Special Populations — Practice Questions

Pharmacology — Prescribing in Pregnancy and Childhood, NMC MBBS licence examination syllabus (Nepal Medical Council).

Prescribing in pregnancy and childhood — 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. All drug safety decisions, doses and formulae come from a current national formulary.

Level 1–2 — recall and understanding

Q1. The period of greatest risk of STRUCTURAL malformation from a teratogenic drug is: A. The weeks before conception B. ORGANOGENESIS in the first trimester C. The third trimester D. During labour ANSWER: B. Why: organ formation occurs in the first trimester, so exposure then risks structural abnormality. Very early exposure is largely all-or-nothing; later exposure affects growth and function. LEARNING POINT: this period is often before the woman knows she is pregnant.

Q2. Paediatric doses are calculated by weight, so the weight should be: A. Estimated from age B. MEASURED at this attendance C. Taken from the last admission D. Based on the parents' recollection ANSWER: B — measured now. Why: children grow between attendances, and an inaccurate weight produces an inaccurate dose. Estimated and recalled weights are a leading contributor to serious paediatric dosing error. LEARNING POINT: record the weight used on the chart and have the calculation checked.

Level 3–4 — application and clinical reasoning

Q3. A woman with well-controlled epilepsy discovers she is pregnant and is told to stop her antiepileptic immediately. This advice is: A. Correct — all antiepileptics are contraindicated B. DANGEROUS — uncontrolled seizures endanger mother and fetus, and abrupt withdrawal precipitates them C. Correct if she is in the first trimester D. Correct if she has been seizure-free ANSWER: B. Why: untreated maternal illness harms the fetus too, and abrupt withdrawal is a recognised precipitant of seizures. The decision requires weighing both risks with specialist input. LEARNING POINT: such changes are best made BEFORE conception.

Q4. A 26-year-old is prescribed a teratogenic drug. The single most important omission is: A. Not checking renal function B. Not ASKING WHETHER SHE COULD BE PREGNANT before prescribing C. Not warning about nausea D. Not arranging follow-up ANSWER: B. Why: organogenesis is well under way before pregnancy is usually recognised, so asking afterwards is too late. Asking every woman of childbearing age beforehand is the only question that arrives in time. LEARNING POINT: discuss contraception where a teratogenic drug is genuinely required.

Q5. A breastfeeding mother needs treatment for a common condition and is told to stop feeding "to be safe" without any source being checked. This is: A. Sensible caution B. INAPPROPRIATE — most drugs appear in milk in very small amounts and stopping has real costs C. Required for all medication D. Only relevant for antibiotics ANSWER: B. Why: the nutritional, immunological and relational costs of stopping are substantial and often permanent once formula is established. LEARNING POINT: check a current source, choose a compatible agent, and watch the infant for drowsiness or poor feeding.

Level 5 — exception-based

Q6. Why is the NEWBORN the most vulnerable group of all for drug handling? A. Newborns are simply small B. IMMATURE hepatic metabolism and renal excretion, higher body water and a more permeable blood-brain barrier C. They metabolise all drugs faster D. They cannot absorb oral drugs ANSWER: B. Why: drugs are cleared slowly, distribution differs, and agents reach the central nervous system more readily. Reserve is minimal. LEARNING POINT: older children may actually clear some drugs FASTER than adults relative to weight — handling changes with age in both directions.

Q7. Many drugs used in children are UNLICENSED for paediatric use. This means: A. They are unsafe and should be avoided B. Children are UNDER-REPRESENTED IN TRIALS — follow paediatric formulary guidance rather than adult labelling C. They cannot legally be prescribed D. They require parental consent forms ANSWER: B. Why: the licence reflects what was studied commercially, not what is known to be harmful. Withholding effective treatment on that basis would itself cause harm. LEARNING POINT: use a paediatric formulary as the source rather than adult product information.

Syllabus points

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

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