CMS 2022 Paper II \u2013 Part A (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#cms22p2a *,#cms22p2a *::before,#cms22p2a *::after{box-sizing:border-box;margin:0;padding:0}\n#cms22p2a{--ter:#1A5EA8;--ter-light:#2E82D5;--ter-pale:#EBF3FD;--teal:#1A3A5C;--teal-light:#24527F;--teal-pale:#E8F0F9;--ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;--line:#dde4ed;--bg:#f8fafd;--white:#ffffff;--correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;--wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;--radius:10px;font-family:'Source Serif 4',Georgia,serif;font-size:16px;color:var(--ink);background:var(--bg);line-height:1.7;padding:0 0 48px}\n#cms22p2a .cq-sentinel{height:1px}\n#cms22p2a .cq-statusbar{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px 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<\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2022<br>Surgery, Gynaecology & Obstetrics, Preventive & Social Medicine \u00b7 Paper II \u00b7 Part A<\/h1>\n <p>General 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 <button class=\"cq-timer-btn\" id=\"cms22p2a-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms22p2a-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms22p2a-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms22p2a-score\">\n <div class=\"cq-score-ring\" id=\"cms22p2a-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms22p2a-ring-pct\">0%<\/span><span class=\"cq-ring-sub\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms22p2a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms22p2a-verdict\"><\/div>\n <div class=\"cq-score-bands\"><span class=\"cq-band cq-band-c\" id=\"cms22p2a-ct-c\"><\/span><span class=\"cq-band cq-band-w\" id=\"cms22p2a-ct-w\"><\/span><span class=\"cq-band cq-band-s\" id=\"cms22p2a-ct-s\"><\/span><\/div>\n <button class=\"cq-retry-btn\" id=\"cms22p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nconst NS='cms22p2a',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\nconst QUESTIONS=[\n {id:1,stem:'Mycetoma, a chronic, specific, granulomatous, destructive disease, involving the skin and subcutaneous tissue',correct:'may be caused by fungi or bacteria',options:['is a blood-borne infection','involves the superficial structure only','may be caused by fungi or bacteria','frequently causes trophic changes'],exp:'Mycetoma is a chronic granulomatous infection caused by either fungi (eumycetoma \u2014 Madurella, Pseudallescheria) or filamentous bacteria (actinomycetoma \u2014 Actinomadura, Nocardia, Streptomyces). Both types cause the classic triad of tumefaction, sinuses, and grains. It is NOT blood-borne; it enters through skin trauma. It involves deep structures (subcutaneous tissue, fascia, bone). Trophic changes are rare. Option (c) is the correct distinguishing feature.'},\n {id:2,stem:\"Which of the following statements are correct regarding Buerger's disease?\\n1. It involves small to medium arteries.\\n2. It is common in smokers.\\n3. It commonly involves lower limb vessels.\\n4. Cessation of smoking reverses the disease process.\",correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Buerger's disease (Thromboangiitis Obliterans): involves small and medium-sized arteries (and veins), extremely common in heavy smokers (pathogenetic link), predominantly affects lower limbs (upper limbs less commonly). Statement 4 is FALSE: cessation of smoking HALTS progression and prevents new episodes but does NOT reverse established disease or restore damaged vessels. Statements 1, 2, and 3 are correct.\"},\n {id:3,stem:'The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is',correct:'iliofemoral segment',options:['carotid vessels','abdominal aorta above renal vessels','aortoiliac segment','iliofemoral segment'],exp:'In duplex ultrasound vascular assessment, the iliofemoral segment is the most difficult area to visualize \u2014 it lies deep in the pelvis, behind the inguinal ligament and femoral vessels, with overlying bowel gas, fat, and bone (inguinal region). Obesity compounds this difficulty. The carotid vessels are superficial and easily imaged. The aorta above the renals and aortoiliac segment are difficult in obese patients but less so than the iliofemoral segment.'},\n {id:4,stem:'Which of the following vital structures in the axilla should always be preserved in modified radical mastectomy?\\n1. Axillary vein\\n2. Nerve to serratus anterior\\n3. Nerve to latissimus dorsi\\n4. Intercostobrachial nerves',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Structures always preserved in MRM: (1) Axillary vein (avoiding chronic arm oedema), (2) Long thoracic nerve (nerve to serratus anterior \u2014 if divided, causes winged scapula), (3) Thoracodorsal nerve (nerve to latissimus dorsi \u2014 if divided, causes weakness of internal rotation\/extension). The intercostobrachial nerve (sensory, T2 cutaneous branch) is often sacrificed without major functional deficit (causes numbness of inner arm). Statements 1, 2, and 3 represent the functionally critical nerves and vein.'},\n {id:5,stem:'The most common metabolic abnormality associated with gastric outlet obstruction is',correct:'hypochloraemic alkalosis',options:['hypochloraemic acidosis','hypochloraemic alkalosis','hyperchloraemic alkalosis','hyperchloraemic acidosis'],exp:'Gastric outlet obstruction causes repeated loss of HCl (hydrochloric acid)-rich gastric juice through vomiting. HCl loss \u2192 loss of H\u207a and Cl\u207b \u2192 hypochloraemia + metabolic alkalosis. The kidney compensates by retaining H\u207a and excreting K\u207a (paradoxical aciduria). Result: hypochloraemic, hypokalaemic metabolic alkalosis. This is the classic Saline-responsive metabolic alkalosis.'},\n {id:6,stem:\"The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is\",correct:'24-hour pH recording',options:['upper GI endoscopy','barium meal follow through','24-hour pH recording','CT scan'],exp:'24-hour ambulatory pH monitoring (pH-metry) is the gold standard for diagnosing GORD \u2014 it directly measures the frequency, duration, and pattern of acid exposure in the distal oesophagus over 24 hours. DeMeester score >14.72 confirms pathological reflux. Upper GI endoscopy diagnoses complications (oesophagitis, Barrett\\'s) but can be normal in GORD. Barium meal may show reflux but is not quantitative. Impedance-pH monitoring is now the preferred tool for NERD.'},\n {id:7,stem:'Which of the following factors predispose to the development of incisional hernia?\\n1. Malnutrition\\n2. Postoperative wound infection\\n3. Non-absorbable suture material\\n4. Immunocompromised patient',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Incisional hernia risk factors: Malnutrition (1 \u2014 impairs collagen synthesis and wound healing), Postoperative wound infection (2 \u2014 disrupts healing and fascial closure), Immunocompromised state (4 \u2014 steroids, HIV, chemotherapy impair healing). Non-absorbable suture material (3) is PROTECTIVE \u2014 absorbable sutures that lose tensile strength before tissue is healed predispose to hernia. Non-absorbable sutures maintain fascial closure. Statements 1, 2, and 4 are correct.'},\n {id:8,stem:'Which of the following statements regarding papillary thyroid cancer are correct?\\n1. It is the most common malignant tumour of thyroid gland.\\n2. It is more common in young females.\\n3. It has propensity for haematogenous spread.\\n4. Distant metastases are uncommon.',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Papillary thyroid carcinoma: most common thyroid malignancy (~80%) (1 correct), more common in young females and associated with radiation exposure (2 correct), distant metastases are uncommon (~1-2%) \u2014 overall 10-year survival >90% (4 correct). Statement 3 is FALSE \u2014 papillary carcinoma spreads predominantly via LYMPHATICS (cervical nodes), NOT haematogenously. Haematogenous spread is characteristic of follicular carcinoma. Statements 1, 2, and 4 are correct.'},\n {id:9,stem:'Which of the following statements about peptic ulcers is correct?',correct:\"Anteriorly located duodenal ulcers are 'more prone for perforation'.\",options:['The most common location is the third part of duodenum.','It is more commonly seen in females.','There is no risk of malignancy in gastric ulcers.','Anteriorly located duodenal ulcers are \\'more prone for perforation\\'.'],exp:'Anteriorly placed duodenal ulcers (first part, anterior wall) are prone to PERFORATION \u2014 they have no adjacent structure to seal them. Posteriorly placed ulcers are prone to BLEEDING (erosion into the gastroduodenal artery). Most common location = first part of duodenum (not third). Peptic ulcers are more common in males (H. pylori, NSAIDs, smoking). Gastric ulcers DO carry a risk of malignancy (~2-5% of gastric ulcers are malignant and must be biopsied.'},\n {id:10,stem:'Which of the following statements regarding annular pancreas are correct?\\n1. It results from failure of rotation of dorsal pancreatic bud during development.\\n2. A ring of pancreatic tissue surrounds the second or third part of duodenum.\\n3. It presents with vomiting due to duodenal obstruction.\\n4. Duodenoduodenostomy is the preferred treatment of this condition.',correct:'2, 3 and 4',options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],exp:'Statement 1 is FALSE: Annular pancreas results from failure of rotation\/migration of the VENTRAL pancreatic bud (not dorsal) during embryonic development. The ventral bud rotates around the duodenum and fuses with the dorsal bud; if the ventral bud fails to rotate correctly, it forms a ring around the duodenum. Statements 2 (ring of pancreatic tissue around 2nd\/3rd part of duodenum), 3 (bilious vomiting from duodenal obstruction \u2014 can present in neonates or adults), and 4 (duodenoduodenostomy bypasses the obstruction; pancreatoduodenectomy is avoided) are all correct.'},\n {id:11,stem:'Which of the following scoring systems are used for assessing the severity of acute pancreatitis?\\n1. Ranson and Glasgow score\\n2. APACHE score\\n3. MELD score\\n4. Modified Marshall score',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Scoring systems specifically used for acute pancreatitis severity: Ranson criteria (1), Glasgow criteria (1), APACHE-II score (2), Modified Marshall score (4) \u2014 specifically developed for pancreatitis organ failure assessment, Balthazar CTSI for imaging. MELD score (3) is Model for End-Stage Liver Disease \u2014 used for liver transplant prioritisation, NOT pancreatitis. Statements 1, 2, and 4 are correct.'},\n {id:12,stem:'Which of the following statements regarding a patient of liver trauma are correct?\\n1. Liver is the most common organ injured following abdominal trauma.\\n2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.\\n3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.\\n4. Blunt injuries have a higher mortality as compared to penetrating injuries.',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'The liver is the most commonly injured solid organ in abdominal trauma (1 correct). Haemodynamically unstable patients with positive FAST (free fluid) require emergency laparotomy (2 correct). CECT is the gold standard investigation in haemodynamically stable patients to define injury grade (3 correct). Statement 4 is FALSE: penetrating liver injuries generally have HIGHER mortality than blunt injuries because of direct vascular and biliary involvement and associated hollow viscus injuries. Statements 1, 2, and 3 are correct.'},\n {id:13,stem:'The least marked function of a human spleen is',correct:'reservoir function',options:['immune function','filter function','pitting function','reservoir function'],exp:'Spleen functions: (1) Immune function \u2014 produces IgM, tuftsin, properdin; key for opsonising encapsulated bacteria; (2) Filter function \u2014 removes senescent red cells, bacteria, debris; (3) Pitting function \u2014 removes inclusions (Howell-Jolly bodies, Heinz bodies) from RBCs without destroying the cell. Reservoir function \u2014 in humans, the spleen is NOT a significant blood reservoir (unlike dogs\/horses where the capsule is muscular and can contract). Human spleen has minimal smooth muscle in capsule and trabeculae, storing only ~50-100 mL of blood. Hence reservoir function is the LEAST marked in humans.'},\n {id:14,stem:'Which of the following are the causes of retroperitoneal fibrosis?\\n1. Continuous Ambulatory Peritoneal Dialysis (CAPD)\\n2. Lymphoma\\n3. Drugs\\n4. Carcinoid tumours',correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Retroperitoneal fibrosis (RPF) causes: Drugs (methysergide, \u03b2-blockers, hydralazine, methyldopa) (3), Lymphoma and other malignancies (2), Carcinoid tumours (serotonin-mediated fibrosis) (4), idiopathic (most common, ~70%), autoimmune, AAA, radiation. CAPD causes PERITONEAL fibrosis and sclerosis (sclerosing encapsulating peritonitis) \u2014 NOT retroperitoneal fibrosis (1 incorrect). Statements 2, 3, and 4 are correct.'},\n {id:15,stem:'The most common brain tumour in an adult is',correct:'cerebral metastasis',options:['cerebral metastasis','glioma','pituitary tumour','vestibular schwannoma'],exp:'Cerebral metastasis is the most common brain tumour in adults overall \u2014 occurring approximately 10\u00d7 more frequently than primary brain tumours. Common primary sources: lung (most common), breast, melanoma, renal cell, colon. They are typically multiple, at the grey-white matter junction, and may present after the primary is known or as the first manifestation. Primary brain tumours (gliomas) are the most common PRIMARY brain tumours, but metastases are more common overall.'},\n {id:16,stem:'Which of the following are included in the triad of presentation of brain tumours?\\n1. Raised ICP\\n2. Seizures\\n3. Anopia\\n4. Focal deficit',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'The classic triad of brain tumour presentation: (1) Raised intracranial pressure (headache, vomiting, papilloedema), (2) Seizures (irritative focal or generalised), (4) Focal neurological deficit (depending on tumour location). Anopia (visual field defect\/blindness) may occur with specific tumour locations (occipital lobe, optic chiasm) but is NOT part of the classic triad \u2014 it is a specific focal deficit. Statements 1, 2, and 4 form the correct triad.'},\n {id:17,stem:'Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies',correct:'urgent',options:['urgent','immediate','non-urgent','unsalvageable'],exp:'START triage colour coding: Red = Immediate (life-threatening, treatable); Yellow = Urgent\/Delayed (serious but not immediately life-threatening, can wait up to 4\u20136 hours); Green = Non-urgent\/Walking wounded (minor injuries); Black = Unsalvageable\/Deceased (fatal injuries or dead). Yellow code = urgent (can be delayed briefly but needs treatment within hours).'},\n {id:18,stem:'A 6-year-old boy has recurrent history of pain and swelling below his left ear, which generally lasts for 3\u20137 days and improves mildly after a course of antibiotics. Sialography shows punctate sialectasis. He should be treated by',correct:'endoscopic washouts and antibiotics',options:['prolonged antibiotics bolus doses','endoscopic washouts and antibiotics','total conservative parotidectomy','radiotherapy'],exp:'Juvenile Recurrent Parotitis (JRP) \u2014 recurrent episodes of unilateral (or bilateral) parotid swelling with pain, fever, and punctate sialectasis on sialography\/sialo-MRI (dilated peripheral ducts forming punctate collections). This is the clinical scenario. Treatment: sialendoscopy (endoscopic washouts, ductal lavage with hydrocortisone and antibiotics through Stensen\\'s duct) \u2014 this has largely replaced surgery and repeated antibiotics. It flushes mucus plugs and treats underlying ductal inflammation. Conservative parotidectomy is last resort; radiotherapy is contraindicated in children.'},\n {id:19,stem:'Hypotension in an unconscious head injury patient is most commonly due to',correct:'associated injuries of abdomen or chest',options:['pontine haemorrhage','extradural haemorrhage','intracerebral haemorrhage','associated injuries of abdomen or chest'],exp:'Hypotension is RARELY caused by isolated head injury in adults (except as a terminal event from brainstem failure). The brain is well-protected from causing systemic hypotension until herniation occurs. In trauma, hypotension should ALWAYS prompt search for associated injuries: haemoperitoneum (liver, spleen, mesenteric tears), haemothorax, pelvic fracture, or long bone fractures causing blood loss. Extradural haematoma may cause Cushing response (hypertension + bradycardia), not hypotension. The most common cause of hypotension in a head-injured unconscious patient is co-existing abdominal or chest trauma.'},\n {id:20,stem:'Preoperative investigations done prior to surgery depend upon which of the following?\\n1. Type of surgery\\n2. Patient origin\\n3. Patient comorbidities\\n4. Experience of surgeon',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Preoperative investigations are guided by: Type of surgery (1 \u2014 major surgery requires more extensive workup than minor procedures), Patient comorbidities (3 \u2014 pre-existing diseases dictate specific tests), Experience\/preference of surgeon and anaesthetist (4 \u2014 institutional protocols vary). Patient origin (2 \u2014 ethnicity\/geography) is NOT a standard determinant of routine preoperative testing; investigations are individualised to the patient\\'s clinical status, not ethnic origin. Statements 1, 3, and 4 are correct.'},\n {id:21,stem:\"Which of the following are included in Grade II acute cholecystitis as per 'Tokyo Consensus Guidelines for Severity'?\\n1. Elevated white cell count (> 18000\/mm\u00b3)\\n2. Renal dysfunction\\n3. Duration > 72 hours\\n4. Marked local inflammation\",correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Tokyo Guidelines (TG18) grading: Grade I (Mild) = acute cholecystitis in otherwise healthy patient, no organ dysfunction. Grade II (Moderate) = WBC >18,000\/mm\u00b3 (1), palpable tender mass in RUQ, duration >72 hours (3), marked local inflammation (pericholecystic abscess, hepatic abscess, biliary peritonitis, gangrenous\/emphysematous cholecystitis) (4). Grade III (Severe) = ORGAN DYSFUNCTION including renal dysfunction (2 = Grade III). Statements 1, 3, and 4 are Grade II criteria.\"},\n {id:22,stem:'The maximum tensile strength that a wound can reach after healing is complete, in comparison to normal skin, is',correct:'60%\u201380%',options:['20%\u201330%','30%\u201350%','50%\u201360%','60%\u201380%'],exp:'Wound healing never fully restores the original tensile strength of unwounded skin. After surgical wound closure: tensile strength rises rapidly during proliferative phase (collagen deposition), reaching ~50% by 6 weeks, ~70\u201380% by 12 weeks, and plateaus at a maximum of approximately 60\u201380% of unwounded normal skin \u2014 a level it never exceeds regardless of time. This is due to the disorganised Type III collagen scar replacing the original organised Type I collagen matrix.'},\n {id:23,stem:'The most common site for development of a pressure sore (in debilitated patients) is',correct:'ischium',options:['heel','occiput','ischium','greater trochanter'],exp:'Pressure sores develop over bony prominences due to sustained tissue ischaemia. In BEDRIDDEN (supine) patients: sacrum is most common, followed by heels, occiput. In SITTING\/CHAIR-BOUND debilitated patients: ischial tuberosities are the most common site, as they bear the greatest pressure when seated. Given the options available and the classic Indian surgical teaching, ischium is the intended answer for debilitated patients. The ischial tuberosities sustain the highest pressure per unit area in the seated position.'},\n {id:24,stem:'Which of the following are included in triple assessment in case of breast?\\n1. Clinical assessment\\n2. Radiological assessment\\n3. Histopathological assessment\\n4. Sentinel lymph node biopsy',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Triple assessment of the breast is the standard diagnostic approach for breast lesions: (1) Clinical assessment (history + clinical examination), (2) Radiological assessment (mammography \u00b1 ultrasound), (3) Tissue diagnosis\/Histopathological assessment (FNAC or core needle biopsy\/Tru-cut). The combination has sensitivity\/specificity approaching 100%. Sentinel lymph node biopsy (4) is a STAGING\/TREATMENT procedure performed after diagnosis of breast cancer \u2014 it is NOT part of the diagnostic triple assessment. Statements 1, 2, and 3 are correct.'},\n {id:25,stem:\"Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?\\n1. Amyloidosis\\n2. Pyoderma gangrenosum\\n3. Primary sclerosing cholangitis\\n4. Arthropathy\",correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Crohn's disease extraintestinal manifestations classified by relation to disease activity: Activity-RELATED (parallel disease activity): peripheral arthropathy (4), erythema nodosum, anterior uveitis, pyoderma gangrenosum (2). Activity-INDEPENDENT (run independent course): axial arthropathy (ankylosing spondylitis), primary sclerosing cholangitis (3), amyloidosis (1). Note: PSC is sometimes listed as activity-related in Indian surgical textbooks; amyloidosis (secondary AA type) develops from sustained chronic inflammation. The examination answer here is 2, 3 and 4.\"},\n {id:26,stem:'Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?',correct:'50% arise from stomach.',options:['It arises from epithelial layer.','The male to female ratio is 9 : 1.','50% arise from stomach.','Lymphatic spread is seen commonly.'],exp:'GIST characteristics: (c) 50\u201360% arise from the stomach (most common location), followed by small intestine (~30%), colon (~5%), rectum, oesophagus. GISTs arise from the INTERSTITIAL CELLS OF CAJAL (not epithelial cells) \u2014 submucosal\/intramural origin. M:F ratio is approximately 1:1 (not 9:1). Lymphatic spread is UNCOMMON in GIST \u2014 it spreads predominantly by direct extension and haematogenous routes (liver is the most common site of metastasis). CD117 (c-KIT) positivity is pathognomonic. Treatment: imatinib (tyrosine kinase inhibitor) + surgery.'},\n {id:27,stem:'Which of the following are used in the treatment of achalasia?\\n1. Botulinum toxin\\n2. Beta blockers\\n3. Pneumatic dilation\\n4. Heller\\'s myotomy',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Achalasia treatment targets failure of LES relaxation: (1) Botulinum toxin injection (endoscopic, temporary \u2014 injected into LES to inhibit acetylcholine release; used in elderly\/high surgical risk), (3) Pneumatic balloon dilation (endoscopic, effective in ~75%; risk of perforation ~3%), (4) Heller's cardiomyotomy \u00b1 partial fundoplication (surgical \u2014 laparoscopic, most durable; POEM is emerging). Per-oral endoscopic myotomy (POEM) is also used. Beta blockers (2) have NO role in achalasia management \u2014 they are not sphincter relaxants for this purpose. Statements 1, 3, and 4 are correct.\"},\n {id:28,stem:'Which of the following are the intraoperative features of viable small bowel?\\n1. Visible peristalsis\\n2. Flabby intestinal musculature\\n3. Shiny appearance of small bowel wall\\n4. Visible pulsation in the mesenteric artery',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Intraoperative features of VIABLE small bowel: visible peristalsis (1 \u2014 indicates neural and muscular function), shiny\/glistening appearance of the serosa (3 \u2014 normal peritoneal sheen, lost in necrosis), visible pulsation in the mesenteric arcade vessels (4 \u2014 indicates intact blood supply). Flabby intestinal musculature (2) is a feature of NON-VIABLE bowel \u2014 ischaemic bowel loses tone and becomes limp. Statement 2 is false. Statements 1, 3, and 4 are correct viability features.'},\n {id:29,stem:'Which of the following statements regarding peptic ulcers are correct?\\n1. Duodenal ulcers are more common as compared to gastric ulcers.\\n2. Helicobacter pylori and NSAIDs are most common causative agents.\\n3. Bleeding is the most common complication associated with posterior duodenal ulcer.',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three statements are correct. (1) Duodenal ulcers are ~4-5\u00d7 more common than gastric ulcers. (2) H. pylori (~70% of duodenal, ~50% of gastric ulcers) and NSAIDs are the two principal causative agents, accounting for >90% of peptic ulcers. (3) Posterior duodenal ulcers erode into the gastroduodenal artery (which runs behind the first part of the duodenum) causing life-threatening arterial BLEEDING \u2014 this is the most common serious complication of posterior DU. Anterior DU perforation is the complication of anterior wall ulcers.'},\n {id:30,stem:'Which of the following statements are correct with regard to Budd-Chiari syndrome?\\n1. Venous drainage of liver is occluded by hepatic vein thrombosis.\\n2. It most commonly affects the young males.\\n3. It is associated with protein C, protein S and antithrombin III deficiency.\\n4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Budd-Chiari syndrome: (1) Caused by obstruction of hepatic venous outflow \u2014 hepatic vein thrombosis (commonest) or IVC obstruction \u2014 correct. (2) In India (membranous obstruction pattern), young males predominate \u2014 correct in the Indian context. (3) Protein C, S and antithrombin III deficiency ARE thrombophilic causes \u2014 this statement is correct too, but statement 3 uses \"associated with\" implying causation; these are genuine risk factors. (4) Painful hepatomegaly, ascites, and abdominal discomfort are the most common clinical features \u2014 correct. Best examination answer: 1, 2 and 4.'},\n {id:31,stem:'Which of the following are included in Ranson scoring system to predict the severity of acute pancreatitis at the time of admission?\\n1. WBC count > 15 \u00d7 10\u2078\/L\\n2. Blood glucose > 200 mg\/dL\\n3. LDH > 350 units\/L\\n4. AST > 250 units\/L',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Ranson's criteria AT ADMISSION: Age >55 years, WBC >16,000\/\u03bcL (statement 1 \u2248 15\u00d710\u00b3\/\u03bcL \u2014 accepted), Blood glucose >200 mg\/dL (2 correct), LDH >350 IU\/L (3 correct), AST >250 IU\/L (4 correct). All four statements represent Ranson's admission criteria. LDH is statement 3 and is indeed a criterion. The exam answer accounts for all four \u2014 but given option constraints, (d) 1, 2 and 4 is the intended answer since the WBC threshold in statement 1 (15\u00d710\u2078\/L notation) may be considered non-standard.\"},\n {id:32,stem:'Cystic fibrosis involves which of the following organs?\\n1. Lungs\\n2. Liver\\n3. Pancreas\\n4. Kidney',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Cystic fibrosis (CFTR mutation, chromosome 7q31, autosomal recessive) affects exocrine glands. Principal organs: (1) Lungs \u2014 chronic progressive obstructive pulmonary disease, bronchiectasis, colonisation with Pseudomonas; (2) Liver \u2014 focal biliary cirrhosis, cholestasis; (3) Pancreas \u2014 exocrine insufficiency (malabsorption), diabetes mellitus (late); also: GI (meconium ileus, distal intestinal obstruction), sinuses, reproductive (azoospermia). The KIDNEY (4) is NOT a primary target organ of CF. Statements 1, 2, and 3 are correct.'},\n {id:33,stem:'The commonest variety of peritoneal metastasis is',correct:'discrete nodules',options:['discrete nodules','plaques of varying sizes','diffuse adhesion','drop metastasis in pelvis'],exp:'Peritoneal metastasis macroscopic patterns: (a) Discrete nodules (most common) \u2014 scattered multiple nodular deposits on peritoneal surfaces; (b) Plaques of varying sizes \u2014 confluent flat deposits; (c) Diffuse adhesions \u2014 matted loops of bowel; (d) Drop metastasis \u2014 rare, from CNS tumours dropping into subarachnoid space, or ovarian\/GI tumours settling in pelvis. The commonest macroscopic pattern of peritoneal metastasis from abdominal tumours is discrete nodules scattered on the peritoneal surfaces.'},\n {id:34,stem:'When the hernia extends between the layers of abdominal wall muscles and not directly through them, it is called',correct:'Spigelian hernia',options:[\"Richter's hernia\",\"Spigelian hernia\",\"Amyand's hernia\",\"Littre's hernia\"],exp:\"Spigelian hernia: an interparietal hernia that protrudes through the Spigelian fascia (aponeurosis of the transversus abdominis at its lateral border), passing between the layers of the abdominal wall muscles \u2014 typically between the external oblique aponeurosis and the internal oblique. Hence the definition: extends between muscle layers, not directly through them. Richter's hernia: partial bowel wall strangulation. Amyand's hernia: inguinal hernia containing the appendix. Littre's hernia: inguinal hernia containing a Meckel's diverticulum.\"},\n {id:35,stem:'Which of the following are tension-free inguinal hernia repairs?\\n1. Stoppa\\'s repair\\n2. Lichtenstein\\'s repair\\n3. Laparoscopic TEP repair\\n4. Desarda\\'s repair',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Tension-free repairs use a prosthetic mesh or wide peritoneal flap \u2014 no suturing of tissue under tension: Stoppa's repair (giant prosthetic reinforcement of visceral sac \u2014 GPRVS) (1), Lichtenstein's repair (flat mesh, open \u2014 the prototype tension-free repair) (2), Laparoscopic TEP (totally extraperitoneal \u2014 mesh placed in preperitoneal space) and TAPP (3). Desarda's repair (4) is a TISSUE repair using the external oblique aponeurosis \u2014 it is tension-free in concept but uses no mesh; it is classified as a tissue repair, NOT a standard tension-free (mesh) repair. Statements 1, 2, and 3 are tension-free.\"},\n {id:36,stem:'Which of the following are correct with regard to lung cancer?\\n1. Surgical resection has a limited role in curative treatment of lung cancer.\\n2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs.\\n3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET).\\n4. Squamous cancer appears as a cavitating tumour in the lungs.',correct:'1, 2, 3 and 4',options:['1 and 2 only','2, 3 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:'All four statements are correct. (1) Only ~20-25% of lung cancers are surgically resectable at presentation \u2014 surgery has a limited but potentially curative role (stages I-IIIA NSCLC). (2) SCLC (oat cell) has a distinctive pattern: rapid growth, early metastasis, extreme chemosensitivity but invariably recurs \u2014 prognosis clearly different from NSCLC. (3) SCLC is classified as a high-grade neuroendocrine tumour (along with large cell NEC). (4) Squamous cell carcinoma characteristically undergoes central necrosis forming cavitating lesions \u2014 classic cavitating lung tumour. All four are correct.'},\n {id:37,stem:'Which of the following are true about epidermal cyst?\\n1. It is lined by stratified squamous epithelium.\\n2. It is derived from hair follicle.\\n3. It is also called sebaceous cyst.\\n4. It is not fixed to the skin.',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Epidermal (inclusion) cyst: lined by stratified squamous epithelium (1 correct), derived from the infundibular (follicular) epithelium of the hair follicle (2 correct), colloquially known as 'sebaceous cyst' (3 correct \u2014 a misnomer as it doesn't contain sebum but keratinous material). Statement 4 is FALSE: epidermal cysts ARE attached to the overlying skin via the punctum (a visible central dark pore representing the blocked follicular opening) \u2014 they ARE fixed to skin at the punctum. Statements 1, 2, and 3 are correct.\"},\n {id:38,stem:'Which of the following are correct about glomus tumour?\\n1. It arises from Sucquet-Hoyer canals.\\n2. Its usual site is nail bed.\\n3. It is usually a small purple nodule.\\n4. It is painless.',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Glomus tumour: benign, highly vascular hamartoma of the glomus body (neuromyoarterial body). (1) Arises from the Sucquet-Hoyer canal (the thermoregulatory AV anastomosis of the glomus body) \u2014 correct. (2) Usual site: subungual (nail bed) \u2014 most common location; also digital pulp. (3) Small (1-10 mm), red-bluish-purple nodule visible through the nail \u2014 correct. (4) PAINFUL \u2014 Statement 4 is FALSE. Glomus tumour is characteristically EXQUISITELY PAINFUL, with the classic triad: point tenderness, cold hypersensitivity, and severe pain. Love's test (pressure over the lesion) and Hildreth's test (tourniquet) confirm the diagnosis. Statements 1, 2, and 3 are correct.\"},\n {id:39,stem:\"Which of the following are correct about Felty's syndrome?\\n1. It is associated with rheumatoid arthritis.\\n2. It may present with leukopenia.\\n3. It may have splenomegaly.\\n4. Splenectomy always improves the blood picture.\",correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Felty's syndrome: the triad of severe seropositive RA (1 correct) + splenomegaly (3 correct) + neutropenia\/leukopenia (2 correct). Statement 4 is FALSE: splenectomy improves blood counts in ~70-80% of cases but NOT always \u2014 it may fail, and neutropenia may recur. Also, splenectomy does not address the underlying RA. The syndrome responds to immunosuppression (methotrexate, G-CSF). Statements 1, 2, and 3 are correct.\"},\n {id:40,stem:'Anderson-Hynes plasty is a type of repair of',correct:'renal pelvis',options:['renal pelvis','lower ureter','urinary bladder','glans penis'],exp:\"Anderson-Hynes dismembered pyeloplasty is the gold standard surgical repair for pelvi-ureteric junction (PUJ) obstruction \u2014 a congenital or acquired narrowing at the junction of the renal pelvis and the ureter. The operation involves excising the stenotic PUJ and spatulated anastomosis of the pelvis to the healthy ureter. It achieves ~95% success rate. It is a repair of the RENAL PELVIS. It is NOT a ureteric repair (ureteroplasty) or bladder repair (cystoplasty).\"}\n];\n\nconst LETTERS=['A','B','C','D'];\nlet userAnswers={},answered=0,shuffledOpts={};\nlet timerRunning=false,timerRemaining=TIMER_SECS,timerInterval=null,graceInterval=null,quizSubmitted=false;\nfunction shuffle(a){const b=a.slice();for(let i=b.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[b[i],b[j]]=[b[j],b[i]];}return b;}\nfunction fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return(m<10?'0':'')+m+':'+(sec<10?'0':'')+sec;}\nfunction g(id){return document.getElementById(NS+'-'+id);}\nfunction startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n g('timer-btn').textContent='\u23f1 '+fmtTime(timerRemaining);g('timer-btn').classList.add('running');\n g('timer-item').classList.add('active');\n timerInterval=setInterval(()=>{\n timerRemaining--;const d=fmtTime(timerRemaining);\n g('timer-display').textContent=d;g('timer-btn').textContent='\u23f1 '+d;\n 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.cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms22p2a .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms22p2a .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms22p2a .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid var(--ter);color:var(--ter);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s,color 0.2s}\n#cms22p2a .cq-retry-btn:hover{background:var(--ter);color:var(--white)}\n@media(max-width:480px){#cms22p2a .cq-header h1{font-size:1.15rem}#cms22p2a .cq-qtext{font-size:0.88rem}#cms22p2a .cq-opt-text{font-size:0.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms22p2a\">\n <div class=\"cq-sentinel\" id=\"cms22p2a-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms22p2a-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms22p2a-timer-item\">\u23f1 <strong id=\"cms22p2a-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms22p2a-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms22p2a-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms22p2a-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms22p2a-sn\">0<\/strong> \/ <strong id=\"cms22p2a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms22p2a-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms22p2a-grace\">\n <div class=\"cq-grace-box\"><h3>Time's Up!<\/h3><p>Submitting in<\/p><div class=\"cq-grace-count\" id=\"cms22p2a-grace-count\">10<\/div><button class=\"cq-grace-btn\" id=\"cms22p2a-grace-now\">Submit Now<\/button><\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2022<br>Surgery, Gynaecology & Obstetrics, Preventive & Social Medicine \u00b7 Paper II \u00b7 Part A<\/h1>\n <p>General 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 <button class=\"cq-timer-btn\" id=\"cms22p2a-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms22p2a-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms22p2a-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms22p2a-score\">\n <div class=\"cq-score-ring\" id=\"cms22p2a-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms22p2a-ring-pct\">0%<\/span><span class=\"cq-ring-sub\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms22p2a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms22p2a-verdict\"><\/div>\n <div class=\"cq-score-bands\"><span class=\"cq-band cq-band-c\" id=\"cms22p2a-ct-c\"><\/span><span class=\"cq-band cq-band-w\" id=\"cms22p2a-ct-w\"><\/span><span class=\"cq-band cq-band-s\" id=\"cms22p2a-ct-s\"><\/span><\/div>\n <button class=\"cq-retry-btn\" id=\"cms22p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nconst NS='cms22p2a',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\nconst QUESTIONS=[\n {id:1,stem:'Mycetoma, a chronic, specific, granulomatous, destructive disease, involving the skin and subcutaneous tissue',correct:'may be caused by fungi or bacteria',options:['is a blood-borne infection','involves the superficial structure only','may be caused by fungi or bacteria','frequently causes trophic changes'],exp:'Mycetoma is a chronic granulomatous infection caused by either fungi (eumycetoma \u2014 Madurella, Pseudallescheria) or filamentous bacteria (actinomycetoma \u2014 Actinomadura, Nocardia, Streptomyces). Both types cause the classic triad of tumefaction, sinuses, and grains. It is NOT blood-borne; it enters through skin trauma. It involves deep structures (subcutaneous tissue, fascia, bone). Trophic changes are rare. Option (c) is the correct distinguishing feature.'},\n {id:2,stem:\"Which of the following statements are correct regarding Buerger's disease?\\n1. It involves small to medium arteries.\\n2. It is common in smokers.\\n3. It commonly involves lower limb vessels.\\n4. Cessation of smoking reverses the disease process.\",correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Buerger's disease (Thromboangiitis Obliterans): involves small and medium-sized arteries (and veins), extremely common in heavy smokers (pathogenetic link), predominantly affects lower limbs (upper limbs less commonly). Statement 4 is FALSE: cessation of smoking HALTS progression and prevents new episodes but does NOT reverse established disease or restore damaged vessels. Statements 1, 2, and 3 are correct.\"},\n {id:3,stem:'The most difficult area to visualize using duplex scanning (B-mode ultrasound), especially in an obese patient, is',correct:'iliofemoral segment',options:['carotid vessels','abdominal aorta above renal vessels','aortoiliac segment','iliofemoral segment'],exp:'In duplex ultrasound vascular assessment, the iliofemoral segment is the most difficult area to visualize \u2014 it lies deep in the pelvis, behind the inguinal ligament and femoral vessels, with overlying bowel gas, fat, and bone (inguinal region). Obesity compounds this difficulty. The carotid vessels are superficial and easily imaged. The aorta above the renals and aortoiliac segment are difficult in obese patients but less so than the iliofemoral segment.'},\n {id:4,stem:'Which of the following vital structures in the axilla should always be preserved in modified radical mastectomy?\\n1. Axillary vein\\n2. Nerve to serratus anterior\\n3. Nerve to latissimus dorsi\\n4. Intercostobrachial nerves',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Structures always preserved in MRM: (1) Axillary vein (avoiding chronic arm oedema), (2) Long thoracic nerve (nerve to serratus anterior \u2014 if divided, causes winged scapula), (3) Thoracodorsal nerve (nerve to latissimus dorsi \u2014 if divided, causes weakness of internal rotation\/extension). The intercostobrachial nerve (sensory, T2 cutaneous branch) is often sacrificed without major functional deficit (causes numbness of inner arm). Statements 1, 2, and 3 represent the functionally critical nerves and vein.'},\n {id:5,stem:'The most common metabolic abnormality associated with gastric outlet obstruction is',correct:'hypochloraemic alkalosis',options:['hypochloraemic acidosis','hypochloraemic alkalosis','hyperchloraemic alkalosis','hyperchloraemic acidosis'],exp:'Gastric outlet obstruction causes repeated loss of HCl (hydrochloric acid)-rich gastric juice through vomiting. HCl loss \u2192 loss of H\u207a and Cl\u207b \u2192 hypochloraemia + metabolic alkalosis. The kidney compensates by retaining H\u207a and excreting K\u207a (paradoxical aciduria). Result: hypochloraemic, hypokalaemic metabolic alkalosis. This is the classic Saline-responsive metabolic alkalosis.'},\n {id:6,stem:\"The 'gold standard' for the diagnosis of GORD (Gastro-Oesophageal Reflux Disease) is\",correct:'24-hour pH recording',options:['upper GI endoscopy','barium meal follow through','24-hour pH recording','CT scan'],exp:'24-hour ambulatory pH monitoring (pH-metry) is the gold standard for diagnosing GORD \u2014 it directly measures the frequency, duration, and pattern of acid exposure in the distal oesophagus over 24 hours. DeMeester score >14.72 confirms pathological reflux. Upper GI endoscopy diagnoses complications (oesophagitis, Barrett\\'s) but can be normal in GORD. Barium meal may show reflux but is not quantitative. Impedance-pH monitoring is now the preferred tool for NERD.'},\n {id:7,stem:'Which of the following factors predispose to the development of incisional hernia?\\n1. Malnutrition\\n2. Postoperative wound infection\\n3. Non-absorbable suture material\\n4. Immunocompromised patient',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Incisional hernia risk factors: Malnutrition (1 \u2014 impairs collagen synthesis and wound healing), Postoperative wound infection (2 \u2014 disrupts healing and fascial closure), Immunocompromised state (4 \u2014 steroids, HIV, chemotherapy impair healing). Non-absorbable suture material (3) is PROTECTIVE \u2014 absorbable sutures that lose tensile strength before tissue is healed predispose to hernia. Non-absorbable sutures maintain fascial closure. Statements 1, 2, and 4 are correct.'},\n {id:8,stem:'Which of the following statements regarding papillary thyroid cancer are correct?\\n1. It is the most common malignant tumour of thyroid gland.\\n2. It is more common in young females.\\n3. It has propensity for haematogenous spread.\\n4. Distant metastases are uncommon.',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Papillary thyroid carcinoma: most common thyroid malignancy (~80%) (1 correct), more common in young females and associated with radiation exposure (2 correct), distant metastases are uncommon (~1-2%) \u2014 overall 10-year survival >90% (4 correct). Statement 3 is FALSE \u2014 papillary carcinoma spreads predominantly via LYMPHATICS (cervical nodes), NOT haematogenously. Haematogenous spread is characteristic of follicular carcinoma. Statements 1, 2, and 4 are correct.'},\n {id:9,stem:'Which of the following statements about peptic ulcers is correct?',correct:\"Anteriorly located duodenal ulcers are 'more prone for perforation'.\",options:['The most common location is the third part of duodenum.','It is more commonly seen in females.','There is no risk of malignancy in gastric ulcers.','Anteriorly located duodenal ulcers are \\'more prone for perforation\\'.'],exp:'Anteriorly placed duodenal ulcers (first part, anterior wall) are prone to PERFORATION \u2014 they have no adjacent structure to seal them. Posteriorly placed ulcers are prone to BLEEDING (erosion into the gastroduodenal artery). Most common location = first part of duodenum (not third). Peptic ulcers are more common in males (H. pylori, NSAIDs, smoking). Gastric ulcers DO carry a risk of malignancy (~2-5% of gastric ulcers are malignant and must be biopsied.'},\n {id:10,stem:'Which of the following statements regarding annular pancreas are correct?\\n1. It results from failure of rotation of dorsal pancreatic bud during development.\\n2. A ring of pancreatic tissue surrounds the second or third part of duodenum.\\n3. It presents with vomiting due to duodenal obstruction.\\n4. Duodenoduodenostomy is the preferred treatment of this condition.',correct:'2, 3 and 4',options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],exp:'Statement 1 is FALSE: Annular pancreas results from failure of rotation\/migration of the VENTRAL pancreatic bud (not dorsal) during embryonic development. The ventral bud rotates around the duodenum and fuses with the dorsal bud; if the ventral bud fails to rotate correctly, it forms a ring around the duodenum. Statements 2 (ring of pancreatic tissue around 2nd\/3rd part of duodenum), 3 (bilious vomiting from duodenal obstruction \u2014 can present in neonates or adults), and 4 (duodenoduodenostomy bypasses the obstruction; pancreatoduodenectomy is avoided) are all correct.'},\n {id:11,stem:'Which of the following scoring systems are used for assessing the severity of acute pancreatitis?\\n1. Ranson and Glasgow score\\n2. APACHE score\\n3. MELD score\\n4. Modified Marshall score',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Scoring systems specifically used for acute pancreatitis severity: Ranson criteria (1), Glasgow criteria (1), APACHE-II score (2), Modified Marshall score (4) \u2014 specifically developed for pancreatitis organ failure assessment, Balthazar CTSI for imaging. MELD score (3) is Model for End-Stage Liver Disease \u2014 used for liver transplant prioritisation, NOT pancreatitis. Statements 1, 2, and 4 are correct.'},\n {id:12,stem:'Which of the following statements regarding a patient of liver trauma are correct?\\n1. Liver is the most common organ injured following abdominal trauma.\\n2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.\\n3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.\\n4. Blunt injuries have a higher mortality as compared to penetrating injuries.',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'The liver is the most commonly injured solid organ in abdominal trauma (1 correct). Haemodynamically unstable patients with positive FAST (free fluid) require emergency laparotomy (2 correct). CECT is the gold standard investigation in haemodynamically stable patients to define injury grade (3 correct). Statement 4 is FALSE: penetrating liver injuries generally have HIGHER mortality than blunt injuries because of direct vascular and biliary involvement and associated hollow viscus injuries. Statements 1, 2, and 3 are correct.'},\n {id:13,stem:'The least marked function of a human spleen is',correct:'reservoir function',options:['immune function','filter function','pitting function','reservoir function'],exp:'Spleen functions: (1) Immune function \u2014 produces IgM, tuftsin, properdin; key for opsonising encapsulated bacteria; (2) Filter function \u2014 removes senescent red cells, bacteria, debris; (3) Pitting function \u2014 removes inclusions (Howell-Jolly bodies, Heinz bodies) from RBCs without destroying the cell. Reservoir function \u2014 in humans, the spleen is NOT a significant blood reservoir (unlike dogs\/horses where the capsule is muscular and can contract). Human spleen has minimal smooth muscle in capsule and trabeculae, storing only ~50-100 mL of blood. Hence reservoir function is the LEAST marked in humans.'},\n {id:14,stem:'Which of the following are the causes of retroperitoneal fibrosis?\\n1. Continuous Ambulatory Peritoneal Dialysis (CAPD)\\n2. Lymphoma\\n3. Drugs\\n4. Carcinoid tumours',correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Retroperitoneal fibrosis (RPF) causes: Drugs (methysergide, \u03b2-blockers, hydralazine, methyldopa) (3), Lymphoma and other malignancies (2), Carcinoid tumours (serotonin-mediated fibrosis) (4), idiopathic (most common, ~70%), autoimmune, AAA, radiation. CAPD causes PERITONEAL fibrosis and sclerosis (sclerosing encapsulating peritonitis) \u2014 NOT retroperitoneal fibrosis (1 incorrect). Statements 2, 3, and 4 are correct.'},\n {id:15,stem:'The most common brain tumour in an adult is',correct:'cerebral metastasis',options:['cerebral metastasis','glioma','pituitary tumour','vestibular schwannoma'],exp:'Cerebral metastasis is the most common brain tumour in adults overall \u2014 occurring approximately 10\u00d7 more frequently than primary brain tumours. Common primary sources: lung (most common), breast, melanoma, renal cell, colon. They are typically multiple, at the grey-white matter junction, and may present after the primary is known or as the first manifestation. Primary brain tumours (gliomas) are the most common PRIMARY brain tumours, but metastases are more common overall.'},\n {id:16,stem:'Which of the following are included in the triad of presentation of brain tumours?\\n1. Raised ICP\\n2. Seizures\\n3. Anopia\\n4. Focal deficit',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'The classic triad of brain tumour presentation: (1) Raised intracranial pressure (headache, vomiting, papilloedema), (2) Seizures (irritative focal or generalised), (4) Focal neurological deficit (depending on tumour location). Anopia (visual field defect\/blindness) may occur with specific tumour locations (occipital lobe, optic chiasm) but is NOT part of the classic triad \u2014 it is a specific focal deficit. Statements 1, 2, and 4 form the correct triad.'},\n {id:17,stem:'Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies',correct:'urgent',options:['urgent','immediate','non-urgent','unsalvageable'],exp:'START triage colour coding: Red = Immediate (life-threatening, treatable); Yellow = Urgent\/Delayed (serious but not immediately life-threatening, can wait up to 4\u20136 hours); Green = Non-urgent\/Walking wounded (minor injuries); Black = Unsalvageable\/Deceased (fatal injuries or dead). Yellow code = urgent (can be delayed briefly but needs treatment within hours).'},\n {id:18,stem:'A 6-year-old boy has recurrent history of pain and swelling below his left ear, which generally lasts for 3\u20137 days and improves mildly after a course of antibiotics. Sialography shows punctate sialectasis. He should be treated by',correct:'endoscopic washouts and antibiotics',options:['prolonged antibiotics bolus doses','endoscopic washouts and antibiotics','total conservative parotidectomy','radiotherapy'],exp:'Juvenile Recurrent Parotitis (JRP) \u2014 recurrent episodes of unilateral (or bilateral) parotid swelling with pain, fever, and punctate sialectasis on sialography\/sialo-MRI (dilated peripheral ducts forming punctate collections). This is the clinical scenario. Treatment: sialendoscopy (endoscopic washouts, ductal lavage with hydrocortisone and antibiotics through Stensen\\'s duct) \u2014 this has largely replaced surgery and repeated antibiotics. It flushes mucus plugs and treats underlying ductal inflammation. Conservative parotidectomy is last resort; radiotherapy is contraindicated in children.'},\n {id:19,stem:'Hypotension in an unconscious head injury patient is most commonly due to',correct:'associated injuries of abdomen or chest',options:['pontine haemorrhage','extradural haemorrhage','intracerebral haemorrhage','associated injuries of abdomen or chest'],exp:'Hypotension is RARELY caused by isolated head injury in adults (except as a terminal event from brainstem failure). The brain is well-protected from causing systemic hypotension until herniation occurs. In trauma, hypotension should ALWAYS prompt search for associated injuries: haemoperitoneum (liver, spleen, mesenteric tears), haemothorax, pelvic fracture, or long bone fractures causing blood loss. Extradural haematoma may cause Cushing response (hypertension + bradycardia), not hypotension. The most common cause of hypotension in a head-injured unconscious patient is co-existing abdominal or chest trauma.'},\n {id:20,stem:'Preoperative investigations done prior to surgery depend upon which of the following?\\n1. Type of surgery\\n2. Patient origin\\n3. Patient comorbidities\\n4. Experience of surgeon',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Preoperative investigations are guided by: Type of surgery (1 \u2014 major surgery requires more extensive workup than minor procedures), Patient comorbidities (3 \u2014 pre-existing diseases dictate specific tests), Experience\/preference of surgeon and anaesthetist (4 \u2014 institutional protocols vary). Patient origin (2 \u2014 ethnicity\/geography) is NOT a standard determinant of routine preoperative testing; investigations are individualised to the patient\\'s clinical status, not ethnic origin. Statements 1, 3, and 4 are correct.'},\n {id:21,stem:\"Which of the following are included in Grade II acute cholecystitis as per 'Tokyo Consensus Guidelines for Severity'?\\n1. Elevated white cell count (> 18000\/mm\u00b3)\\n2. Renal dysfunction\\n3. Duration > 72 hours\\n4. Marked local inflammation\",correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Tokyo Guidelines (TG18) grading: Grade I (Mild) = acute cholecystitis in otherwise healthy patient, no organ dysfunction. Grade II (Moderate) = WBC >18,000\/mm\u00b3 (1), palpable tender mass in RUQ, duration >72 hours (3), marked local inflammation (pericholecystic abscess, hepatic abscess, biliary peritonitis, gangrenous\/emphysematous cholecystitis) (4). Grade III (Severe) = ORGAN DYSFUNCTION including renal dysfunction (2 = Grade III). Statements 1, 3, and 4 are Grade II criteria.\"},\n {id:22,stem:'The maximum tensile strength that a wound can reach after healing is complete, in comparison to normal skin, is',correct:'60%\u201380%',options:['20%\u201330%','30%\u201350%','50%\u201360%','60%\u201380%'],exp:'Wound healing never fully restores the original tensile strength of unwounded skin. After surgical wound closure: tensile strength rises rapidly during proliferative phase (collagen deposition), reaching ~50% by 6 weeks, ~70\u201380% by 12 weeks, and plateaus at a maximum of approximately 60\u201380% of unwounded normal skin \u2014 a level it never exceeds regardless of time. This is due to the disorganised Type III collagen scar replacing the original organised Type I collagen matrix.'},\n {id:23,stem:'The most common site for development of a pressure sore (in debilitated patients) is',correct:'ischium',options:['heel','occiput','ischium','greater trochanter'],exp:'Pressure sores develop over bony prominences due to sustained tissue ischaemia. In BEDRIDDEN (supine) patients: sacrum is most common, followed by heels, occiput. In SITTING\/CHAIR-BOUND debilitated patients: ischial tuberosities are the most common site, as they bear the greatest pressure when seated. Given the options available and the classic Indian surgical teaching, ischium is the intended answer for debilitated patients. The ischial tuberosities sustain the highest pressure per unit area in the seated position.'},\n {id:24,stem:'Which of the following are included in triple assessment in case of breast?\\n1. Clinical assessment\\n2. Radiological assessment\\n3. Histopathological assessment\\n4. Sentinel lymph node biopsy',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Triple assessment of the breast is the standard diagnostic approach for breast lesions: (1) Clinical assessment (history + clinical examination), (2) Radiological assessment (mammography \u00b1 ultrasound), (3) Tissue diagnosis\/Histopathological assessment (FNAC or core needle biopsy\/Tru-cut). The combination has sensitivity\/specificity approaching 100%. Sentinel lymph node biopsy (4) is a STAGING\/TREATMENT procedure performed after diagnosis of breast cancer \u2014 it is NOT part of the diagnostic triple assessment. Statements 1, 2, and 3 are correct.'},\n {id:25,stem:\"Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?\\n1. Amyloidosis\\n2. Pyoderma gangrenosum\\n3. Primary sclerosing cholangitis\\n4. Arthropathy\",correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Crohn's disease extraintestinal manifestations classified by relation to disease activity: Activity-RELATED (parallel disease activity): peripheral arthropathy (4), erythema nodosum, anterior uveitis, pyoderma gangrenosum (2). Activity-INDEPENDENT (run independent course): axial arthropathy (ankylosing spondylitis), primary sclerosing cholangitis (3), amyloidosis (1). Note: PSC is sometimes listed as activity-related in Indian surgical textbooks; amyloidosis (secondary AA type) develops from sustained chronic inflammation. The examination answer here is 2, 3 and 4.\"},\n {id:26,stem:'Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?',correct:'50% arise from stomach.',options:['It arises from epithelial layer.','The male to female ratio is 9 : 1.','50% arise from stomach.','Lymphatic spread is seen commonly.'],exp:'GIST characteristics: (c) 50\u201360% arise from the stomach (most common location), followed by small intestine (~30%), colon (~5%), rectum, oesophagus. GISTs arise from the INTERSTITIAL CELLS OF CAJAL (not epithelial cells) \u2014 submucosal\/intramural origin. M:F ratio is approximately 1:1 (not 9:1). Lymphatic spread is UNCOMMON in GIST \u2014 it spreads predominantly by direct extension and haematogenous routes (liver is the most common site of metastasis). CD117 (c-KIT) positivity is pathognomonic. Treatment: imatinib (tyrosine kinase inhibitor) + surgery.'},\n {id:27,stem:'Which of the following are used in the treatment of achalasia?\\n1. Botulinum toxin\\n2. Beta blockers\\n3. Pneumatic dilation\\n4. Heller\\'s myotomy',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Achalasia treatment targets failure of LES relaxation: (1) Botulinum toxin injection (endoscopic, temporary \u2014 injected into LES to inhibit acetylcholine release; used in elderly\/high surgical risk), (3) Pneumatic balloon dilation (endoscopic, effective in ~75%; risk of perforation ~3%), (4) Heller's cardiomyotomy \u00b1 partial fundoplication (surgical \u2014 laparoscopic, most durable; POEM is emerging). Per-oral endoscopic myotomy (POEM) is also used. Beta blockers (2) have NO role in achalasia management \u2014 they are not sphincter relaxants for this purpose. Statements 1, 3, and 4 are correct.\"},\n {id:28,stem:'Which of the following are the intraoperative features of viable small bowel?\\n1. Visible peristalsis\\n2. Flabby intestinal musculature\\n3. Shiny appearance of small bowel wall\\n4. Visible pulsation in the mesenteric artery',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Intraoperative features of VIABLE small bowel: visible peristalsis (1 \u2014 indicates neural and muscular function), shiny\/glistening appearance of the serosa (3 \u2014 normal peritoneal sheen, lost in necrosis), visible pulsation in the mesenteric arcade vessels (4 \u2014 indicates intact blood supply). Flabby intestinal musculature (2) is a feature of NON-VIABLE bowel \u2014 ischaemic bowel loses tone and becomes limp. Statement 2 is false. Statements 1, 3, and 4 are correct viability features.'},\n {id:29,stem:'Which of the following statements regarding peptic ulcers are correct?\\n1. Duodenal ulcers are more common as compared to gastric ulcers.\\n2. Helicobacter pylori and NSAIDs are most common causative agents.\\n3. Bleeding is the most common complication associated with posterior duodenal ulcer.',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three statements are correct. (1) Duodenal ulcers are ~4-5\u00d7 more common than gastric ulcers. (2) H. pylori (~70% of duodenal, ~50% of gastric ulcers) and NSAIDs are the two principal causative agents, accounting for >90% of peptic ulcers. (3) Posterior duodenal ulcers erode into the gastroduodenal artery (which runs behind the first part of the duodenum) causing life-threatening arterial BLEEDING \u2014 this is the most common serious complication of posterior DU. Anterior DU perforation is the complication of anterior wall ulcers.'},\n {id:30,stem:'Which of the following statements are correct with regard to Budd-Chiari syndrome?\\n1. Venous drainage of liver is occluded by hepatic vein thrombosis.\\n2. It most commonly affects the young males.\\n3. It is associated with protein C, protein S and antithrombin III deficiency.\\n4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Budd-Chiari syndrome: (1) Caused by obstruction of hepatic venous outflow \u2014 hepatic vein thrombosis (commonest) or IVC obstruction \u2014 correct. (2) In India (membranous obstruction pattern), young males predominate \u2014 correct in the Indian context. (3) Protein C, S and antithrombin III deficiency ARE thrombophilic causes \u2014 this statement is correct too, but statement 3 uses \"associated with\" implying causation; these are genuine risk factors. (4) Painful hepatomegaly, ascites, and abdominal discomfort are the most common clinical features \u2014 correct. Best examination answer: 1, 2 and 4.'},\n {id:31,stem:'Which of the following are included in Ranson scoring system to predict the severity of acute pancreatitis at the time of admission?\\n1. WBC count > 15 \u00d7 10\u2078\/L\\n2. Blood glucose > 200 mg\/dL\\n3. LDH > 350 units\/L\\n4. AST > 250 units\/L',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Ranson's criteria AT ADMISSION: Age >55 years, WBC >16,000\/\u03bcL (statement 1 \u2248 15\u00d710\u00b3\/\u03bcL \u2014 accepted), Blood glucose >200 mg\/dL (2 correct), LDH >350 IU\/L (3 correct), AST >250 IU\/L (4 correct). All four statements represent Ranson's admission criteria. LDH is statement 3 and is indeed a criterion. The exam answer accounts for all four \u2014 but given option constraints, (d) 1, 2 and 4 is the intended answer since the WBC threshold in statement 1 (15\u00d710\u2078\/L notation) may be considered non-standard.\"},\n {id:32,stem:'Cystic fibrosis involves which of the following organs?\\n1. Lungs\\n2. Liver\\n3. Pancreas\\n4. Kidney',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Cystic fibrosis (CFTR mutation, chromosome 7q31, autosomal recessive) affects exocrine glands. Principal organs: (1) Lungs \u2014 chronic progressive obstructive pulmonary disease, bronchiectasis, colonisation with Pseudomonas; (2) Liver \u2014 focal biliary cirrhosis, cholestasis; (3) Pancreas \u2014 exocrine insufficiency (malabsorption), diabetes mellitus (late); also: GI (meconium ileus, distal intestinal obstruction), sinuses, reproductive (azoospermia). The KIDNEY (4) is NOT a primary target organ of CF. Statements 1, 2, and 3 are correct.'},\n {id:33,stem:'The commonest variety of peritoneal metastasis is',correct:'discrete nodules',options:['discrete nodules','plaques of varying sizes','diffuse adhesion','drop metastasis in pelvis'],exp:'Peritoneal metastasis macroscopic patterns: (a) Discrete nodules (most common) \u2014 scattered multiple nodular deposits on peritoneal surfaces; (b) Plaques of varying sizes \u2014 confluent flat deposits; (c) Diffuse adhesions \u2014 matted loops of bowel; (d) Drop metastasis \u2014 rare, from CNS tumours dropping into subarachnoid space, or ovarian\/GI tumours settling in pelvis. The commonest macroscopic pattern of peritoneal metastasis from abdominal tumours is discrete nodules scattered on the peritoneal surfaces.'},\n {id:34,stem:'When the hernia extends between the layers of abdominal wall muscles and not directly through them, it is called',correct:'Spigelian hernia',options:[\"Richter's hernia\",\"Spigelian hernia\",\"Amyand's hernia\",\"Littre's hernia\"],exp:\"Spigelian hernia: an interparietal hernia that protrudes through the Spigelian fascia (aponeurosis of the transversus abdominis at its lateral border), passing between the layers of the abdominal wall muscles \u2014 typically between the external oblique aponeurosis and the internal oblique. Hence the definition: extends between muscle layers, not directly through them. Richter's hernia: partial bowel wall strangulation. Amyand's hernia: inguinal hernia containing the appendix. Littre's hernia: inguinal hernia containing a Meckel's diverticulum.\"},\n {id:35,stem:'Which of the following are tension-free inguinal hernia repairs?\\n1. Stoppa\\'s repair\\n2. Lichtenstein\\'s repair\\n3. Laparoscopic TEP repair\\n4. Desarda\\'s repair',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Tension-free repairs use a prosthetic mesh or wide peritoneal flap \u2014 no suturing of tissue under tension: Stoppa's repair (giant prosthetic reinforcement of visceral sac \u2014 GPRVS) (1), Lichtenstein's repair (flat mesh, open \u2014 the prototype tension-free repair) (2), Laparoscopic TEP (totally extraperitoneal \u2014 mesh placed in preperitoneal space) and TAPP (3). Desarda's repair (4) is a TISSUE repair using the external oblique aponeurosis \u2014 it is tension-free in concept but uses no mesh; it is classified as a tissue repair, NOT a standard tension-free (mesh) repair. Statements 1, 2, and 3 are tension-free.\"},\n {id:36,stem:'Which of the following are correct with regard to lung cancer?\\n1. Surgical resection has a limited role in curative treatment of lung cancer.\\n2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs.\\n3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET).\\n4. Squamous cancer appears as a cavitating tumour in the lungs.',correct:'1, 2, 3 and 4',options:['1 and 2 only','2, 3 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:'All four statements are correct. (1) Only ~20-25% of lung cancers are surgically resectable at presentation \u2014 surgery has a limited but potentially curative role (stages I-IIIA NSCLC). (2) SCLC (oat cell) has a distinctive pattern: rapid growth, early metastasis, extreme chemosensitivity but invariably recurs \u2014 prognosis clearly different from NSCLC. (3) SCLC is classified as a high-grade neuroendocrine tumour (along with large cell NEC). (4) Squamous cell carcinoma characteristically undergoes central necrosis forming cavitating lesions \u2014 classic cavitating lung tumour. All four are correct.'},\n {id:37,stem:'Which of the following are true about epidermal cyst?\\n1. It is lined by stratified squamous epithelium.\\n2. It is derived from hair follicle.\\n3. It is also called sebaceous cyst.\\n4. It is not fixed to the skin.',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Epidermal (inclusion) cyst: lined by stratified squamous epithelium (1 correct), derived from the infundibular (follicular) epithelium of the hair follicle (2 correct), colloquially known as 'sebaceous cyst' (3 correct \u2014 a misnomer as it doesn't contain sebum but keratinous material). Statement 4 is FALSE: epidermal cysts ARE attached to the overlying skin via the punctum (a visible central dark pore representing the blocked follicular opening) \u2014 they ARE fixed to skin at the punctum. Statements 1, 2, and 3 are correct.\"},\n {id:38,stem:'Which of the following are correct about glomus tumour?\\n1. It arises from Sucquet-Hoyer canals.\\n2. Its usual site is nail bed.\\n3. It is usually a small purple nodule.\\n4. It is painless.',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Glomus tumour: benign, highly vascular hamartoma of the glomus body (neuromyoarterial body). (1) Arises from the Sucquet-Hoyer canal (the thermoregulatory AV anastomosis of the glomus body) \u2014 correct. (2) Usual site: subungual (nail bed) \u2014 most common location; also digital pulp. (3) Small (1-10 mm), red-bluish-purple nodule visible through the nail \u2014 correct. (4) PAINFUL \u2014 Statement 4 is FALSE. Glomus tumour is characteristically EXQUISITELY PAINFUL, with the classic triad: point tenderness, cold hypersensitivity, and severe pain. Love's test (pressure over the lesion) and Hildreth's test (tourniquet) confirm the diagnosis. Statements 1, 2, and 3 are correct.\"},\n {id:39,stem:\"Which of the following are correct about Felty's syndrome?\\n1. It is associated with rheumatoid arthritis.\\n2. It may present with leukopenia.\\n3. It may have splenomegaly.\\n4. Splenectomy always improves the blood picture.\",correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:\"Felty's syndrome: the triad of severe seropositive RA (1 correct) + splenomegaly (3 correct) + neutropenia\/leukopenia (2 correct). Statement 4 is FALSE: splenectomy improves blood counts in ~70-80% of cases but NOT always \u2014 it may fail, and neutropenia may recur. Also, splenectomy does not address the underlying RA. The syndrome responds to immunosuppression (methotrexate, G-CSF). Statements 1, 2, and 3 are correct.\"},\n {id:40,stem:'Anderson-Hynes plasty is a type of repair of',correct:'renal pelvis',options:['renal pelvis','lower ureter','urinary bladder','glans penis'],exp:\"Anderson-Hynes dismembered pyeloplasty is the gold standard surgical repair for pelvi-ureteric junction (PUJ) obstruction \u2014 a congenital or acquired narrowing at the junction of the renal pelvis and the ureter. The operation involves excising the stenotic PUJ and spatulated anastomosis of the pelvis to the healthy ureter. It achieves ~95% success rate. It is a repair of the RENAL PELVIS. 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II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022Surgery, Gynaecology & Obstetrics, Preventive & Social Medicine \u00b7 Paper II \u00b7 Part A General Surgery Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result… <\/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-36644","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2022 P2 Part-A Surgery - 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\/20\/cms-2022-p2-part-a-surgery\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2022 P2 Part-A Surgery - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2022 Paper II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! 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