NORCET 10 Mains CHN Pharma MCQs with Answers for Quick Revision

With NORCET 10 Mains approaching, practising high-yield CHM Pharma MCQs is one of the smartest ways to strengthen revision and boost scoring confidence. These exam-focused questions are curated from frequently tested clinical and surgical concepts, helping you sharpen accuracy, revise key facts quickly, and prepare for real exam-level scenarios in the final days before the exam.

NORCET 10 Mains CHN Pharma Most Important MCQs

Question 1: What is the earliest sign of postoperative volume overload in a patient?

A. Distended neck veins
B. Peripheral edema
C. Weight gain
D. Increased cardiac output

Answer: C) Weight gain 

The earliest and most reliable sign of postoperative volume overload is Weight Gain. This directly reflects increased fluid retention before other clinical signs, such as distended neck veins or peripheral edema, become evident. Daily weight checks are crucial for monitoring fluid status in postoperative patients.

Question 2: Ileus is common in patients with conditions associated with:

A. Volume deficit
B. Volume excess
C. Both A and B
D. Bowel edema

 Answer: A. Volume deficit

Ileus is a functional disruption of the intestines' normal propulsive activity, leading to hypoperfusion in the bowel. This hypoperfusion results in a volume deficit. Unlike volume overload, which causes pulmonary edema, a volume deficit due to ileus typically has no significant or specific effect on the lungs.

Question 3:Which parameter is the best guide to monitor adequacy of fluid resuscitation?

A. Central venous pressure
B. Urine output
C. Blood pressure
D. Oxygen saturation

Answer: B. Urine output

The Urine Output is the best and most sensitive parameter to monitor the adequacy of fluid resuscitation.

• Normal Urine Output in Adults:

• 0.5 mL/kg/hour

• 30 mL/hour (for general hourly assessment)

• Approximately 720 mL/24 hours (30 mL/hour * 24 hours).

Question 4: All of the following are indications to give fluid bolus EXCEPT:

A. Tachycardia
B. Low hematocrit
C. Restlessness
D. Cool peripheries

Answer: B. Low hematocrit

When monitoring a burn patient for adequate fluid resuscitation, indicators of hypoperfusion include Tachycardia, Restlessness, Cool Peripheries, and High Hematocrit (indicating hemoconcentration). Low Hematocrit is NOT an indication for bolus fluid, as it suggests normal fluid status, fluid overload, or anemia, not hypoperfusion due to fluid deficit.

Question 5: What is the main source of endogenous fluid in the body?

A. Consumed liquids
B. Reduction of solid food
C. Oxidation of solid food
D. Both A and C

Answer: C. Oxidation of solid food

The primary source of endogenous fluid (fluid produced within the body) is the oxidation of solid food stuffs. In this metabolic process, glucose and oxygen combine to produce carbon dioxide, water, and energy. The water generated is the main endogenous fluid source. When external fluid intake is insufficient, the body increases its reliance on this internal water production.

Question 6: A patient with a stab wound to the abdomen underwent an emergency laparotomy. After the damaged intestine was resected, less than 100 cm of jejunum remained and a jejunostomy was made. Which of the following is not true?
A. The patient is a net secretor
B. Water intake should be less than a litre a day
C. Ensure adequate resuscitation with hypotonic fluids
D. Anti-secretory drugs should be administered

Answer: C. Ensure adequate resuscitation with hypotonic fluids

The jejunum is crucial for water and sodium absorption. In a patient with a jejunostomy where less than 100 cm of jejunum remains, the patient becomes a net secretor, leading to fluid and sodium loss via the jejunostomy. Conversely, if more than 150 cm remains, the patient often becomes a net absorber.

For patients with a short remaining jejunum, fluid management includes:

• Limiting water intake to less than 1 liter per day.

• Using hypertonic fluid for resuscitation, not hypotonic.

• Administering antisecretory drugs to reduce fluid secretion.

Question 7: A patient with Crohn's disease has multiple skip lesions in the intestine. Surgical resection of damaged areas is being planned. Removal of which part will cause steatorrhoea?

A) Duodenum

B) Jejunum

C) Ileum

D) Caecum

Answer: C) Ileum

Surgical removal of the ileum (specifically terminal ileum) in Crohn's disease will cause steatorrhea. The ileum is responsible for absorbing Vitamin B12 and fat. Its removal impairs fat absorption, leading to the presence of excessive fat in the stool.

Question 8: In spinal cord injury with hypotension, which finding is NOT seen?

A. Tachycardia
B. Warm extremities
C. Decreased venous return
D. Increased vascular capacitance

Answer: A. Tachycardia

A patient with spinal cord injury and hypotension may be experiencing Neurogenic Shock. Expected findings include Warm Extremities, Decreased Venous Return, and Increased Vascular Capacitance. The exception is Tachycardia; neurogenic shock is characterized by bradycardia due to the loss of sympathetic tone.

Question 9: Modified shock index is calculated using?

• A) HR/SBP

• B) HR/DBP

• C) HR/MAP

• D) PR/SBP

Correct Answer: C) HR/MAP

The Shock Index (SI) is calculated as Heart Rate / Systolic Blood Pressure. The Modified Shock Index (MSI), calculated as Heart Rate / Mean Arterial Pressure (MAP), is considered a more sensitive indicator of hemodynamic stability. An MSI value of 0.9 or greater indicates higher mortality risk.

Question 10: Peripheral vascular resistance decreases in:

A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock

Answer: D. Distributive shock

Peripheral vascular resistance decreases in Distributive Shock. This type of shock includes Septic, Anaphylactic, and Neurogenic Shock. The table below compares hemodynamic parameters across different shock types:

Question 11: A patient who was admitted with third-degree burns presents with light-headedness and oliguria on the third day of admission. On examination, the peripheries are warm and capillary refill is brisk. His pulse rate is 138/min. In which of the following types of shock do you see this presentation?

A) Hypovolemic shock

B) Septic shock

C) Cardiogenic shock

D) Endocrine shock

Answer: B) Septic shock

A patient with third-degree burns presenting on the third day with lightheadedness, oliguria, warm peripheries, brisk capillary refill, and tachycardia (138 bpm) is indicative of Septic Shock. This is a common complication in burn patients due to infection.

Question 12: An 82-year-old man with a history of recurrent urinary tract infection presents with fever, tachypnea, and tachycardia. On examination, he appears confused and has [hypotension]. Which of the following is used as the initial treatment for his condition?

• A) Vasopressors

• B) Blood transfusion

• C) Crystalloids

• D) Inotropic agents

Answer: C) Crystalloids

For an elderly patient with recurrent UTI and symptoms suggestive of Septic Shock (fever, tachypnea, tachycardia, confusion), initial treatment priorities are:

1. Aggressive Intravenous Fluid (IVF) Administration: Crystalloids (e.g., Normal Saline, Lactated Ringer's) at approximately 30 mL/kg body weight within 3 hours.

2. Initiate Empirical Antibiotics: Within one hour of diagnosis.

3. Administer Vasopressors: If fluids alone are insufficient, Norepinephrine is the inotrope of choice.

Question 13: Most common electrolyte abnormality in pancreatitis:

A. Hypercalcemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperkalemia

Answer: B. Hypocalcemia

The most common electrolyte abnormality associated with pancreatitis is hypocalcemia. This occurs due to the saponification of fat, where calcium ions combine with fatty acids released from necrotic fat, thus depleting serum calcium levels.

Question 14: A cachectic patient with a BMI of 14 was brought to a nursing care facility. Calorie-rich food through a nasogastric tube was started. On day 3 of therapy, the patient suddenly developed a seizure. An ECG showed dysrhythmia. Which of the following findings is most likely?

A) Hypophosphatemia, hypocalcemia, hypomagnesemia

B) Hypophosphatemia, hypokalemia, hypercalcemia

C) Hypocalcemia, hyperphosphatemia, hypokalemia

D) Hypomagnesemia, hyponatremia, hyperkalemia

Answer: A. Hypophosphatemia, hypocalcemia, hypomagnesemia

Refeeding syndrome is a fatal condition in severely malnourished patients receiving rapid, excessive caloric intake. The sudden increase in metabolism and insulin release causes an increased cellular uptake of electrolytes, leading to a significant decrease in blood electrolyte levels. The three key hypo-electrolytemias are Hypophosphatemia, Hypocalcemia, and Hypomagnesemia. Hypocalcemia can cause arrhythmias and congestive heart failure, which are main causes of death.

Question 15: Which of the following is not true regarding the Enhanced Recovery After Surgery (ERAS) protocol?

A) Early planned physiotherapy and mobilization

B) It can be used after colorectal surgery

C) Waiting for one week to start oral feeding

D) Discharge planning is started before the patient is even admitted to hospital

Answer: C

The ERAS protocol aims to accelerate patient recovery after surgery, reduce hospital stay, and decrease costs. Its principles include early planned physiotherapy and mobilization, applicability to various surgeries (e.g., colorectal), and starting discharge planning before hospital admission. The statement that waiting for one week to start oral feeding is a compulsory aspect of ERAS is NOT TRUE, as feeding timing varies greatly based on surgery type and patient condition.

Question 16: A 60-year-old male who is on warfarin prophylaxis for atrial fibrillation presents with massive uncontrolled haemorrhage following a fall from height. Which of the following blood components can be used for emergency reversal of warfarin therapy in this patient?

A) Cryoprecipitate

B) Prothrombin complex concentrates (PCC)

C) Fresh-frozen plasma (FFP)

D) Platelets

Answer: B

For emergency reversal of warfarin therapy in patients with massive uncontrolled hemorrhage, Prothrombin Complex Concentrate (PCC) is the best choice. PCC contains Factor II, Factor IX, and Factor X.

• Antidotes:

• Heparin: Protamine Sulfate

• Warfarin: Vitamin K (for non-emergency reversal) and PCC (for emergency reversal).

Question 17: Cryoprecipitate is stored at a temperature of ............

A) -20°C

B) -30°C

C) -40°C

D) -50°C

Correct Answer: B

Cryoprecipitate is derived from Fresh Frozen Plasma (FFP) and contains Fibrinogen and Factor VIII. It should be stored at -20°C to -30°C (preferably -30°C for 2 years). Once removed from storage and brought to normal temperature, it must be administered within 30 minutes.

Question 18: A 22-year-old male patient was brought to the emergency room following a road traffic accident. Upon arrival, the patient was unconscious with blood pressure of 90/64 mmHg and a pulse rate of 139 per minute. He was immediately transfused with 4 units of packed RBCs. All of the following complications can occur in this patient except:

A) Hypercalcemia

B) Hyperkalemia

C) Hypokalemia

D) Metabolic alkalosis

Answer: A

Massive Blood Transfusion is defined as transfusing more than 4 units of blood in 1 hour or 10 units in 24 hours. Complications include hypocalcemia (due to citrate toxicity), hypokalemia, hyperkalemia, hypomagnesemia, and metabolic alkalosis. Hypercalcemia is generally NOT a complication and is the LEAST likely to occur. The Lethal Triad critical for patient survival in massive transfusion is Acidosis, Hypothermia, and Coagulopathy.

Question 19: A young patient is brought to the emergency room following a motorcycle collision. On examination, the patient is drowsy and has decreased blood pressure due to bleeding from multiple injuries. 1 unit of packed RBCs has been obtained from the blood bank. What is the correct procedure for blood transfusion?

A) The blood should be brought to room temperature before the transfusion

B) Transfusion should be started within one hour of removal from the refrigerator

C) Transfusion of PRBC should be completed within 4 hours

D) The rate of transfusion of PRBC is 50ml per hour

Answer: C

The transfusion of Packed Red Blood Cells (PRBCs) should be completed within 4 hours. The typical transfusion rate is 100-150 mL per hour. While blood warms gradually during infusion, it is not strictly necessary to bring it to full room temperature beforehand. Transfusion should ideally be initiated within 30 minutes of removal from controlled storage, not within an hour.

• Administration Time for Blood Products:

• PRBCs: Transfusion completed within 4 hours.

• Platelets, Fresh Frozen Plasma (FFP), Cryoprecipitate: Administered within 30 minutes of removal from storage.

Question 20: A patient with a road traffic accident presented to the emergency room and requires a large amount of fluids to be transfused. Which of the following IV cannula is preferred?

A) Green (18G)

B) Blue (22G)

C) Pink (20G)

D) Grey (16G)

Answer: D

.

For a patient requiring a large amount of fluid to be transfused rapidly, the largest possible cannula size should be selected. Among the given options, the Grey cannula (16 Gauge) is preferred.

• Cannula Gauges and Colors:

• Pink: 20 Gauge

• Blue: 22 Gauge

• Green: 18 Gauge

• Grey: 16 Gauge

• Orange: 14 Gauge

• White: 17 Gauge

Question 21: Which of the following are used to stop esophageal variceal bleed?

A) A, B, C and D

B) A and B only

C) A, B and C

D) A, B and D

Answer: D

Methods used to stop esophageal varices bleeding include:

• Sengstaken-Blakemore Tube: Features three lumens (one gastric aspiration port, two for gastric and esophageal balloon inflation) for tamponade.

• Minnesota Tube: Similar to Sengstaken-Blakemore but with four openings allowing for both gastric and esophageal aspiration.

• Upper GI Endoscope: Used for both diagnosis and treatment (e.g., band ligation, sclerotherapy) of bleeding varices.

Question 22: A patient has the catheter shown below (Malecot catheter) inserted for draining a large liver abscess. All of the following statements are true except:

A) It is a self-retaining catheter

B) It may be introduced into the urethra to relieve bladder retention

C) It can be placed percutaneously through an existing nephrostomy

D) It is radio-opaque

Answer: A) It is a self-retaining catheter

The Malecot catheter, identifiable by its "flower-like" self-retaining tip, is used for draining large abscesses. It is a self-retaining catheter, is radiopaque, and can be used in nephrostomy, suprapubic cystostomy, cholecystostomy, gastrostomy, and amebic liver abscess drainage. However, it is NEVER introduced perurethrally for bladder retention due to its design and size.

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