CMS 2020 Paper II \u2013 Part 1 (Q1\u2013Q40)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms20p2a \u2500\u2500 *\/\n#cms20p2a *,#cms20p2a *::before,#cms20p2a *::after{box-sizing:border-box;margin:0;padding:0}\n\n#cms20p2a{\n --ter:#C0603A;\n --ter-light:#e8825f;\n --ter-pale:#fdf1ec;\n --teal:#2A7A6F;\n --teal-light:#3da394;\n --teal-pale:#eaf4f3;\n --ink:#1a1a1a;\n --ink-mid:#444;\n --ink-soft:#777;\n --line:#e0d8d4;\n --bg:#fdfaf8;\n --white:#ffffff;\n --correct:#1e6f46;\n --correct-bg:#eaf7ef;\n --correct-border:#43a047;\n --wrong:#b83232;\n --wrong-bg:#fdf0f0;\n --wrong-border:#e53935;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;\n color:var(--ink);\n background:var(--bg);\n line-height:1.7;\n padding:0 0 48px;\n}\n\n#cms20p2a .cq-sentinel{height:1px}\n\n#cms20p2a 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.cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n\n@media(max-width:480px){\n #cms20p2a .cq-header h1{font-size:1.15rem}\n #cms20p2a .cq-qtext{font-size:0.88rem}\n #cms20p2a .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms20p2a\">\n\n <div class=\"cq-sentinel\" id=\"cms20p2a-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms20p2a-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p2a-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p2a-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p2a-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p2a-sn\">0<\/strong> \/ <strong id=\"cms20p2a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p2a-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper II \u00b7 Part 1<\/h1>\n <p>General Surgery \u00b7 Orthopaedics \u00b7 Anaesthesia \u00b7 Vascular Surgery<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 1 \u2013 40<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p2a-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p2a-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p2a-score\">\n <div class=\"cq-score-ring\" id=\"cms20p2a-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p2a-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms20p2a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p2a-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p2a-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p2a-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p2a-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms20p2a', TOTAL=40, MAX=TOTAL*4;\n\n const QUESTIONS=[\n {\n id:1,\n stem:'Indications for fasciotomy in compartment syndrome include all EXCEPT:',\n correct:'Palpable distal pulses',\n options:['Distal sensory disturbance','Compartment pressure > 30 mm Hg','Pain on passive movement of affected muscles','Palpable distal pulses'],\n exp:'Palpable distal pulses do NOT exclude compartment syndrome and are not an indication for fasciotomy \u2014 pulses may persist even with critical compartment pressures. Indications include compartment pressure >30 mmHg (or within 30 mmHg of diastolic BP), sensory disturbance, and pain on passive muscle stretch.'\n },\n {\n id:2,\n stem:'Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?',\n correct:'They are monomicrobial in nature',\n options:['Crepitus, skin blistering and focal skin gangrene are typical presenting features','They are monomicrobial in nature','Treatment consists of wide local excision and appropriate antibiotics','Tissue biopsy is required for culture and diagnosis'],\n exp:'Necrotising soft tissue infections (NSTIs) are typically polymicrobial (Type I) \u2014 a synergistic mix of aerobic and anaerobic organisms. Monomicrobial NSTIs (Type II, e.g., Group A Streptococcus) are less common. The statement that they are monomicrobial is therefore NOT correct.'\n },\n {\n id:3,\n stem:'Which type of surgery is laparoscopic cholecystectomy classified as?',\n correct:'Clean contaminated',\n options:['Clean','Clean contaminated','Contaminated','Dirty'],\n exp:'Laparoscopic cholecystectomy involves entering the biliary tract (a hollow viscus) under controlled conditions without spillage \u2014 this classifies it as clean-contaminated (Class II). Clean wounds have no hollow viscus entry; contaminated implies spillage or acute inflammation.'\n },\n {\n id:4,\n stem:'A 22-year female has presented with malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for 6 months, and abdominal distension for 2 days. On examination her abdomen has a doughy feel with an ill-defined mass over the right lower quadrant. She is most likely suffering from:',\n correct:'Ileocaecal tuberculosis',\n options:['Appendicular lump','Ileocaecal tuberculosis','Carcinoma caecum','Ovarian mass'],\n exp:'The combination of constitutional symptoms (malaise, cough), alternating bowel habits, right iliac fossa mass, and doughy abdomen (plastic peritonitis from TB) in a young Indian female is classic for ileocaecal tuberculosis. Carcinoma caecum is unlikely at 22 years. Appendicular lump is acute, not 6 months.'\n },\n {\n id:5,\n stem:'Consider the following statements regarding needle stick injuries:\\n1. Injured part should be washed under running water\\n2. Dominant index finger is the commonest site for needle stick injury\\n3. All needle stick injuries should be reported\\n4. Hepatitis\/HIV testing should be done after needle stick injury\\nWhich of the statements given above are correct?',\n correct:'1, 3 and 4',\n options:['1, 2 and 4','1, 2 and 3','1, 3 and 4','2, 3 and 4'],\n exp:'Statement 2 is false \u2014 the non-dominant index finger is the most common site (held near needle tip during procedures). Statements 1 (immediate washing), 3 (mandatory reporting), and 4 (baseline serology for HIV, HBV, HCV) are all correct standard occupational exposure protocol.'\n },\n {\n id:6,\n stem:'Consider the following statements regarding claudication:\\n1. It is a marker for silent coronary disease\\n2. Structured exercise program (2 hours per week for 3 months) leads to improvement\\n3. Diabetes mellitus increases the risk and severity of claudication\\n4. Beta blockers may exacerbate claudication\\nWhich of the above statements are correct?',\n correct:'1, 2, 3 and 4',\n options:['1 and 2 only','1, 3 and 4 only','2, 3 and 4 only','1, 2, 3 and 4'],\n exp:'All four statements are correct. Claudication is a surrogate marker for systemic atherosclerosis including coronary artery disease. Supervised exercise is first-line treatment. Diabetes accelerates peripheral arterial disease. Beta-blockers cause peripheral vasoconstriction, potentially worsening claudication though the evidence is not absolute.'\n },\n {\n id:7,\n stem:'A 50-year-old lady underwent uneventful bariatric surgery. On the third postoperative day she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:',\n correct:'CT pulmonary angiography',\n options:['Echocardiography','Duplex venography','CT pulmonary angiography','MR angiography'],\n exp:'CT pulmonary angiography (CTPA) is the gold standard for diagnosing pulmonary embolism \u2014 it directly visualises the clot in the pulmonary vasculature with high sensitivity and specificity. Echocardiography may show RV strain but cannot confirm PE. Duplex venography detects DVT, not PE directly.'\n },\n {\n id:8,\n stem:'Medical management of thyrotoxic crisis includes all of the following EXCEPT:',\n correct:'IV antibiotics',\n options:['IV fluids','IV propranolol','IV hydrocortisone','IV antibiotics'],\n exp:'Thyroid storm management: IV fluids (hydration), propranolol (control heart rate\/adrenergic symptoms), hydrocortisone (blocks T4\u2192T3 conversion, treats possible adrenal insufficiency), PTU\/carbimazole, iodine (Lugol\\'s). IV antibiotics are only added if there is a precipitating infection \u2014 they are not a routine component of thyroid storm management.'\n },\n {\n id:9,\n stem:'A patient operated for a parotid gland tumour developed sweating and erythema over the region of surgical excision while eating. The probable diagnosis is:',\n correct:\"Frey's syndrome\",\n options:['Parotid gland fistula','Sialadenitis','Chronic wound infection',\"Frey's syndrome\"],\n exp:\"Frey's syndrome (auriculotemporal nerve syndrome) occurs after parotidectomy \u2014 aberrant regeneration of parasympathetic secretomotor fibres to sweat glands causes gustatory sweating and flushing. The auriculotemporal nerve (branch of V3) is the key nerve involved.\"\n },\n {\n id:10,\n stem:'First-line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:',\n correct:'Anastrozole',\n options:['Tamoxifen','Ovarian suppression by surgery','Antiprogestins','Anastrozole'],\n exp:'In post-menopausal women with hormone receptor-positive metastatic breast cancer, aromatase inhibitors (anastrozole, letrozole, exemestane) are first-line hormonal therapy. Tamoxifen is preferred in pre-menopausal women. Ovarian suppression is irrelevant post-menopausally.'\n },\n {\n id:11,\n stem:'All of the following are major subtypes of breast cancer based on gene array analysis EXCEPT:',\n correct:'Oestrogen receptor positive',\n options:['Luminal A and Luminal B','Triple negative','Her-2 receptor positive','Oestrogen receptor positive'],\n exp:'Gene expression profiling (PAM50) defines breast cancer intrinsic subtypes as: Luminal A, Luminal B, HER2-enriched, Basal-like (triple negative), and Normal-like. \"Oestrogen receptor positive\" is a receptor status classification \u2014 not a molecular subtype from gene array analysis. ER+ tumours encompass both Luminal A and B subtypes.'\n },\n {\n id:12,\n stem:'All of the following are sequelae of peptic ulcer surgery EXCEPT:',\n correct:'Increased appetite',\n options:['Bilious vomiting','Dumping syndrome','Diarrhoea','Increased appetite'],\n exp:'Post-gastrectomy sequelae include dumping syndrome, bilious vomiting (bile reflux), post-vagotomy diarrhoea, malabsorption, weight loss, and anaemia. Increased appetite is not a post-operative sequela \u2014 anorexia and early satiety are more typical after gastric surgery.'\n },\n {\n id:13,\n stem:'The Child-Turcotte-Pugh (CTP) score for quantifying severity of chronic liver disease includes all variables EXCEPT:',\n correct:'Serum creatinine',\n options:['Serum bilirubin','Serum albumin','Serum creatinine','INR (International Normalised Ratio)'],\n exp:'The CTP score uses 5 variables: serum bilirubin, serum albumin, INR (prothrombin time), degree of ascites, and degree of encephalopathy. Serum creatinine is NOT part of CTP \u2014 it is a component of the MELD score instead.'\n },\n {\n id:14,\n stem:\"'Chain of Lakes' appearance due to sacculation with intervening short strictures of pancreatic duct is seen on:\",\n correct:'ERCP',\n options:['ERCP','CECT abdomen','Plain X-ray abdomen','Ultrasonography'],\n exp:\"The 'chain of lakes' pattern \u2014 alternating dilatations and strictures of the main pancreatic duct \u2014 is the hallmark ERCP finding in chronic pancreatitis. ERCP provides the best ductal detail. CECT shows parenchymal changes and calcification but cannot demonstrate the ductal architecture as clearly.\"\n },\n {\n id:15,\n stem:'Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?',\n correct:'Treatment is with oral antibiotics alone',\n options:['Anorexia, fever, malaise and right upper quadrant discomfort are the most common presenting features','It is more common in elderly, diabetics and immunocompromised patients','Treatment is with oral antibiotics alone','Streptococcus milleri and Escherichia coli are the most common causative organisms'],\n exp:'Pyogenic liver abscess requires percutaneous aspiration or drainage in addition to IV antibiotics \u2014 oral antibiotics alone are insufficient and inadequate. Small abscesses (<3 cm) may respond to antibiotics alone, but drainage is the standard of care for established abscesses.'\n },\n {\n id:16,\n stem:\"'Swiss cheese defects' are seen during laparoscopic repair of:\",\n correct:'Ventral hernia',\n options:['Ventral hernia','Inguinal hernia','Obturator hernia','Femoral hernia'],\n exp:\"Swiss cheese defects refer to multiple small fascial defects in the anterior abdominal wall \u2014 a characteristic finding during laparoscopic ventral\/incisional hernia repair. They represent areas of fascial weakness around the main defect and must all be covered by the mesh.\"\n },\n {\n id:17,\n stem:'Which of the following are correct regarding splenic artery aneurysm?\\n1. Main arterial trunk is the common site\\n2. Palpable thrill can be felt\\n3. It is symptomless unless it ruptures',\n correct:'1 and 3 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:\"Splenic artery aneurysms occur most commonly in the mid or distal trunk (not the origin). They are usually asymptomatic until rupture \u2014 the classic 'double rupture' into the lesser sac followed by the peritoneum. A palpable thrill is not typically described \u2014 a bruit on auscultation is more characteristic if anything. Statements 1 and 3 are correct.\"\n },\n {\n id:18,\n stem:\"Valentino's syndrome is:\",\n correct:'Pain in right iliac fossa in perforated peptic ulcer',\n options:['Pain on per-vaginal examination in pelvic abscess','Pain over left shoulder in left hypochondriac collection','Pain over left groin in perirenal collection','Pain in right iliac fossa in perforated peptic ulcer'],\n exp:\"Valentino's syndrome: gastric\/duodenal perforation with spillage of gastric contents tracking down the right paracolic gutter to the right iliac fossa, mimicking acute appendicitis. Named after film star Rudolph Valentino who died from a perforated peptic ulcer misdiagnosed as appendicitis.\"\n },\n {\n id:19,\n stem:'Spontaneous bacterial peritonitis occurs due to:',\n correct:'Acute bacterial infection of ascites',\n options:['Duodenal stump blowout','Peptic ulcer perforation','Acute bacterial infection of ascites','Infection via fallopian tubes'],\n exp:'Spontaneous bacterial peritonitis (SBP) is defined as bacterial infection of ascitic fluid without an evident intra-abdominal surgically treatable source \u2014 it occurs via haematogenous or lymphatic bacterial translocation in patients with cirrhotic ascites. Diagnosis: ascitic fluid PMN >250 cells\/mm\u00b3.'\n },\n {\n id:20,\n stem:'Structure NOT forming boundaries of the \"Triangle of doom\" seen during laparoscopic inguinal hernia surgery dissection is:',\n correct:'Inferior epigastric artery',\n options:['Vas deferens','Inferior epigastric artery','Spermatic cord vessels','Peritoneum'],\n exp:'The Triangle of Doom is bounded medially by the vas deferens, laterally by the spermatic cord vessels (testicular vessels), and posteriorly by the peritoneum. The external iliac vessels lie within it \u2014 hence the \"doom.\" The inferior epigastric artery is NOT a boundary of this triangle.'\n },\n {\n id:21,\n stem:'The term mid-line shift is associated with:',\n correct:'Head injury',\n options:['Head injury','Chest injury','Abdominal injury','Limb injury'],\n exp:'Midline shift refers to displacement of midline brain structures (septum pellucidum, third ventricle, pineal gland) on CT \u2014 caused by space-occupying intracranial lesions such as haematomas, contusions, or oedema following head injury. >5 mm shift is clinically significant and may warrant surgical intervention.'\n },\n {\n id:22,\n stem:'Which one of the following cranial nerves does NOT supply the external ear?',\n correct:'Cranial nerve VI',\n options:['Cranial nerve V','Cranial nerve VI','Cranial nerve VII','Cranial nerve IX'],\n exp:'The external ear receives sensory supply from CN V (auriculotemporal branch of V3), CN VII (posterior auricular branch), CN IX (Jacobson\\'s nerve area), and CN X (Arnold\\'s nerve). CN VI (abducens) is a pure motor nerve to the lateral rectus \u2014 it has no sensory distribution to the ear.'\n },\n {\n id:23,\n stem:'Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior Descending (LAD) artery during coronary artery bypass grafting because:',\n correct:'Long term patency rates are more than 98%',\n options:['Long term patency rates are more than 98%','It is close to LAD','Atherosclerosis is never seen in this vessel','It is very easy to harvest'],\n exp:'LIMA is the preferred conduit for LAD because of exceptional long-term patency \u2014 10-year patency exceeds 95% (often quoted as >98% at 5\u20137 years). This is far superior to saphenous vein grafts (~50\u201360% at 10 years). The vessel\\'s resistance to atherosclerosis (due to its internal elastic lamina and endothelial nitric oxide production) is the physiological basis.'\n },\n {\n id:24,\n stem:'A 50-year-old male with significant smoking history presents with sudden severe breathlessness. Chest X-ray shows right-sided pneumothorax. The appropriate management requires:',\n correct:'Right chest drain of size 8\u201314 Fr',\n options:['Aspiration of air with 16\u201318G cannula','Right chest drain of size 8\u201314 Fr','Oxygen by face mask','Mechanical ventilation'],\n exp:'A smoker with spontaneous pneumothorax has an underlying bullous lung disease (secondary spontaneous pneumothorax). In a symptomatic secondary spontaneous pneumothorax, intercostal chest drain insertion is the recommended management. Simple aspiration is appropriate for primary spontaneous pneumothorax in younger patients.'\n },\n {\n id:25,\n stem:'Which one of the following statements regarding Felon is NOT correct?',\n correct:'It is a painless condition',\n options:['There is infection of the finger tip between specialised fibrous septa','It is a painless condition','Incision and drainage is the treatment of choice','It is common in diabetics'],\n exp:'A felon is an abscess of the pulp space of the distal finger tip \u2014 it is characteristically EXTREMELY painful due to the tight fibrous septa that compartmentalise the space, causing pressure build-up. Painless is entirely wrong. Treatment is incision and drainage; common in diabetics and immunocompromised patients.'\n },\n {\n id:26,\n stem:'The most common site for osteosarcoma is:',\n correct:'Distal femur',\n options:['Proximal femur','Distal femur','Proximal humerus','Distal humerus'],\n exp:\"Osteosarcoma most commonly arises in the metaphysis of long bones near the knee: distal femur (most common ~40%), proximal tibia (~20%), proximal humerus (~10%). The rule of thumb: 'away from the elbow, towards the knee.' Distal femur is the single most common site.\"\n },\n {\n id:27,\n stem:'Rapid Sequence Induction is indicated in:',\n correct:'Emergency surgery for intestinal obstruction',\n options:['Emergency surgery for intestinal obstruction','Elective open hernia surgery','Cardiopulmonary bypass surgery','Elective laparoscopic surgery'],\n exp:'Rapid Sequence Induction (RSI) is used when there is risk of pulmonary aspiration of gastric contents \u2014 i.e., full stomach situations: emergency surgery, intestinal obstruction, trauma, obstetric emergencies. Elective procedures allow adequate fasting; CPB uses different techniques altogether.'\n },\n {\n id:28,\n stem:'Which one of the following statements about Compartment Syndrome is NOT correct?',\n correct:'Pain is on active movement but not on passive movement of muscles',\n options:['It is commonest in a closed fracture','Pain is on active movement but not on passive movement of muscles','Fasciotomy is the treatment of choice',\"Volkmann's Ischaemic contracture is a late complication\"],\n exp:\"In compartment syndrome, pain on PASSIVE STRETCH of muscles in the involved compartment is the cardinal and most reliable early sign \u2014 not just active movement. The statement that pain occurs only on active (not passive) movement is therefore incorrect. The 5 P's include pain on passive stretch as the key early indicator.\"\n },\n {\n id:29,\n stem:'Which one of the following is NOT the strength of ultrasound as a diagnostic modality?',\n correct:'Short learning curve',\n options:['No radiation','Short learning curve','Inexpensive','Allows dynamic studies to be done'],\n exp:'Ultrasound advantages include: no ionising radiation, relatively inexpensive, portable, real-time\/dynamic imaging capability. Its significant limitation is operator dependence \u2014 it has a LONG, steep learning curve, not a short one. Image quality and interpretation vary greatly with operator skill.'\n },\n {\n id:30,\n stem:'Which of the following statements regarding lymphoedema following breast cancer treatment are correct?\\n1. Incidence has decreased due to rarely combined therapy of axillary LN dissection and radiotherapy\\n2. Precipitating cause like LN metastasis is a major determinant\\n3. The condition is often painful\\n4. Oedematous limb is susceptible to bacterial infection',\n correct:'1, 2 and 4',\n options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],\n exp:'Breast cancer-related lymphoedema is typically painless or causes a dull heavy sensation \u2014 it is NOT classically described as painful (statement 3 false). Incidence has fallen as combined ALND + radiotherapy is avoided, LN metastasis burden determines severity, and the oedematous limb has impaired immune surveillance making it susceptible to cellulitis. Statements 1, 2, and 4 are correct.'\n },\n {\n id:31,\n stem:'Which one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?',\n correct:'Diabetes (HbA1c > 7.5%)',\n options:['Age > 60 years','Pregnancy','Obesity (BMI > 30 kg\/m\u00b2)','Diabetes (HbA1c > 7.5%)'],\n exp:'Recognised VTE risk factors in surgical patients include age >60, obesity, pregnancy, malignancy, immobility, previous DVT, thrombophilia, and prolonged surgery. Diabetes per se (even with poor control) is not a recognised independent VTE risk factor in standard surgical risk stratification (Caprini\/Rogers scores).'\n },\n {\n id:32,\n stem:'Which one of the following is NOT a complication of massive blood transfusion?',\n correct:'Hyperthermia',\n options:['Coagulopathy','Hypocalcaemia','Hyperthermia','Hyperkalaemia'],\n exp:'Massive blood transfusion complications: hypothermia (stored blood is cold \u2014 not hyperthermia), coagulopathy (dilutional + consumptive), hypocalcaemia (citrate chelates calcium), hyperkalaemia (RBC lysis releases potassium), metabolic acidosis, TRALI, TACO. Hyperthermia is not a recognised complication.'\n },\n {\n id:33,\n stem:'Stage III pressure sore is full thickness skin loss extending:',\n correct:'Into subcutaneous tissue but not through fascia',\n options:['Into subcutaneous tissue but not through fascia','Through subcutaneous tissue into fascia','Through subcutaneous tissue into fascia and muscles','Through subcutaneous tissue into fascia, muscles and bone'],\n exp:'NPUAP\/EPUAP staging: Stage I = non-blanchable erythema; Stage II = partial thickness, dermis exposed; Stage III = full thickness skin loss into subcutaneous fat but NOT through the underlying fascia; Stage IV = full thickness through fascia to muscle, tendon, or bone.'\n },\n {\n id:34,\n stem:'During subclavian vein puncture in a surgical ward, a patient suddenly develops severe breathlessness. On auscultation breath sounds are absent and the ipsilateral chest is tympanitic. The probable diagnosis is:',\n correct:'Iatrogenic pneumothorax',\n options:['Iatrogenic pneumothorax','Iatrogenic haemothorax','Spontaneous pneumothorax','Tension pneumothorax'],\n exp:'Pneumothorax is the most common complication of subclavian vein cannulation (occurs in ~1\u20133%). Absent breath sounds and ipsilateral tympanism after the procedure = iatrogenic pneumothorax. Tension pneumothorax would additionally cause tracheal deviation and haemodynamic compromise. The timing (during\/after the procedure) makes it iatrogenic, not spontaneous.'\n },\n {\n id:35,\n stem:\"K\u00f6hler's disease is avascular necrosis of:\",\n correct:'Navicular',\n options:['Lunate','Capitellum of humerus','First metatarsal head','Navicular'],\n exp:\"Osteochondroses mnemonics: K\u00f6hler's = navicular (foot, children); Kienb\u00f6ck's = lunate (wrist); Panner's = capitellum; Freiberg's = 2nd metatarsal head; Legg-Calv\u00e9-Perthes = femoral head; Osgood-Schlatter = tibial tubercle. K\u00f6hler's presents as foot pain in children aged 4\u20137.\"\n },\n {\n id:36,\n stem:'Which one of the following is NOT true of Pyoderma gangrenosum?',\n correct:'Cultures often show Gram-positive Staphylococci',\n options:['It is characterised by cutaneous ulceration with purple undermined edges','It is often secondary to heightened immunological reactivity from another disease process','Cultures often show Gram-positive Staphylococci','Lesions generally respond to steroids'],\n exp:'Pyoderma gangrenosum is a neutrophilic dermatosis \u2014 cultures are characteristically sterile or show only superficial colonisers. It is NOT caused by Staphylococci. The pathognomonic feature is pathergy (worsening with trauma), purple undermined wound edges, association with IBD\/RA\/haematological malignancies, and steroid responsiveness.'\n },\n {\n id:37,\n stem:'Which of the following is NOT a tissue repair surgery for inguinal hernia repair?',\n correct:\"Stoppa's repair\",\n options:[\"Bassini's repair\",\"Shouldice repair\",\"Stoppa's repair\",\"Desarda repair\"],\n exp:\"Tissue (non-mesh) repairs: Bassini's (posterior wall reconstruction with conjoint tendon to inguinal ligament), Shouldice (multilayer continuous suture repair), Desarda (external oblique aponeurosis flap). Stoppa's repair (giant prosthetic reinforcement of visceral sac \u2014 GPRVS) is a MESH-based repair, placing a large prosthetic mesh in the preperitoneal space.\"\n },\n {\n id:38,\n stem:'Which one of the following type of meshes is recommended for intraperitoneal use in abdominal wall hernia?',\n correct:'Tissue separating meshes',\n options:['Light weight, porous meshes','Heavy weight, porous meshes','Absorbable meshes','Tissue separating meshes'],\n exp:'For intraperitoneal onlay mesh (IPOM) repair, tissue-separating (composite) meshes are mandatory \u2014 one side is non-adherent (PTFE or anti-adhesion coating) to prevent bowel adhesions, while the other side promotes tissue ingrowth. Standard polypropylene meshes cause severe visceral adhesions when placed intraperitoneally.'\n },\n {\n id:39,\n stem:'Which one of the following is NOT correct regarding MEN-1 syndrome?',\n correct:'It involves pineal gland',\n options:['It involves parathyroid glands','It involves pancreas','It involves pituitary gland','It involves pineal gland'],\n exp:\"MEN-1 (Wermer's syndrome) = 3 P's: Parathyroid (hyperparathyroidism, most common ~95%), Pancreatic islet cell tumours (gastrinoma, insulinoma), Pituitary adenomas (prolactinoma most common). The pineal gland is NOT involved in MEN-1. Caused by mutations in the menin tumour suppressor gene on chromosome 11q13.\"\n },\n {\n id:40,\n stem:'Which one of the following is NOT an electronic information site in surgery?',\n correct:'National medical library',\n options:['Pubmed','Embase','Cochrane library','National medical library'],\n exp:\"PubMed (MEDLINE database, NLM\/NIH), Embase (Elsevier's biomedical database), and the Cochrane Library (systematic reviews) are the three major electronic evidence databases used in surgical research. 'National medical library' is not the name of a recognised electronic database \u2014 the US National Library of Medicine hosts PubMed, not a separate 'National medical library' database.\"\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){\n const j=Math.floor(Math.random()*(i+1));\n [a[i],a[j]]=[a[j],a[i]];\n }\n return a;\n }\n function esc(s){return s.replace(\/&\/g,'&').replace(\/<\/g,'<').replace(\/>\/g,'>').replace(\/\"\/g,'"')}\n\n const LETTERS=['A','B','C','D'];\n let userAnswers={}, answered=0, shuffledOpts={};\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n container.innerHTML='';\n userAnswers={};answered=0;shuffledOpts={};\n document.getElementById(NS+'-score').style.display='none';\n updateStats();\n\n QUESTIONS.forEach(function(q){\n const opts=shuffle(q.options);\n shuffledOpts[q.id]=opts;\n const card=document.createElement('div');\n card.className='cq-card';\n card.innerHTML=\n '<div 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Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36547","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 Paper-2 Part-1 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/13\/cms-2020-paper-2-part-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" 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{"id":36547,"date":"2026-04-13T14:49:15","date_gmt":"2026-04-13T09:19:15","guid":{"rendered":"https:\/\/atsixty.com\/?p=36547"},"modified":"2026-04-13T14:51:52","modified_gmt":"2026-04-13T09:21:52","slug":"cms-2020-paper-2-part-1","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/04\/13\/cms-2020-paper-2-part-1\/","title":{"rendered":"CMS 2020 Paper-2 Part-1"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2020 Paper II \u2013 Part 1 (Q1\u2013Q40)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms20p2a \u2500\u2500 *\/\n#cms20p2a *,#cms20p2a *::before,#cms20p2a *::after{box-sizing:border-box;margin:0;padding:0}\n\n#cms20p2a{\n --ter:#C0603A;\n --ter-light:#e8825f;\n --ter-pale:#fdf1ec;\n --teal:#2A7A6F;\n --teal-light:#3da394;\n --teal-pale:#eaf4f3;\n --ink:#1a1a1a;\n 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text-transform:uppercase;color:var(--teal);margin-bottom:4px;\n}\n\n#cms20p2a .cq-submit-wrap{text-align:center;padding:28px 16px 8px}\n#cms20p2a .cq-btn{\n background:var(--teal);color:var(--white);border:none;border-radius:8px;\n padding:13px 36px;font-family:'Playfair Display',serif;\n font-size:1rem;font-weight:700;cursor:pointer;letter-spacing:0.02em;\n transition:background 0.2s,transform 0.1s;\n}\n#cms20p2a .cq-btn:hover{background:var(--teal-light)}\n#cms20p2a .cq-btn:active{transform:scale(0.98)}\n\n#cms20p2a .cq-score{\n display:none;background:var(--white);border:2px solid var(--teal);\n border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center;\n}\n#cms20p2a .cq-score-ring{\n width:110px;height:110px;border-radius:50%;\n background:conic-gradient(var(--teal) 0%,var(--line) 0%);\n display:flex;align-items:center;justify-content:center;\n margin:0 auto 20px;position:relative;\n}\n#cms20p2a .cq-score-ring::before{\n content:'';position:absolute;width:86px;height:86px;\n border-radius:50%;background:var(--white);\n}\n#cms20p2a .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms20p2a .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms20p2a .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms20p2a .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms20p2a .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms20p2a .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms20p2a .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms20p2a .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms20p2a .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms20p2a .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms20p2a .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms20p2a .cq-retry-btn{\n margin-top:22px;background:transparent;border:2px solid var(--teal);\n color:var(--teal);border-radius:8px;padding:10px 28px;\n font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;\n cursor:pointer;transition:background 0.2s,color 0.2s;\n}\n#cms20p2a .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n\n@media(max-width:480px){\n #cms20p2a .cq-header h1{font-size:1.15rem}\n #cms20p2a .cq-qtext{font-size:0.88rem}\n #cms20p2a .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms20p2a\">\n\n <div class=\"cq-sentinel\" id=\"cms20p2a-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms20p2a-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p2a-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p2a-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p2a-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p2a-sn\">0<\/strong> \/ <strong id=\"cms20p2a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p2a-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper II \u00b7 Part 1<\/h1>\n <p>General Surgery \u00b7 Orthopaedics \u00b7 Anaesthesia \u00b7 Vascular Surgery<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 1 \u2013 40<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p2a-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p2a-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p2a-score\">\n <div class=\"cq-score-ring\" id=\"cms20p2a-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p2a-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms20p2a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p2a-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p2a-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p2a-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p2a-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms20p2a', TOTAL=40, MAX=TOTAL*4;\n\n const QUESTIONS=[\n {\n id:1,\n stem:'Indications for fasciotomy in compartment syndrome include all EXCEPT:',\n correct:'Palpable distal pulses',\n options:['Distal sensory disturbance','Compartment pressure > 30 mm Hg','Pain on passive movement of affected muscles','Palpable distal pulses'],\n exp:'Palpable distal pulses do NOT exclude compartment syndrome and are not an indication for fasciotomy \u2014 pulses may persist even with critical compartment pressures. Indications include compartment pressure >30 mmHg (or within 30 mmHg of diastolic BP), sensory disturbance, and pain on passive muscle stretch.'\n },\n {\n id:2,\n stem:'Which one of the following statements is NOT correct regarding Necrotising Soft Tissue infections?',\n correct:'They are monomicrobial in nature',\n options:['Crepitus, skin blistering and focal skin gangrene are typical presenting features','They are monomicrobial in nature','Treatment consists of wide local excision and appropriate antibiotics','Tissue biopsy is required for culture and diagnosis'],\n exp:'Necrotising soft tissue infections (NSTIs) are typically polymicrobial (Type I) \u2014 a synergistic mix of aerobic and anaerobic organisms. Monomicrobial NSTIs (Type II, e.g., Group A Streptococcus) are less common. The statement that they are monomicrobial is therefore NOT correct.'\n },\n {\n id:3,\n stem:'Which type of surgery is laparoscopic cholecystectomy classified as?',\n correct:'Clean contaminated',\n options:['Clean','Clean contaminated','Contaminated','Dirty'],\n exp:'Laparoscopic cholecystectomy involves entering the biliary tract (a hollow viscus) under controlled conditions without spillage \u2014 this classifies it as clean-contaminated (Class II). Clean wounds have no hollow viscus entry; contaminated implies spillage or acute inflammation.'\n },\n {\n id:4,\n stem:'A 22-year female has presented with malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for 6 months, and abdominal distension for 2 days. On examination her abdomen has a doughy feel with an ill-defined mass over the right lower quadrant. She is most likely suffering from:',\n correct:'Ileocaecal tuberculosis',\n options:['Appendicular lump','Ileocaecal tuberculosis','Carcinoma caecum','Ovarian mass'],\n exp:'The combination of constitutional symptoms (malaise, cough), alternating bowel habits, right iliac fossa mass, and doughy abdomen (plastic peritonitis from TB) in a young Indian female is classic for ileocaecal tuberculosis. Carcinoma caecum is unlikely at 22 years. Appendicular lump is acute, not 6 months.'\n },\n {\n id:5,\n stem:'Consider the following statements regarding needle stick injuries:\\n1. Injured part should be washed under running water\\n2. Dominant index finger is the commonest site for needle stick injury\\n3. All needle stick injuries should be reported\\n4. Hepatitis\/HIV testing should be done after needle stick injury\\nWhich of the statements given above are correct?',\n correct:'1, 3 and 4',\n options:['1, 2 and 4','1, 2 and 3','1, 3 and 4','2, 3 and 4'],\n exp:'Statement 2 is false \u2014 the non-dominant index finger is the most common site (held near needle tip during procedures). Statements 1 (immediate washing), 3 (mandatory reporting), and 4 (baseline serology for HIV, HBV, HCV) are all correct standard occupational exposure protocol.'\n },\n {\n id:6,\n stem:'Consider the following statements regarding claudication:\\n1. It is a marker for silent coronary disease\\n2. Structured exercise program (2 hours per week for 3 months) leads to improvement\\n3. Diabetes mellitus increases the risk and severity of claudication\\n4. Beta blockers may exacerbate claudication\\nWhich of the above statements are correct?',\n correct:'1, 2, 3 and 4',\n options:['1 and 2 only','1, 3 and 4 only','2, 3 and 4 only','1, 2, 3 and 4'],\n exp:'All four statements are correct. Claudication is a surrogate marker for systemic atherosclerosis including coronary artery disease. Supervised exercise is first-line treatment. Diabetes accelerates peripheral arterial disease. Beta-blockers cause peripheral vasoconstriction, potentially worsening claudication though the evidence is not absolute.'\n },\n {\n id:7,\n stem:'A 50-year-old lady underwent uneventful bariatric surgery. On the third postoperative day she develops breathlessness and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:',\n correct:'CT pulmonary angiography',\n options:['Echocardiography','Duplex venography','CT pulmonary angiography','MR angiography'],\n exp:'CT pulmonary angiography (CTPA) is the gold standard for diagnosing pulmonary embolism \u2014 it directly visualises the clot in the pulmonary vasculature with high sensitivity and specificity. Echocardiography may show RV strain but cannot confirm PE. Duplex venography detects DVT, not PE directly.'\n },\n {\n id:8,\n stem:'Medical management of thyrotoxic crisis includes all of the following EXCEPT:',\n correct:'IV antibiotics',\n options:['IV fluids','IV propranolol','IV hydrocortisone','IV antibiotics'],\n exp:'Thyroid storm management: IV fluids (hydration), propranolol (control heart rate\/adrenergic symptoms), hydrocortisone (blocks T4\u2192T3 conversion, treats possible adrenal insufficiency), PTU\/carbimazole, iodine (Lugol\\'s). IV antibiotics are only added if there is a precipitating infection \u2014 they are not a routine component of thyroid storm management.'\n },\n {\n id:9,\n stem:'A patient operated for a parotid gland tumour developed sweating and erythema over the region of surgical excision while eating. The probable diagnosis is:',\n correct:\"Frey's syndrome\",\n options:['Parotid gland fistula','Sialadenitis','Chronic wound infection',\"Frey's syndrome\"],\n exp:\"Frey's syndrome (auriculotemporal nerve syndrome) occurs after parotidectomy \u2014 aberrant regeneration of parasympathetic secretomotor fibres to sweat glands causes gustatory sweating and flushing. The auriculotemporal nerve (branch of V3) is the key nerve involved.\"\n },\n {\n id:10,\n stem:'First-line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:',\n correct:'Anastrozole',\n options:['Tamoxifen','Ovarian suppression by surgery','Antiprogestins','Anastrozole'],\n exp:'In post-menopausal women with hormone receptor-positive metastatic breast cancer, aromatase inhibitors (anastrozole, letrozole, exemestane) are first-line hormonal therapy. Tamoxifen is preferred in pre-menopausal women. Ovarian suppression is irrelevant post-menopausally.'\n },\n {\n id:11,\n stem:'All of the following are major subtypes of breast cancer based on gene array analysis EXCEPT:',\n correct:'Oestrogen receptor positive',\n options:['Luminal A and Luminal B','Triple negative','Her-2 receptor positive','Oestrogen receptor positive'],\n exp:'Gene expression profiling (PAM50) defines breast cancer intrinsic subtypes as: Luminal A, Luminal B, HER2-enriched, Basal-like (triple negative), and Normal-like. \"Oestrogen receptor positive\" is a receptor status classification \u2014 not a molecular subtype from gene array analysis. ER+ tumours encompass both Luminal A and B subtypes.'\n },\n {\n id:12,\n stem:'All of the following are sequelae of peptic ulcer surgery EXCEPT:',\n correct:'Increased appetite',\n options:['Bilious vomiting','Dumping syndrome','Diarrhoea','Increased appetite'],\n exp:'Post-gastrectomy sequelae include dumping syndrome, bilious vomiting (bile reflux), post-vagotomy diarrhoea, malabsorption, weight loss, and anaemia. Increased appetite is not a post-operative sequela \u2014 anorexia and early satiety are more typical after gastric surgery.'\n },\n {\n id:13,\n stem:'The Child-Turcotte-Pugh (CTP) score for quantifying severity of chronic liver disease includes all variables EXCEPT:',\n correct:'Serum creatinine',\n options:['Serum bilirubin','Serum albumin','Serum creatinine','INR (International Normalised Ratio)'],\n exp:'The CTP score uses 5 variables: serum bilirubin, serum albumin, INR (prothrombin time), degree of ascites, and degree of encephalopathy. Serum creatinine is NOT part of CTP \u2014 it is a component of the MELD score instead.'\n },\n {\n id:14,\n stem:\"'Chain of Lakes' appearance due to sacculation with intervening short strictures of pancreatic duct is seen on:\",\n correct:'ERCP',\n options:['ERCP','CECT abdomen','Plain X-ray abdomen','Ultrasonography'],\n exp:\"The 'chain of lakes' pattern \u2014 alternating dilatations and strictures of the main pancreatic duct \u2014 is the hallmark ERCP finding in chronic pancreatitis. ERCP provides the best ductal detail. CECT shows parenchymal changes and calcification but cannot demonstrate the ductal architecture as clearly.\"\n },\n {\n id:15,\n stem:'Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?',\n correct:'Treatment is with oral antibiotics alone',\n options:['Anorexia, fever, malaise and right upper quadrant discomfort are the most common presenting features','It is more common in elderly, diabetics and immunocompromised patients','Treatment is with oral antibiotics alone','Streptococcus milleri and Escherichia coli are the most common causative organisms'],\n exp:'Pyogenic liver abscess requires percutaneous aspiration or drainage in addition to IV antibiotics \u2014 oral antibiotics alone are insufficient and inadequate. Small abscesses (<3 cm) may respond to antibiotics alone, but drainage is the standard of care for established abscesses.'\n },\n {\n id:16,\n stem:\"'Swiss cheese defects' are seen during laparoscopic repair of:\",\n correct:'Ventral hernia',\n options:['Ventral hernia','Inguinal hernia','Obturator hernia','Femoral hernia'],\n exp:\"Swiss cheese defects refer to multiple small fascial defects in the anterior abdominal wall \u2014 a characteristic finding during laparoscopic ventral\/incisional hernia repair. They represent areas of fascial weakness around the main defect and must all be covered by the mesh.\"\n },\n {\n id:17,\n stem:'Which of the following are correct regarding splenic artery aneurysm?\\n1. Main arterial trunk is the common site\\n2. Palpable thrill can be felt\\n3. It is symptomless unless it ruptures',\n correct:'1 and 3 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:\"Splenic artery aneurysms occur most commonly in the mid or distal trunk (not the origin). They are usually asymptomatic until rupture \u2014 the classic 'double rupture' into the lesser sac followed by the peritoneum. A palpable thrill is not typically described \u2014 a bruit on auscultation is more characteristic if anything. Statements 1 and 3 are correct.\"\n },\n {\n id:18,\n stem:\"Valentino's syndrome is:\",\n correct:'Pain in right iliac fossa in perforated peptic ulcer',\n options:['Pain on per-vaginal examination in pelvic abscess','Pain over left shoulder in left hypochondriac collection','Pain over left groin in perirenal collection','Pain in right iliac fossa in perforated peptic ulcer'],\n exp:\"Valentino's syndrome: gastric\/duodenal perforation with spillage of gastric contents tracking down the right paracolic gutter to the right iliac fossa, mimicking acute appendicitis. Named after film star Rudolph Valentino who died from a perforated peptic ulcer misdiagnosed as appendicitis.\"\n },\n {\n id:19,\n stem:'Spontaneous bacterial peritonitis occurs due to:',\n correct:'Acute bacterial infection of ascites',\n options:['Duodenal stump blowout','Peptic ulcer perforation','Acute bacterial infection of ascites','Infection via fallopian tubes'],\n exp:'Spontaneous bacterial peritonitis (SBP) is defined as bacterial infection of ascitic fluid without an evident intra-abdominal surgically treatable source \u2014 it occurs via haematogenous or lymphatic bacterial translocation in patients with cirrhotic ascites. Diagnosis: ascitic fluid PMN >250 cells\/mm\u00b3.'\n },\n {\n id:20,\n stem:'Structure NOT forming boundaries of the \"Triangle of doom\" seen during laparoscopic inguinal hernia surgery dissection is:',\n correct:'Inferior epigastric artery',\n options:['Vas deferens','Inferior epigastric artery','Spermatic cord vessels','Peritoneum'],\n exp:'The Triangle of Doom is bounded medially by the vas deferens, laterally by the spermatic cord vessels (testicular vessels), and posteriorly by the peritoneum. The external iliac vessels lie within it \u2014 hence the \"doom.\" The inferior epigastric artery is NOT a boundary of this triangle.'\n },\n {\n id:21,\n stem:'The term mid-line shift is associated with:',\n correct:'Head injury',\n options:['Head injury','Chest injury','Abdominal injury','Limb injury'],\n exp:'Midline shift refers to displacement of midline brain structures (septum pellucidum, third ventricle, pineal gland) on CT \u2014 caused by space-occupying intracranial lesions such as haematomas, contusions, or oedema following head injury. >5 mm shift is clinically significant and may warrant surgical intervention.'\n },\n {\n id:22,\n stem:'Which one of the following cranial nerves does NOT supply the external ear?',\n correct:'Cranial nerve VI',\n options:['Cranial nerve V','Cranial nerve VI','Cranial nerve VII','Cranial nerve IX'],\n exp:'The external ear receives sensory supply from CN V (auriculotemporal branch of V3), CN VII (posterior auricular branch), CN IX (Jacobson\\'s nerve area), and CN X (Arnold\\'s nerve). CN VI (abducens) is a pure motor nerve to the lateral rectus \u2014 it has no sensory distribution to the ear.'\n },\n {\n id:23,\n stem:'Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior Descending (LAD) artery during coronary artery bypass grafting because:',\n correct:'Long term patency rates are more than 98%',\n options:['Long term patency rates are more than 98%','It is close to LAD','Atherosclerosis is never seen in this vessel','It is very easy to harvest'],\n exp:'LIMA is the preferred conduit for LAD because of exceptional long-term patency \u2014 10-year patency exceeds 95% (often quoted as >98% at 5\u20137 years). This is far superior to saphenous vein grafts (~50\u201360% at 10 years). The vessel\\'s resistance to atherosclerosis (due to its internal elastic lamina and endothelial nitric oxide production) is the physiological basis.'\n },\n {\n id:24,\n stem:'A 50-year-old male with significant smoking history presents with sudden severe breathlessness. Chest X-ray shows right-sided pneumothorax. The appropriate management requires:',\n correct:'Right chest drain of size 8\u201314 Fr',\n options:['Aspiration of air with 16\u201318G cannula','Right chest drain of size 8\u201314 Fr','Oxygen by face mask','Mechanical ventilation'],\n exp:'A smoker with spontaneous pneumothorax has an underlying bullous lung disease (secondary spontaneous pneumothorax). In a symptomatic secondary spontaneous pneumothorax, intercostal chest drain insertion is the recommended management. Simple aspiration is appropriate for primary spontaneous pneumothorax in younger patients.'\n },\n {\n id:25,\n stem:'Which one of the following statements regarding Felon is NOT correct?',\n correct:'It is a painless condition',\n options:['There is infection of the finger tip between specialised fibrous septa','It is a painless condition','Incision and drainage is the treatment of choice','It is common in diabetics'],\n exp:'A felon is an abscess of the pulp space of the distal finger tip \u2014 it is characteristically EXTREMELY painful due to the tight fibrous septa that compartmentalise the space, causing pressure build-up. Painless is entirely wrong. Treatment is incision and drainage; common in diabetics and immunocompromised patients.'\n },\n {\n id:26,\n stem:'The most common site for osteosarcoma is:',\n correct:'Distal femur',\n options:['Proximal femur','Distal femur','Proximal humerus','Distal humerus'],\n exp:\"Osteosarcoma most commonly arises in the metaphysis of long bones near the knee: distal femur (most common ~40%), proximal tibia (~20%), proximal humerus (~10%). The rule of thumb: 'away from the elbow, towards the knee.' Distal femur is the single most common site.\"\n },\n {\n id:27,\n stem:'Rapid Sequence Induction is indicated in:',\n correct:'Emergency surgery for intestinal obstruction',\n options:['Emergency surgery for intestinal obstruction','Elective open hernia surgery','Cardiopulmonary bypass surgery','Elective laparoscopic surgery'],\n exp:'Rapid Sequence Induction (RSI) is used when there is risk of pulmonary aspiration of gastric contents \u2014 i.e., full stomach situations: emergency surgery, intestinal obstruction, trauma, obstetric emergencies. Elective procedures allow adequate fasting; CPB uses different techniques altogether.'\n },\n {\n id:28,\n stem:'Which one of the following statements about Compartment Syndrome is NOT correct?',\n correct:'Pain is on active movement but not on passive movement of muscles',\n options:['It is commonest in a closed fracture','Pain is on active movement but not on passive movement of muscles','Fasciotomy is the treatment of choice',\"Volkmann's Ischaemic contracture is a late complication\"],\n exp:\"In compartment syndrome, pain on PASSIVE STRETCH of muscles in the involved compartment is the cardinal and most reliable early sign \u2014 not just active movement. The statement that pain occurs only on active (not passive) movement is therefore incorrect. The 5 P's include pain on passive stretch as the key early indicator.\"\n },\n {\n id:29,\n stem:'Which one of the following is NOT the strength of ultrasound as a diagnostic modality?',\n correct:'Short learning curve',\n options:['No radiation','Short learning curve','Inexpensive','Allows dynamic studies to be done'],\n exp:'Ultrasound advantages include: no ionising radiation, relatively inexpensive, portable, real-time\/dynamic imaging capability. Its significant limitation is operator dependence \u2014 it has a LONG, steep learning curve, not a short one. Image quality and interpretation vary greatly with operator skill.'\n },\n {\n id:30,\n stem:'Which of the following statements regarding lymphoedema following breast cancer treatment are correct?\\n1. Incidence has decreased due to rarely combined therapy of axillary LN dissection and radiotherapy\\n2. Precipitating cause like LN metastasis is a major determinant\\n3. The condition is often painful\\n4. Oedematous limb is susceptible to bacterial infection',\n correct:'1, 2 and 4',\n options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],\n exp:'Breast cancer-related lymphoedema is typically painless or causes a dull heavy sensation \u2014 it is NOT classically described as painful (statement 3 false). Incidence has fallen as combined ALND + radiotherapy is avoided, LN metastasis burden determines severity, and the oedematous limb has impaired immune surveillance making it susceptible to cellulitis. Statements 1, 2, and 4 are correct.'\n },\n {\n id:31,\n stem:'Which one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?',\n correct:'Diabetes (HbA1c > 7.5%)',\n options:['Age > 60 years','Pregnancy','Obesity (BMI > 30 kg\/m\u00b2)','Diabetes (HbA1c > 7.5%)'],\n exp:'Recognised VTE risk factors in surgical patients include age >60, obesity, pregnancy, malignancy, immobility, previous DVT, thrombophilia, and prolonged surgery. Diabetes per se (even with poor control) is not a recognised independent VTE risk factor in standard surgical risk stratification (Caprini\/Rogers scores).'\n },\n {\n id:32,\n stem:'Which one of the following is NOT a complication of massive blood transfusion?',\n correct:'Hyperthermia',\n options:['Coagulopathy','Hypocalcaemia','Hyperthermia','Hyperkalaemia'],\n exp:'Massive blood transfusion complications: hypothermia (stored blood is cold \u2014 not hyperthermia), coagulopathy (dilutional + consumptive), hypocalcaemia (citrate chelates calcium), hyperkalaemia (RBC lysis releases potassium), metabolic acidosis, TRALI, TACO. Hyperthermia is not a recognised complication.'\n },\n {\n id:33,\n stem:'Stage III pressure sore is full thickness skin loss extending:',\n correct:'Into subcutaneous tissue but not through fascia',\n options:['Into subcutaneous tissue but not through fascia','Through subcutaneous tissue into fascia','Through subcutaneous tissue into fascia and muscles','Through subcutaneous tissue into fascia, muscles and bone'],\n exp:'NPUAP\/EPUAP staging: Stage I = non-blanchable erythema; Stage II = partial thickness, dermis exposed; Stage III = full thickness skin loss into subcutaneous fat but NOT through the underlying fascia; Stage IV = full thickness through fascia to muscle, tendon, or bone.'\n },\n {\n id:34,\n stem:'During subclavian vein puncture in a surgical ward, a patient suddenly develops severe breathlessness. On auscultation breath sounds are absent and the ipsilateral chest is tympanitic. The probable diagnosis is:',\n correct:'Iatrogenic pneumothorax',\n options:['Iatrogenic pneumothorax','Iatrogenic haemothorax','Spontaneous pneumothorax','Tension pneumothorax'],\n exp:'Pneumothorax is the most common complication of subclavian vein cannulation (occurs in ~1\u20133%). Absent breath sounds and ipsilateral tympanism after the procedure = iatrogenic pneumothorax. Tension pneumothorax would additionally cause tracheal deviation and haemodynamic compromise. The timing (during\/after the procedure) makes it iatrogenic, not spontaneous.'\n },\n {\n id:35,\n stem:\"K\u00f6hler's disease is avascular necrosis of:\",\n correct:'Navicular',\n options:['Lunate','Capitellum of humerus','First metatarsal head','Navicular'],\n exp:\"Osteochondroses mnemonics: K\u00f6hler's = navicular (foot, children); Kienb\u00f6ck's = lunate (wrist); Panner's = capitellum; Freiberg's = 2nd metatarsal head; Legg-Calv\u00e9-Perthes = femoral head; Osgood-Schlatter = tibial tubercle. K\u00f6hler's presents as foot pain in children aged 4\u20137.\"\n },\n {\n id:36,\n stem:'Which one of the following is NOT true of Pyoderma gangrenosum?',\n correct:'Cultures often show Gram-positive Staphylococci',\n options:['It is characterised by cutaneous ulceration with purple undermined edges','It is often secondary to heightened immunological reactivity from another disease process','Cultures often show Gram-positive Staphylococci','Lesions generally respond to steroids'],\n exp:'Pyoderma gangrenosum is a neutrophilic dermatosis \u2014 cultures are characteristically sterile or show only superficial colonisers. It is NOT caused by Staphylococci. The pathognomonic feature is pathergy (worsening with trauma), purple undermined wound edges, association with IBD\/RA\/haematological malignancies, and steroid responsiveness.'\n },\n {\n id:37,\n stem:'Which of the following is NOT a tissue repair surgery for inguinal hernia repair?',\n correct:\"Stoppa's repair\",\n options:[\"Bassini's repair\",\"Shouldice repair\",\"Stoppa's repair\",\"Desarda repair\"],\n exp:\"Tissue (non-mesh) repairs: Bassini's (posterior wall reconstruction with conjoint tendon to inguinal ligament), Shouldice (multilayer continuous suture repair), Desarda (external oblique aponeurosis flap). Stoppa's repair (giant prosthetic reinforcement of visceral sac \u2014 GPRVS) is a MESH-based repair, placing a large prosthetic mesh in the preperitoneal space.\"\n },\n {\n id:38,\n stem:'Which one of the following type of meshes is recommended for intraperitoneal use in abdominal wall hernia?',\n correct:'Tissue separating meshes',\n options:['Light weight, porous meshes','Heavy weight, porous meshes','Absorbable meshes','Tissue separating meshes'],\n exp:'For intraperitoneal onlay mesh (IPOM) repair, tissue-separating (composite) meshes are mandatory \u2014 one side is non-adherent (PTFE or anti-adhesion coating) to prevent bowel adhesions, while the other side promotes tissue ingrowth. Standard polypropylene meshes cause severe visceral adhesions when placed intraperitoneally.'\n },\n {\n id:39,\n stem:'Which one of the following is NOT correct regarding MEN-1 syndrome?',\n correct:'It involves pineal gland',\n options:['It involves parathyroid glands','It involves pancreas','It involves pituitary gland','It involves pineal gland'],\n exp:\"MEN-1 (Wermer's syndrome) = 3 P's: Parathyroid (hyperparathyroidism, most common ~95%), Pancreatic islet cell tumours (gastrinoma, insulinoma), Pituitary adenomas (prolactinoma most common). The pineal gland is NOT involved in MEN-1. Caused by mutations in the menin tumour suppressor gene on chromosome 11q13.\"\n },\n {\n id:40,\n stem:'Which one of the following is NOT an electronic information site in surgery?',\n correct:'National medical library',\n options:['Pubmed','Embase','Cochrane library','National medical library'],\n exp:\"PubMed (MEDLINE database, NLM\/NIH), Embase (Elsevier's biomedical database), and the Cochrane Library (systematic reviews) are the three major electronic evidence databases used in surgical research. 'National medical library' is not the name of a recognised electronic database \u2014 the US National Library of Medicine hosts PubMed, not a separate 'National medical library' database.\"\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){\n const j=Math.floor(Math.random()*(i+1));\n [a[i],a[j]]=[a[j],a[i]];\n }\n return a;\n }\n function esc(s){return s.replace(\/&\/g,'&').replace(\/<\/g,'<').replace(\/>\/g,'>').replace(\/\"\/g,'"')}\n\n const LETTERS=['A','B','C','D'];\n let userAnswers={}, answered=0, shuffledOpts={};\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n container.innerHTML='';\n userAnswers={};answered=0;shuffledOpts={};\n document.getElementById(NS+'-score').style.display='none';\n updateStats();\n\n QUESTIONS.forEach(function(q){\n const opts=shuffle(q.options);\n shuffledOpts[q.id]=opts;\n const card=document.createElement('div');\n card.className='cq-card';\n card.innerHTML=\n '<div 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Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36547","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 Paper-2 Part-1 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/13\/cms-2020-paper-2-part-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" 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