CMS 2024

The height of the Jugular Venous Pulse is determined by:

The SA node is situated at the junction of:

High output cardiac failure is caused by which of the following diseases?

1. Beri-beri
2. Severe anaemia
3. Thyrotoxicosis

Select the correct answer using the code given below:

Reverse splitting of second heart sound is most commonly seen in:

Which of the following are major criteria under the Jones Criteria for Acute Rheumatic Fever?

1. Chorea
2. Erythema Marginatum
3. Subcutaneous Nodules
4. Polyarthralgia

A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud diamond-shaped, rough quality systolic murmur best heard at the right 2nd intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis?

Which one of the following is the appropriate scoring system used to assess the risk of stroke in patients of non-valvular chronic atrial fibrillation on oral anticoagulation?

1. Unexplained breathlessness is the most common symptoms
2. When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should be considered.
3. Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without  obligatory imaging tests. 

Consider the following criteria :

1. Pleural fluid protein : Serum protein ratio > 0.5
2. Pleural fluid LDH : Serum LDH ratio > 0.6
3. Pleural fluid LDH > Two-thirds of the upper limit of normal serum LDH

Which of the following statements are correct with regard to clubbing ?

1. It usually affects the fingers symmetrically.
2. It does not involve the toes.
3. It may be associated with malignant lung conditions.
4. It may recede following the lung transplantation in cystic fibrosis.

Consider the following statements regarding Lofgren syndrome :

1. It is an acute illness and is more commonly seen in females.
2. It is a clinically distinct phenotype of sarcoidosis characterized by peripheral arthropathy and uveitis.
3. Clinical features include fever, erythema, nodosum and bilateral lymphadenopathy.

Which of the following investigations may be used for the diagnosis of pulmonary tuberculosis ?

1. Nucleic acid amplification
2. Culture in Middlebrook medium
3. Light emitting diode fluorescent microscopy with auramine staining
4. Peripheral blood smear

The distance walked in 6 minutes is an indirect measure of which of the following variables of the ‘BODE Index’ which is used to assess the prognosis in chronic obstructive pulmonary disease?

A 65-year-old female, a stone-cutter by occupation had multiple well circumscribed nodular opacities in upper and middle zones of a chest X-ray along with mediastinal lymph nodes showing egg-shell calcification. Which one of the following is the most likely etiology ?

Which of the following are complications of acute pancreatitis ?

1. Hypoxia
2. Hypercalcemia
3. Hyperglycemia
4. Reduced serum albumin

The Gold Standard for diagnosis of Celiac disease is:

1. Proton-pump inhibitor is taken with two antibiotics.
2. Treatment is prescribed for at least 7 days.
3. Treatment of Helicobacter pylori infection leads to vitamin B12 deficiency.  
4. Patients requiring long-term NSAIDs should undergo Helicobacter pylori eradication therapy to reduce ulcer risk.

Which of the following are precipitating factors for hepatic encephalopathy ?

1. Hypokalemia
2. Septicemia
3. Increased dietary protein load

Which one of the following statements is correct regarding Upper Gastro Intestinal Bleeding (UGIB)?

Crigler-Najjar syndrome Type-I is inherited as an:

Which of the following are risk factors for wound infection?

1. Malnutrition
2. Poor perfusion
3. Antibodies
4. Foreign body material

1. Leukaemia
2. Lung cancer
3. Breast cancer
4. Lymphoma 

Which of the following are correct regarding Li-Fraumeni syndrome?

1. It has autosomal dominant inheritance and is associated with P53 gene.
2. It has autosomal recessive inheritance and is associated with P53 gene.
3. It is associated with an increased risk of sarcomas and leukaemia.
4. It is associated with an increased risk of brain tumours and osteosarcomas.

Select the answer using the code given below.

A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100-150 metres. The pain is relieved on taking rest for about 2-3 minutes and  the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of

A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is

A 40-year-old smoker presents with soreness of tongue since last 2 months. On examination, it is found that the oral hygiene is poor and there is a white plaque over the lateral border of the tongue. What is the next step in the management of this patient?

Consider the following causes of visual loss :

1. Obstruction of the central retinal artery
2. Vitreous and retinal haemorrhage
3. Cataract
4. Retinal detachment

Which of the above causes are associated with acute visual loss in a patient?

A 60-year-old lady presents with a recent onset increase in a long-standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?

Which of the following chromosomal abnormalities are associated with brain tumours?

1. Neurofibromatosis type 1
2. Neurofibromatosis type 2
3. Peutz-Jeghers syndrome
4. Hereditary nonpolyposis colorectal cancer

Select the correct answer using the code given below.

Which one of the following is correct regarding "witch's milk"?

Which of the following statements are correct regarding Barrett's oesophagus?

1. It is a metaplastic change.
2. It is a risk factor for development of adenocarcinoma.
3. Ingestion of NSAIDs is the aetiological factor for its development.
4. Endoscopic mucosal resection is an effective treatment.

Select the answer using the code given below.

Which among the following are complications of liver trauma?

1. Liver abscess
2. Biliary fistula
3. Portal thrombosis
4. Liver failure

Select the correct answer using the code given below.

Which of the following are local complications of acute pancreatitis?

1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection

Select the correct answer using the code given below.

Which of the following are risk factors for the development of pancreatic cancer?

1. Cigarette smoking
2. Diabetes mellitus
3. Caucasian ethnicity
4. Male gender

Select the correct answer using the code given below.

Which of the following are metabolic causes of splenic enlargement?

Which one of the following statements is correct about mesenteric cysts?

Which of the following of umbilical hernia in

1. Patients arc conunonly with a thinned ottcnuotcd midline raphe.
2. Most patients complain of pain due to tissue tension.
3. Men are affcctcd more commonly than women.
4. Hernia repair can be done by the technique described by Mayo.

Select the correct answer using the code given below.

What is the most common cause of perforation of the oesophagus?

Which of the following are stages of damage control surgery?

1. Patient's selection
2. Control of haemorrhage
3. Resuscitation in ICU
4. Preventive surgery

Select the correct answer using the code given below.

Which of the following statements are correct regarding renal cell carcinoma?

1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease.

Which of the following are features of autosomal dominant polycystic kidney disease?

1. Cyst may also occur in liver, pancreas and arachnoid membrane.
2. Most commonly manifests between 20—30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.

Extracorporal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of

1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache

The most common type of brain tumours associated with neurofibromatosis type 1 brain tumour syndrome is

Which of the following are correct for herniation via foramen of Morgagni?

1. It occurs posteriorly in chest.
2. Transverse colon is the commonest content.
3. Defect is between sternal and costal attachments.
4. It is a type of congenital hernia.

A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improve as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion
and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?

A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?

A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm x 1 cm in size. What is the likely diagnosis in this case?

Upper motor neuron lesions are characterized by which of the following?

1. Increased tone spasticity
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness

A 56-year-old female has been diagnosed with gallstones and is undergoing a preanaesthesia checkup. She has been a diabetic since last 15 years, but sugar levels are within the limits. Which category of physical status does she fit into?

The paraxial mesoderm contributes to the development of which of the following structures?

Which of the following statements on Deep Vein Thrombosis are true?

1. Proximal DVTs are more likely to cause Pulmonary embolism. PE has both cardiovascular and respiratory effects – hypotension and hypoxia.
2. Compared to Proximal DVT, Distal DVT carries lower risk of embolization.
3. Estrogen increases the production of clotting factors in the liver.
4. An Autoimmune disease like Anti-phospholipid syndrome can cause DVT. This APS is more common in women than in men.
5. Chronic DVT can be asymptomatic and cause chronic venous insufficiency.

A 2-year-old child with a history of fall 1 year back with parietal bone fracture, has now presented with a painful and growing parietal swelling. What is the likely diagnosis?

A 19-year-old athlete was training. While doing the hyperextension exercises, he felt a sharp pain in the shoulders. His trainer suspected avulsion of the long head of the triceps. From which site was the muscle detached?

A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?

Consider the following

1. Pain relief
2. Prevention of infection
3. Anaesthesia
4. Restoration of anatomy

A 3D-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates

Which of the following are Correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?

1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 x 10^9 /litre are present.

A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the

Which of following are correct for managing hypertrophic scars?

Which of the following are approximate daily requirements of the common electrolytes in an adult?

1. Sodium 50—90 mM/day 
2. Calcium 1 mM/day
3. Potassium 50 mM/day
4. Magnesium 1 mM/day

Distributive shock is described by which of the following patterns of cardiovascular responses?

1. Vasodilation
2. Reduced peripheral vascular resistance
3. Inadequate 'afterload'
4. Low cardiac output

The best measure of organ perfusion and the best monitor of adequacy of shock therapy is

Which one of the following statements is correct regarding foetal physiology?

Which of the following are advantages of state of haemodilution during pregnancy?

1. Optimum gaseous exchange between maternal and foetal circulation due to decreased blood viscosity
2. Protection against adverse effect of supine and erect posture
3. Protection against adverse effect of blood loss during delivery

Consider the following statements regarding oligohydramnios:

1. It is defined on USG when maximum vertical pocket of liquor is less than 5 cm.
2. It is defined on USG when AFI is less than 5 cm.

Which of the following are correct about endocrine changes in normal pregnancy?

1. Increase in levels of maternal serum iodine
2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH)
3. Increase in serum levels of aldosterone
4. Increase in serum levels of ACTH 

Which of the following features are regarding onset of true labour? 

1. Regular uterine contractions
2. Progressive cervical dilation and effacement
3. Presence of show
4. Labour and delivery are synonymous

According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?

The diameter of engagement of foetal skull in marked deflexion is

Onset of labour is initiated by which of the following?

1. Uterine distension
2. Increased CRH and ACTH from foetal hypothalamic-pituitaryadrenal axis
3. Increased level of progesterone immediately before labour
4. Increased synthesis of myometrial receptors for oxytocin due to effect of oestrogen

A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

Which of the following are correct regarding pathological findings of placenta accreta?

1. Absence of decidua basalis
2. Absence of Nitabuch's fibrinoid layer
3. Loss of normal hypoechoic retroplacental myometrial zone in ultrasonography

A 25-year-old otherwise healthy man presented with painless, linear, yellowish patches running along the palmar creases and the flexor creases of the wrists. Histopathology revealed lipid-laden macrophages in the dermis. What is the most likely diagnosis - Hyperlipoproteinaemia Type?

A patient on long-term treatment with levodopa and carbidopa for

A 23-year-old woman wants to undergo an aesthetic rhinoplasty. Which of the following is the safest drug that can be used during the surgery for topical vasoconstriction?

Which of the following statements are correct regarding cardiomyopathy?
1. It is usually seen in multiparous women.
2. Echocardiography shows ejection fraction less than 45%.
3. ACE inhibitors are contraindicated.
4. History of prior heart disease is mostly present.
Select the answer using the code given below.

Mrs. A, who is 9 months pregnant, presents to the labour room with complaints of severe pain in abdomen and vaginal bleeding for 30 minutes. She is 2nd gravida (producing second child) and delivered her first child 2 years back by caesarean delivery. On examination, she has scar tenderness, vaginal bleeding and haematuria. On CTG, she has an abnormal FHR tracing.
What is her likely clinical diagnosis?

A 28-year-old female G2P1L1 with history of previous caesarean presents to the gynecology emergency in labour. On examination, she is hypotension, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?

A 24-year-old primigravida comes to ANC clinic at 8 months amenorrhoea. Her BP is found to be 160/ 100 mm Hg. Lab findings reveal thrombocytopenia increased SGOT/SGPT and LDH. What is her diagnosis?

A patient, who is 2 months pregnant reports to a hospital with complaints of increased vaginal bleeding and pain in lower abdomen. Internal examination reveals dilated internal os of cervix and products of conception are felt through it. What is her likely clinical diagnosis?

Which one of the following is a common pathology associated with ureteric injury while performing surgical procedure of abdominal hysterectomy?

Which of the following are correct regarding pathology of stress urinary incontinence?
1. Hypermobility of urethra
2. Ascend of bladder neck and proximal urethra above pelvic diaphragm
3. Lowered urethral pressure
4. Increased detrusor activity
Select the answer using the code given below.

Which of the following operative procedures is/ are conformity for the diagnosis of bicornuate uterus?

Which of the following are correct regarding pelvic cellular tissue?
1. It supports the pelvic organs.
2. It forms protective sheath for blood vessels and terminal part of ureter.
3. It prevents infection to be spread out of pelvis.
4. Marked hypertrophy of pelvic cellular tissue occurs in pregnancy.

Select the answer using the code given below.

Which of the following are correct regarding androgen insensitivity syndrome?
1. Inherited as X-Iinked recessive disorder
2. Karyotype is 46 XXY
3. It is also called testicular feminization
4. Confirmation of diagnosis by gonadal biopsy
Select the answer using the code given below.

Which of the following are useful investigations for diagnosis of unresponsive endometrium as a cause of primary amenorrhoea?

1. Karyotype
2. Progesterone challenge test
3. Hormonal studies
4. Hysterosalpingography

A 16-year-old girl with primary amenorrhoea presents to the gynecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?