowel and TESTIS
C. It is always painful
D. It causes constipation
ANSWER: B.
Why: incarceration is common in infancy and compromises the
testicular vessels as well as the bowel.
LEARNING POINT: always check both testes are in the scrotum
when examining a child's groin.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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