Paediatrics — Poisoning, Injury and Child Protection, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
1. What must be checked in every drowsy child, whatever the suspected cause?
Answer: The blood glucose. Hypoglycaemia is common in unwell children, mimics almost any cause of altered consciousness, and is correctable within seconds — so missing it is both easy and avoidable.
2. Why should vomiting not be induced after a corrosive ingestion?
Answer: Because the corrosive burns the oesophagus a second time as it comes back up, turning a single injury into two. Inducing vomiting is not a useful first-aid measure in ingestions generally, and is actively harmful here.
3. A two-year-old drank kerosene stored in a drinks bottle and is now coughing. What is the main danger and how does it change management?
Answer: Aspiration into the lungs rather than absorption from the gut — the cough suggests it has already occurred. Vomiting must not be induced because that is what causes aspiration. Assess breathing and oxygenation and observe for chemical pneumonitis.
4. A child swallowed tablets an hour ago and looks entirely well. Why is this not reassuring?
Answer: Because some poisons have a silent interval during which the child appears well while damage accumulates, with organ failure appearing later. The substance must be identified and advice sought; a normal examination at one hour does not exclude a serious ingestion.
5. A four-month-old is brought with facial bruising, said to have rolled off a bed. What concerns you?
Answer: A four-month-old cannot usually roll, so the stated mechanism is not one the child is developmentally capable of. An injury inconsistent with the history — particularly bruising in a non-mobile infant — is a recognised red flag requiring documentation, same-day escalation and ensuring the infant remains safe.
6. You suspect but cannot prove that an injury was inflicted. What is the correct threshold for acting?
Answer: A reasonable concern, not certainty. The duty is to raise the concern through the agreed pathway, not to establish what happened — that is for others with different powers. Waiting for certainty means acting only once harm is undeniable, which is usually too late.
7. A single child is brought after an ingestion. What question is most often forgotten?
Answer: Whether other children were present. Small children share what they find, so a sibling who currently appears well may also have ingested the substance — and if not asked about at this visit, nobody will think of them later.
8. A child attends repeatedly with minor injuries, has faltering growth and incomplete immunisations, with no single alarming event. Is there a protection concern?
Answer: Yes. This pattern suggests neglect, which carries the same duty to escalate as a dramatic injury. It is harder to recognise precisely because it appears as an accumulation over time rather than as one event, which is why it is more often missed.
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