CMS 2023 | General Medicine & Paediatrics | Paper I | Part A<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n*,*::before,*::after{box-sizing:border-box;margin:0;padding:0}\n:root{\n --blue:#1A5EA8;--blue-lt:#2E82D5;--blue-pale:#EBF3FD;\n --navy:#1A3A5C;--navy-lt:#24527F;--navy-pale:#E8F0F9;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#dde4ed;--bg:#f8fafd;--white:#ffffff;\n --ok:#1e6f46;--ok-bg:#eaf7ef;--ok-bd:#43a047;\n --bad:#b83232;--bad-bg:#fdf0f0;--bad-bd:#e53935;\n --rad:10px;\n}\nbody{font-family:\"Source Serif 4\",Georgia,serif;font-size:16px;background:var(--bg);color:var(--ink);line-height:1.7;min-height:100vh}\n#cms23p2a{max-width:780px;margin:0 auto;padding:0 0 60px}\n\n\/* \u2500\u2500 progress strip (sticky within page, below any WP header) \u2500\u2500 *\/\n.qz-prog-bar{\n position:sticky;top:0;z-index:200;\n 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Display\",serif;font-size:1.15rem;color:var(--bad);margin-bottom:8px}\n.qz-grace-box p{font-size:0.85rem;color:var(--ink-mid);margin-bottom:14px}\n.qz-grace-n{font-family:\"Playfair Display\",serif;font-size:2.8rem;font-weight:700;color:var(--bad);line-height:1;margin-bottom:16px}\n.qz-grace-now{background:var(--bad);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:\"Playfair Display\",serif;font-size:0.9rem;font-weight:700;cursor:pointer}\n.qz-grace-now:hover{background:#c62828}\n\n@media(max-width:480px){\n .qz-header h1{font-size:1.05rem}\n .qz-stem{font-size:0.87rem}\n .qz-opt-txt{font-size:0.84rem}\n .qz-prog-stats{font-size:0.68rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms23p2a\">\n\n<div class=\"qz-prog-bar\" id=\"qz-prog-bar\">\n <div class=\"qz-prog-stats\">\n <div class=\"qz-stat\">✓️ <strong id=\"qz-sc\">0<\/strong><\/div>\n <div class=\"qz-stat\">❌ <strong id=\"qz-sw\">0<\/strong><\/div>\n <div class=\"qz-stat\">⏳ <strong id=\"qz-sr\">40<\/strong> left<\/div>\n <div class=\"qz-timer-wrap\">\n <div class=\"qz-timer\" id=\"qz-timer\">⏱ <strong id=\"qz-td\">40:00<\/strong><\/div>\n <div class=\"qz-stat net-score\">Net <strong id=\"qz-sn\">0<\/strong> \/ 160<\/div>\n <\/div>\n <\/div>\n <div class=\"qz-prog-track\"><div class=\"qz-prog-fill\" id=\"qz-fill\"><\/div><\/div>\n<\/div>\n\n<div class=\"qz-grace\" id=\"qz-grace\">\n <div class=\"qz-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"qz-grace-n\" id=\"qz-gn\">10<\/div>\n <button class=\"qz-grace-now\" id=\"qz-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-header\">\n <h1>Combined Medical Services Examination 2023<br>Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part A<\/h1>\n <p>General Surgery · Vascular & GI Surgery · Trauma & Neurosurgery · Anaesthesia<\/p>\n <div class=\"qz-meta\">\n <span class=\"qz-badge\">Questions 1–40<\/span>\n <span class=\"qz-badge\">Options reshuffled<\/span>\n <span class=\"qz-badge\">Score = c × 4 − w<\/span>\n <button class=\"qz-timer-btn\" id=\"qz-tbtn\">⏱ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-body\">\n <div id=\"qz-questions\"><\/div>\n <div class=\"qz-submit-wrap\">\n <button class=\"qz-submit\" id=\"qz-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"qz-result\" id=\"qz-result\">\n <div class=\"qz-ring\" id=\"qz-ring\">\n <div class=\"qz-ring-inner\">\n <div class=\"qz-ring-pct\" id=\"qz-rpct\">0%<\/div>\n <div class=\"qz-ring-sub\">score<\/div>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"qz-net\" id=\"qz-rnet\"><\/div>\n <div class=\"qz-verdict\" id=\"qz-rv\"><\/div>\n <div class=\"qz-bands\">\n <span class=\"qz-band bc\" id=\"qz-bc\"><\/span>\n <span class=\"qz-band bw\" id=\"qz-bw\"><\/span>\n <span class=\"qz-band bs\" id=\"qz-bs\"><\/span>\n <\/div>\n <button class=\"qz-retry\" id=\"qz-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n\n<\/div>\n\n<script>\n(function(){\n\nvar TOTAL = 40, MAX = 160;\nvar TSECS = 2400, GSECS = 10;\nvar LTRS = [\"A\",\"B\",\"C\",\"D\"];\n\nvar QQ = [\n{id:1,\nstem:\"The ratio for Type-I to Type-III collagen during maturation of collagen in remodelling phase is\",\ncorrect:\"4:1\",\nopts:[\"1:1\",\"2:1\",\"3:1\",\"4:1\"],\nexp:\"Wound healing progresses through three phases: inflammation, proliferation, and remodelling. During the proliferative phase, Type III collagen (immature, weaker) predominates. During the remodelling phase (from 3 weeks to 2 years), Type III collagen is progressively replaced by Type I collagen (mature, stronger) via collagenase activity and new synthesis. The final ratio of Type I to Type III collagen in the remodelled scar approaches 4:1, which approximates the ratio found in normal unwounded skin (also approximately 4:1). This restoration accounts for the gradual increase in tensile strength during wound maturation.\"\n},\n{id:2,\nstem:\"Which one of the following statements regarding Gas Gangrene Infection is correct?\",\ncorrect:\"It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli.\",\nopts:[\"It is caused by C. perfringens, a gram negative aerobic non-spore-forming bacilli.\",\"It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli.\",\"It is caused by C. tetani, a gram positive anaerobic spore-forming bacilli.\",\"It is caused by C. tetani, a gram negative anaerobic non-spore-forming bacilli.\"],\nexp:\"Gas gangrene (clostridial myonecrosis) is caused by Clostridium perfringens (also known as C. welchii), which is a gram-positive, anaerobic, spore-forming bacillus. It produces alpha-toxin (lecithinase\/phospholipase C), the principal virulence factor, which destroys cell membranes causing extensive myonecrosis. The organism thrives in devitalised, ischaemic tissue with low oxygen tension. Clinical features: severe pain, crepitus (gas in tissues on palpation\/X-ray), sweet-sour odour, bronze skin discolouration, systemic toxaemia. Treatment: urgent surgical debridement\/amputation plus high-dose penicillin G and hyperbaric oxygen.\"\n},\n{id:3,\nstem:\"The term Gompertzian curve is related to which one of the following?\",\ncorrect:\"Tumour\",\nopts:[\"Tumour\",\"Gallstone\",\"Intestinal obstruction\",\"Hernia\"],\nexp:\"The Gompertzian growth curve describes the pattern of tumour growth over time. Initially, when a tumour is small, it grows rapidly (exponential phase). As the tumour enlarges, growth progressively decelerates due to limited blood supply, nutrient deprivation, accumulating waste products, and immune responses. This produces a sigmoid (S-shaped) growth curve that flattens at large tumour sizes, mathematically described by the Gompertz function. Understanding Gompertzian kinetics is important in oncology: small tumours have the highest growth fraction and are most sensitive to chemotherapy; large tumours have slower growth rates but more resistant cells. The model was adapted from actuarial mortality mathematics by Gompertz in the 19th century.\"\n},\n{id:4,\nstem:\"A 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is\",\ncorrect:\"Herniotomy\",\nopts:[\"To leave it alone (masterly inactivity)\",\"Herniotomy\",\"Eversion of sac\",\"Hernioplasty\"],\nexp:\"The described swelling - absent in the morning, appearing by evening, not reducible on examination but historically reducible - is consistent with an indirect inguinal hernia in a child that reduces spontaneously overnight when the child lies flat. In a 5-year-old child, inguinal hernia is due to a patent processus vaginalis. The treatment is HERNIOTOMY (high ligation of the patent processus vaginalis at the deep inguinal ring) without any mesh repair. In children, the posterior wall of the inguinal canal is strong and intact, so hernioplasty (mesh repair) is not required. Masterly inactivity is not appropriate as the risk of incarceration is significant in children. Eversion of sac is treatment for hydrocele.\"\n},\n{id:5,\nstem:\"A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is\",\ncorrect:\"Percutaneous embolization of gonadal veins\",\nopts:[\"Percutaneous embolization of gonadal veins\",\"Radio frequency ablation of testicular veins\",\"Laparoscopic excision of affected testes\",\"Excision of pampiniform plexus\"],\nexp:\"The bag of worms appearance disappearing on lying down is pathognomonic of varicocele (dilatation of the pampiniform venous plexus of the spermatic cord). Left-sided varicocele is most common (90%) due to the right-angle drainage of the left testicular vein into the left renal vein. Percutaneous embolization of the gonadal veins (radiological embolisation under fluoroscopic guidance) is now the preferred first-line minimally invasive treatment for symptomatic varicocele, with success rates of 85-95% and low recurrence. Surgical options (open Palomo\/Ivanissevich operations, laparoscopic ligation) are alternatives. RFA of testicular veins and excision of the pampiniform plexus are not standard treatment modalities.\"\n},\n{id:6,\nstem:\"A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is\",\ncorrect:\"Deep vein thrombosis\",\nopts:[\"Hypoproteinemia\",\"Oedema of renal failure\",\"Myocardial failue due to fluid overload\",\"Deep vein thrombosis\"],\nexp:\"A painful calf swelling in a post-operative patient after major abdominal surgery is deep vein thrombosis (DVT) until proven otherwise. This patient has multiple risk factors for DVT (Virchow's triad): (1) Stasis - post-operative immobility; (2) Hypercoagulability - malignancy, stress response to surgery, malnutrition; (3) Endothelial injury - surgical trauma. DVT typically presents with unilateral painful, swollen, tender calf with Homan's sign (pain on dorsiflexion). Diagnosis is confirmed by duplex ultrasound. Treatment: anticoagulation (LMWH\/heparin then warfarin). Hypoproteinaemia causes bilateral pitting oedema. Renal failure causes bilateral non-tender oedema. The unilateral, painful nature points firmly to DVT.\"\n},\n{id:7,\nstem:\"Consider the following in respect of Salmon patch:<br>1. It is a hemangioma.<br>2. Its usual site is nape of neck.<br>3. It is common in children.<br>4. It needs surgical excision.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Salmon patch (naevus simplex \/ stork bite \/ angel kiss) is a common benign vascular birthmark (capillary haemangioma\/naevus) present in approximately 40-50% of newborns. Statement 1 TRUE: It is a haemangioma (simple capillary haemangioma\/telangiectasia). Statement 2 TRUE: It most commonly appears on the nape of the neck (stork bite), glabella, eyelids, and forehead. Statement 3 TRUE: It is extremely common in neonates and children; facial lesions typically fade by 1-2 years; nuchal lesions may persist lifelong. Statement 4 FALSE: Salmon patches do NOT need surgical excision; they are benign, cause no symptoms, and most fade spontaneously. Treatment (if desired for cosmesis) is laser therapy, not surgery. Statements 1, 2, and 3 are correct.\"\n},\n{id:8,\nstem:\"Which of the following are components of Klippel-Trenaunay syndrome?<br>1. Cutaneous Naevus<br>2. Subcutaneous Lipomas<br>3. Varicose veins<br>4. Soft tissue hypertrophy<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Klippel-Trenaunay syndrome (KTS) is a congenital vascular malformation syndrome characterised by the classic triad: (1) Cutaneous naevus (port-wine stain \/ capillary vascular malformation) - statement 1 correct; (2) Varicose veins (venous malformations, often with absent or hypoplastic deep veins) - statement 3 correct; (3) Bony and soft tissue hypertrophy (limb overgrowth, typically affecting one lower limb) - statement 4 correct. Subcutaneous lipomas are NOT a component of KTS - statement 2 is incorrect. KTS is to be distinguished from Parkes-Weber syndrome (which has arteriovenous fistulae). Statements 1, 3, and 4 are the correct components.\"\n},\n{id:9,\nstem:\"Mickey Mouse Sign during B-mode duplex ultrasound imaging comprises\",\ncorrect:\"Common femoral vein, Common femoral artery and Great Saphenous vein\",\nopts:[\"Popliteal artery, Popliteal vein and Saphenous nerve\",\"Anterior tibial artery, Dorsalis pedis artery and Extensor hallucis tendon\",\"Common femoral vein, Common femoral artery and Great Saphenous vein\",\"Brachial artery, Basilica vein and Biceps tendon\"],\nexp:\"The Mickey Mouse sign is seen on cross-sectional B-mode duplex ultrasound at the femoral triangle (groin). The three circular structures that together resemble Mickey Mouse face are: the large round head = common femoral vein (CFV, medial, compressible); the large ears = common femoral artery (CFA, lateral, pulsatile, non-compressible); the small ear = great saphenous vein (GSV, anteromedial, small, compressible). This sonographic landmark is used to identify the correct position for femoral vein access, DVT assessment, and sapheno-femoral junction evaluation. The three structures are the CFV, CFA, and GSV.\"\n},\n{id:10,\nstem:\"Which of the following statements regarding Thyroglossal duct are correct?<br>1. It is situated in midline of neck.<br>2. It moves upwards on swallowing but not on tongue protrusion.<br>3. It is treated with Sistrunk operation.<br>4. It may be the only functioning thyroid tissue in the body.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Thyroglossal duct cyst is the most common congenital neck swelling. Statement 1 TRUE: It is situated in the midline of the neck (or just off-midline), anywhere along the path of thyroid descent from the foramen caecum to the thyroid gland. Statement 2 FALSE: The pathognomonic feature is that it moves upwards on BOTH swallowing AND on tongue protrusion (because it is attached to the hyoid bone via the thyroglossal tract which is attached to the tongue base via the foramen caecum). This dual movement distinguishes it from other neck swellings. Statement 3 TRUE: The Sistrunk operation (excision of the cyst with the central portion of the hyoid bone and a core of tongue muscle to the foramen caecum) is the standard treatment, with a low recurrence rate. Statement 4 TRUE: In ectopic thyroid, the thyroglossal cyst may contain the only functioning thyroid tissue; pre-operative thyroid scan is essential. Statements 1, 3, and 4 are correct.\"\n},\n{id:11,\nstem:\"A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is\",\ncorrect:\"Erythroplakia\",\nopts:[\"Speckled leucoplakia\",\"Leukoplakia\",\"Erythroplakia\",\"Oral candidiasis\"],\nexp:\"Erythroplakia is defined as a bright red, velvety plaque on the oral mucosa that cannot be characterised clinically or pathologically as any other definable disease. It is a pre-malignant lesion with the HIGHEST malignant transformation rate of all oral potentially malignant disorders (approximately 50% show severe dysplasia or carcinoma in situ at biopsy, and up to 90% undergo malignant transformation over time). The key descriptor is bright red velvety plaque on a background of white mucosa. Erythroplakia carries a much higher risk than leukoplakia (white patches, about 5-17% transformation rate) or speckled leukoplakia (mixed red and white, intermediate risk). Risk factors: tobacco, alcohol, areca nut. Biopsy is mandatory. The velvety red plaque is the diagnostic clue for erythroplakia.\"\n},\n{id:12,\nstem:\"Collar-stud abscess is seen in\",\ncorrect:\"Tuberculosis\",\nopts:[\"Tuberculosis\",\"Lymphomatous degeneration\",\"Streptococcal infection\",\"Pseudomonas infection\"],\nexp:\"Collar-stud (dumbbell) abscess is pathognomonic of tuberculous lymphadenitis (scrofula). The abscess forms when caseous material from a tuberculous lymph node erodes through the deep fascia. The portion in the deep compartment (deep to deep cervical fascia) remains larger, while the superficial portion (subcutaneous) bulges through the fascial defect, creating the characteristic collar-stud or dumbbell shape with a narrow waist at the fascial opening. The two components communicate through the fascial defect. Treatment: anti-tubercular therapy with surgical drainage of the superficial component if needed. Collar-stud abscess is not a feature of streptococcal, pseudomonal, or lymphomatous conditions.\"\n},\n{id:13,\nstem:\"The best cosmetic result following breast reconstruction is achieved with\",\ncorrect:\"Transverse rectus abdominis myocutaneous flap\",\nopts:[\"Latissimus dorsi flap\",\"Silicone gel implant with reconstruction\",\"Transverse rectus abdominis myocutaneous flap\",\"Acellular dermal matrix flap\"],\nexp:\"The TRAM (Transverse Rectus Abdominis Myocutaneous) flap provides the best cosmetic result for breast reconstruction because: (1) It uses autologous tissue (own abdominal skin and fat) that matches the breast texture, warmth, and consistency; (2) It creates a natural-feeling breast mound that ages with the patient; (3) It achieves excellent symmetry; (4) The donor site results in a simultaneous abdominoplasty (aesthetic benefit). The free TRAM or DIEP (Deep Inferior Epigastric Perforator) flap variations further reduce donor site morbidity. Silicone implants may have complications (capsular contracture, implant failure). Latissimus dorsi flap often requires an implant to achieve adequate volume. TRAM flap gives the best long-term cosmetic outcome.\"\n},\n{id:14,\nstem:\"Which of the following are correct regarding Trichobezoar?<br>1. It is a hair ball in the stomach.<br>2. It is common in psychiatric patients.<br>3. Common complications are bleeding, perforation or obstruction.<br>4. Treated with long course of proton pump inhibitors.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Trichobezoar (Rapunzel syndrome) is a bezoar composed of swallowed hair (trichophagia) accumulating in the stomach. Statement 1 TRUE: It is a hairball in the stomach (and sometimes extending into the small intestine in Rapunzel syndrome). Statement 2 TRUE: It is strongly associated with psychiatric conditions, particularly trichotillomania (hair-pulling disorder) and trichophagia, and occurs predominantly in young females with psychiatric disorders. Statement 3 TRUE: Complications include gastric ulceration and bleeding, intestinal obstruction (if the tail extends into the intestine), and rarely perforation. Statement 4 FALSE: Trichobezoar cannot be dissolved pharmacologically (unlike phytobezoars which may respond to cellulase or papain); treatment requires surgical or endoscopic removal. PPIs have no role in dissolving hair. Statements 1, 2, and 3 are correct.\"\n},\n{id:15,\nstem:\"The inferior rectal artery is a branch of\",\ncorrect:\"Internal pudendal artery\",\nopts:[\"Internal iliac artery\",\"Inferior mesenteric artery\",\"Internal pudendal artery\",\"Median sacral artery\"],\nexp:\"The blood supply of the rectum and anal canal comes from three arteries: (1) Superior rectal artery (branch of inferior mesenteric artery) - supplies upper rectum; (2) Middle rectal artery (branch of internal iliac artery) - supplies middle rectum; (3) Inferior rectal artery (branch of internal pudendal artery, which is a branch of internal iliac) - supplies lower anal canal and external anal sphincter. The internal pudendal artery arises from the anterior division of the internal iliac artery, exits the pelvis through the greater sciatic foramen, crosses the ischial spine, and re-enters through the lesser sciatic foramen to travel in the pudendal canal, giving off the inferior rectal artery. The inferior rectal artery is a branch of the internal pudendal artery.\"\n},\n{id:16,\nstem:\"Zollinger Ellison syndrome is characterized by which of the following?<br>1. Fulminating gastric ulcers<br>2. Recurrent ulceration despite treatment<br>3. Non-beta islet cell tumour of pancreas<br>4. Recurrent episodes of dysentery<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Zollinger-Ellison syndrome (ZES) is characterised by: (1) Fulminating peptic ulceration - multiple, large, atypical ulcers (post-bulbar, jejunal) due to massive gastric acid hypersecretion - statement 1 correct. (2) Recurrent ulceration despite standard treatment (PPIs\/H2 blockers) - the hypergastrinaemia drives relentless acid secretion - statement 2 correct. (3) Non-beta islet cell tumour (gastrinoma) of the pancreas (or duodenum) - the non-beta (delta\/G) cells produce excess gastrin - statement 3 correct. (4) Recurrent dysentery is NOT a feature; diarrhoea (secretory, acid-induced) may occur but not dysentery (bloody diarrhoea with mucus) - statement 4 incorrect. Statements 1, 2, and 3 are correct.\"\n},\n{id:17,\nstem:\"Which of the following statements with regard to Meckel's Diverticulum are correct?<br>1. It represents a persistent remnant of the Vitello intestinal duct.<br>2. It is a pseudo diverticulum of gastrointestinal tract.<br>3. It is most commonly found on antimesenteric border of ileum.<br>4. Heterotopic mucosa is present in 20% patients.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"2, 3 and 4\",\"1, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Statement 1 TRUE: Meckel's diverticulum is the most common congenital anomaly of the GI tract, representing a persistent remnant of the vitello-intestinal (omphalomesenteric) duct, which normally obliterates by the 7th week of gestation. Statement 2 FALSE: It is a TRUE diverticulum (contains all layers of the intestinal wall), not a pseudo-diverticulum (which lacks the muscularis propria, as seen in colonic diverticula). Statement 3 TRUE: It is most commonly found on the antimesenteric border of the ileum (opposite the mesenteric attachment), which explains why it may have its own blood supply. Statement 4 TRUE: Heterotopic mucosa (gastric mucosa most common in approximately 60% of symptomatic cases; pancreatic tissue second most common) is present in approximately 20-50% of all Meckel's diverticula. Statements 1, 3, and 4 are correct.\"\n},\n{id:18,\nstem:\"Which of the following statements with regard to Colorectal Carcinoma are correct?<br>1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.<br>2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.<br>3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.<br>4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"2, 3 and 4\",\"1, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Statement 1 TRUE: Left-sided (descending colon, sigmoid, rectum) CRC presents with altered bowel habits, fresh rectal bleeding (haematochezia), tenesmus, and obstructive symptoms (narrower lumen, solid stool). Statement 2 TRUE: Right-sided (caecum, ascending colon) CRC presents with occult blood loss causing iron deficiency anaemia, a right iliac fossa mass, and vague abdominal pain (wider lumen, liquid stool). Statement 3 FALSE: Left-sided CRC is traditionally more common than right-sided; however, there is a trend towards increasing right-sided cancers. Overall, left-sided predominance persists in most epidemiological data. Statement 4 TRUE: Colonoscopy is the investigation of choice for suspected CRC as it allows direct visualisation, biopsy, and simultaneous polypectomy of the entire colon. Statements 1, 2, and 4 are correct.\"\n},\n{id:19,\nstem:\"While managing oesophageal perforations, which of the following factors favour non-operative management?<br>1. Perforation by a flexible endoscope<br>2. Perforation into mediastinum<br>3. Perforation with a small septic load<br>4. Perforation of the abdominal oesophagus<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Non-operative (conservative) management of oesophageal perforation is appropriate when: (1) Perforation by flexible endoscope (iatrogenic, typically smaller, clean perforation in a controlled setting) - statement 1 correct. (2) Perforation contained within the mediastinum (well-contained perforation draining back into the oesophagus, without free mediastinal\/pleural contamination) - statement 2 correct. (3) Small septic load (minimal contamination, patient not systemically unwell) - statement 3 correct. Perforation of the abdominal oesophagus (statement 4) is actually an INDICATION FOR SURGERY because abdominal perforations rapidly contaminate the peritoneum and require urgent laparotomy. Conservative management includes nil by mouth, IV antibiotics, parenteral nutrition, and close monitoring. Statements 1, 2, and 3 favour non-operative management.\"\n},\n{id:20,\nstem:\"Which of the following statements are correct with regard to Familial Adenomatous Polyposis?<br>1. It is associated with mutation of APC gene located on the short arm of chromosome 5.<br>2. It is inherited as an autosomal recessive condition.<br>3. It is associated with 100% lifetime risk for development of Colorectal carcinoma.<br>4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 TRUE: FAP is caused by mutation of the APC (adenomatous polyposis coli) tumour suppressor gene located on chromosome 5q21 (long arm, not short arm, but this is the answer per the question). Statement 2 FALSE: FAP follows autosomal DOMINANT inheritance with near-complete penetrance (one mutated APC allele is sufficient due to second-hit somatic mutation). Statement 3 TRUE: Without prophylactic colectomy, the lifetime risk of developing colorectal carcinoma approaches 100% (by age 40-50 years); FAP patients develop hundreds to thousands of colorectal adenomatous polyps. Statement 4 TRUE: Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is present in approximately 75-80% of classic FAP patients (not just half, but the statement is broadly correct) and is used as an extracolonic marker for the condition. Statements 1, 3, and 4 are correct.\"\n},\n{id:21,\nstem:\"Which one of the following statements regarding Inflammatory Bowel Disease is correct?\",\ncorrect:\"Perianal disease is common in Crohn's disease.\",\nopts:[\"Rectum is always involved in Crohn's disease.\",\"Fistula formation is common in Ulcerative Colitis.\",\"Stricture formation is common in Ulcerative Colitis.\",\"Perianal disease is common in Crohn's disease.\"],\nexp:\"Key distinguishing features of IBD: Option (a) FALSE: Rectal SPARING is characteristic of Crohn's disease; the rectum is almost always involved in UC. Option (b) FALSE: Fistula formation is characteristic of CROHN's disease (transmural inflammation creates fistulous tracts to adjacent organs, skin, or bowel loops); it is uncommon in UC. Option (c) FALSE: Stricture formation is characteristic of CROHN's disease (transmural fibrosis causing bowel stenosis - lead pipe appearance on barium enema is UC but this refers to loss of haustrations, not strictures). Option (d) TRUE: Perianal disease (fissures, fistulae, skin tags, abscesses, rectovaginal fistulae) is a classic and common extra-intestinal manifestation of Crohn's disease, occurring in approximately 35-50% of patients, especially with colonic disease.\"\n},\n{id:22,\nstem:\"A Sengstaken-Blakemore tube is used for the management of\",\ncorrect:\"Variceal bleeding\",\nopts:[\"Corrosive poisoning\",\"Variceal bleeding\",\"Asphyxia\",\"Tension pneumothorax\"],\nexp:\"The Sengstaken-Blakemore (SB) tube is a triple-lumen tube with two inflatable balloons (gastric and oesophageal) used for emergency tamponade of bleeding oesophageal and gastric varices. The gastric balloon is inflated first and pulled up against the gastro-oesophageal junction to tamponade gastric varices and anchor the tube; the oesophageal balloon is inflated second to compress oesophageal varices. It is used as a temporary bridge (maximum 24-48 hours due to risk of oesophageal necrosis and aspiration) to endoscopic or radiological definitive therapy (variceal band ligation, TIPS). It should never be used for corrosive poisoning (would worsen injury), asphyxia, or pneumothorax.\"\n},\n{id:23,\nstem:\"The most common benign tumour of the liver is\",\ncorrect:\"Haemangioma\",\nopts:[\"Adenoma\",\"Haemangioma\",\"Focal nodular hyperplasia\",\"Angiomyolipoma\"],\nexp:\"Hepatic haemangioma (cavernous haemangioma) is the most common benign liver tumour, with a prevalence of approximately 5-20% in the general population. It is a vascular malformation (not a true neoplasm) composed of large endothelium-lined vascular spaces. Most are asymptomatic and discovered incidentally on imaging. On ultrasound: hyperechoic, well-defined lesion. On MRI: characteristic progressive centripetal fill-in with gadolinium. Most haemangiomas require no treatment. Hepatic adenoma is much less common (associated with OCP use). Focal nodular hyperplasia (FNH) is the second most common benign liver lesion. Haemangioma is the correct answer.\"\n},\n{id:24,\nstem:\"The best position to palpate the minimal enlargement of spleen is\",\ncorrect:\"Palpation of left subcostal area in right lateral decubitus position\",\nopts:[\"Supine with lower limbs extended\",\"Palpation of left subcostal area in right lateral decubitus position\",\"Bimanual palpation in supine position\",\"Palpation of left subcostal area in knee-elbow position\"],\nexp:\"The right lateral decubitus position (patient lying on the right side with knees slightly flexed) is the best position to detect minimal splenic enlargement. In this position, gravity brings the spleen forward and downward towards the examiner, making the spleen more accessible to palpation at the left subcostal area. The spleen normally needs to enlarge to approximately 2-3 times its normal size before it becomes palpable in the supine position. Bimanual palpation in supine is the standard technique but misses minimal enlargement. The right lateral decubitus position maximises the chance of detecting early splenomegaly.\"\n},\n{id:25,\nstem:\"A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is\",\ncorrect:\"Subphrenic abscess\",\nopts:[\"Surgical site infection\",\"Postoperative peritonitis\",\"Subphrenic abscess\",\"Right lobe liver abscess\"],\nexp:\"Right shoulder tip pain and intractable hiccoughs following intra-abdominal surgery are PATHOGNOMONIC of subphrenic abscess. The mechanism: pus collection beneath the right hemidiaphragm irritates the diaphragmatic peritoneum; the phrenic nerve (C3,4,5) refers pain to the right shoulder tip (C4 dermatome); diaphragmatic irritation also triggers persistent hiccoughs via phrenic nerve. The fever with chills and toxaemia developing after initial recovery (5 days post-op) represents the typical post-operative collection timeline. Right shoulder tip pain + hiccoughs = subphrenic abscess. Diagnosis: CT abdomen. Treatment: ultrasound or CT-guided percutaneous drainage plus antibiotics.\"\n},\n{id:26,\nstem:\"In seat belt syndrome the most common site of bleeding is from\",\ncorrect:\"Mesentery\",\nopts:[\"Bowel\",\"Mesentery\",\"Liver\",\"Spleen\"],\nexp:\"Seat belt syndrome refers to the constellation of injuries caused by the restraining force of a lap seat belt (without shoulder strap) during sudden deceleration. The abdominal contents are compressed against the spine, causing: (1) Mesenteric injuries (most common) - mesenteric tears and haematomas causing bowel ischaemia; (2) Hollow viscus injuries - bowel contusions, perforations (especially jejunum); (3) Lumbar spine fractures (Chance fracture, flexion-distraction injury). The mesentery is the most common site of bleeding in seat belt syndrome because it is highly vascular and is subject to the shearing forces between the fixed spine and the mobile bowel loops. The 'seat belt sign' (linear ecchymosis across the abdomen) should raise suspicion for these injuries.\"\n},\n{id:27,\nstem:\"Which one of the following is a cause of exudative ascites?\",\ncorrect:\"Peritoneal malignancy\",\nopts:[\"Congestive cardiac failure\",\"Portal vein thrombosis\",\"Peritoneal malignancy\",\"Nephrotic syndrome\"],\nexp:\"Ascites is classified by the SAAG (Serum-Ascites Albumin Gradient) and by transudate\/exudate distinction. Exudative ascites (protein greater than 2.5 g\/dL, or SAAG less than 1.1 g\/dL): Peritoneal malignancy (tumour cells produce protein-rich fluid, inflame the peritoneum, block lymphatics) - correct. Tuberculous peritonitis, pancreatitis, chylous ascites. Transudative ascites (SAAG greater than 1.1 g\/dL, protein less than 2.5 g\/dL): Congestive cardiac failure (portal hypertension from raised venous pressure), Portal vein thrombosis (pre-hepatic portal hypertension), Nephrotic syndrome (hypoalbuminaemia reducing oncotic pressure). Among the options, peritoneal malignancy is the cause of exudative ascites.\"\n},\n{id:28,\nstem:\"Which one of the following statements is correct regarding eFAST in trauma?\",\ncorrect:\"It is a technique to assess free fluid in abdominal cavity, thoracic cavity and pericardium.\",\nopts:[\"It is a technique to assess free fluid in the abdominal cavity only.\",\"It is a technique to assess free fluid in abdominal cavity, thoracic cavity and pericardium.\",\"It is a technique to assess free fluid in pelvic cavity.\",\"It is a technique to assess free fluid in pleural cavity.\"],\nexp:\"eFAST (extended Focused Assessment with Sonography in Trauma) is a rapid bedside ultrasound protocol used in trauma resuscitation to detect free fluid (haemoperitoneum, haemopericardium, haemothorax). The examination includes: (1) Pericardial window (subxiphoid view) - to detect haemopericardium\/tamponade; (2) Right upper quadrant (Morison's pouch) - hepatorenal space; (3) Left upper quadrant (splenorenal recess); (4) Pelvic view (pouch of Douglas\/rectovesical pouch); (5) Bilateral thoracic views (bilateral pleural spaces) - the extended component detecting haemothorax and pneumothorax. eFAST assesses the abdominal cavity, thoracic cavity, AND pericardium. Option (b) is correct.\"\n},\n{id:29,\nstem:\"A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is\",\ncorrect:\"Colovesical fistula\",\nopts:[\"Anaerobic bacterial infection\",\"Colovesical fistula\",\"Tubercular cystitis\",\"Urethrocutaneous fistula\"],\nexp:\"Pneumaturia (air\/gas in urine, presenting as frothy urine with bubbles) in the context of recurrent UTIs in a middle-aged man is pathognomonic of a colovesical fistula (fistula between colon and urinary bladder). The gas passes from the colon (where it is produced by bacteria) into the bladder through the fistulous connection. Most common cause: diverticular disease of the sigmoid colon (60-65%), followed by colorectal carcinoma, Crohn's disease, and radiation injury. Patients may also pass faeces in urine (faecaluria) or report recurrent polymicrobial UTIs with enteric organisms. Diagnosis: CT cystography or CT abdomen. Treatment: surgical resection with closure of the bladder defect. Pneumaturia = colovesical fistula.\"\n},\n{id:30,\nstem:\"Which of the following are seen in Normal pressure hydrocephalus?<br>1. Hearing loss<br>2. Gait disturbance<br>3. Incontinence<br>4. Cognitive decline<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Normal Pressure Hydrocephalus (NPH) is characterised by the classic Hakim's triad (wet, wobbly, wacky): (1) Gait disturbance (statement 2) - magnetic gait (wide-based, shuffling, feet appear stuck to floor, earliest and most prominent feature); (2) Urinary incontinence (statement 3) - urge incontinence, later faecal incontinence; (3) Cognitive decline \/ dementia (statement 4) - subcortical dementia pattern (slowed processing, memory impairment, executive dysfunction). Hearing loss (statement 1) is NOT a feature of NPH. The CSF pressure is paradoxically normal (intermittently elevated). Diagnosis: CT\/MRI showing ventriculomegaly disproportionate to sulcal atrophy, with periventricular oedema. Treatment: ventriculoperitoneal shunting. Statements 2, 3, and 4 are correct.\"\n},\n{id:31,\nstem:\"Which of the following are the functions of larynx?<br>1. Fixation of the chest<br>2. Aids in swallowing of food<br>3. Phonation<br>4. Respiration<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Functions of the larynx: (1) Protection of the airway (sphincteric function) - the glottis closes during swallowing (via epiglottis, false cords, true cords) to prevent aspiration. (2) Phonation\/voice production (statement 3 correct) - vibration of the true vocal cords. (3) Respiration (statement 4 correct) - the larynx is the gateway between the pharynx and trachea; it regulates airflow. (4) Aids in swallowing (statement 2 correct) - the larynx elevates and moves anteriorly during swallowing, assisting bolus passage into the oesophagus. (5) Fixation of chest (statement 1) - the glottis closes during Valsalva manoeuvre (straining, coughing, defaecation, lifting), fixing the thorax. Statement 1 IS a function of the larynx; however, the question answer per the paper is statements 2, 3, and 4 as the primary functions. Statement 1 (chest fixation\/Valsalva) is a real function but the UPSC CMS answer is 2, 3 and 4.\"\n},\n{id:32,\nstem:\"Which of the following are included in the classical clinical presentation of pericardial tamponade?<br>1. Tachycardia<br>2. Muffled heart sounds<br>3. Decreased arterial pressure<br>4. Collapsed neck veins<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Beck's triad of cardiac tamponade: (1) Hypotension (decreased arterial pressure - statement 3 correct) - reduced cardiac output due to impaired ventricular filling; (2) Muffled\/distant heart sounds (statement 2 correct) - fluid around the heart dampens sound transmission; (3) Raised\/distended neck veins (elevated JVP, statement 4 is WRONG - it says COLLAPSED, not distended). In tamponade, venous pressure RISES (RAISED\/DISTENDED jugular veins), not collapses. Collapsed neck veins would indicate hypovolaemia (haemorrhagic shock). Tachycardia (statement 1 correct) is a compensatory response to reduced cardiac output. Therefore Beck's triad = hypotension + muffled heart sounds + RAISED JVP + tachycardia. Statements 1, 2, and 3 are part of the classical presentation; statement 4 (collapsed veins) is the distractor.\"\n},\n{id:33,\nstem:\"Masaoka staging is used for staging\",\ncorrect:\"Thymoma\",\nopts:[\"Germ cell tumours\",\"Thymoma\",\"Lymphoma\",\"Neurogenic tumours\"],\nexp:\"The Masaoka staging system (1981, revised as Masaoka-Koga 2011) is specifically used for staging THYMOMA, the most common anterior mediastinal tumour in adults. Stages: I - encapsulated tumour, no microscopic capsular invasion; IIa - microscopic transcapsular invasion; IIb - macroscopic invasion into thymic\/perithymic fat or grossly adherent to pleura\/pericardium; III - invasion of adjacent organs; IVa - pleural or pericardial dissemination; IVb - lymphogenous or haematogenous metastasis. Thymomas are associated with myasthenia gravis (30-45%), pure red cell aplasia, and other paraneoplastic syndromes. Germ cell tumours use the TNM system. Lymphomas use the Ann Arbor system. Masaoka staging is specific to thymoma.\"\n},\n{id:34,\nstem:\"Consider the following clinical features:<br>1. Low back pain<br>2. Saddle anaesthesia<br>3. Motor weakness in the lower extremities<br>4. Variable rectal and urinary symptoms<br>Which of the above features may be present in a patient with Cauda Equina syndrome?\",\ncorrect:\"1, 2, 3 and 4\",\nopts:[\"3 and 4 only\",\"1 and 2 only\",\"1, 2 and 3 only\",\"1, 2, 3 and 4\"],\nexp:\"Cauda equina syndrome (CES) is a surgical emergency caused by compression of the cauda equina nerve roots (L2 to coccyx) in the spinal canal. ALL FOUR features may be present: (1) Low back pain (statement 1) - often severe, radiating to one or both legs (sciatica); (2) Saddle anaesthesia (statement 2) - sensory loss in the perineum, buttocks, inner thighs, and genitalia in the distribution corresponding to a saddle; this is the most specific finding; (3) Motor weakness in the lower extremities (statement 3) - flaccid weakness due to lower motor neuron lesion; (4) Variable rectal and urinary symptoms (statement 4) - urinary retention\/incontinence (commonest presentation), faecal incontinence, erectile dysfunction. Urinary retention (inability to void) is the most common and cardinal finding in CES. All four statements are correct.\"\n},\n{id:35,\nstem:\"Which one of the following drugs is a long acting local anaesthetic agent?\",\ncorrect:\"Bupivacaine\",\nopts:[\"Lignocaine\",\"Bupivacaine\",\"Prilocaine\",\"Ropivacaine\"],\nexp:\"Classification of local anaesthetics by duration of action: Short-acting (30-60 min): procaine, chloroprocaine. Medium-acting (60-120 min): lignocaine (lidocaine), prilocaine, mepivacaine. Long-acting (2-8 hours): bupivacaine (duration 2-8 hours, most widely used long-acting LA), ropivacaine, levobupivacaine. Among the options: Lignocaine is medium-acting. Prilocaine is medium-acting (used in EMLA cream; causes methaemoglobinaemia in high doses). Ropivacaine is also long-acting but is a newer agent with less cardiac toxicity than bupivacaine. Bupivacaine (Marcaine) is the classic and most commonly cited LONG-ACTING local anaesthetic; duration up to 8 hours for nerve blocks. Both bupivacaine and ropivacaine are long-acting, but bupivacaine is the standard examination answer.\"\n},\n{id:36,\nstem:\"A patient with head injury with a Glasgow Coma Scale of 10 is classified as\",\ncorrect:\"Moderate injury\",\nopts:[\"Minor injury\",\"Mild injury\",\"Moderate injury\",\"Severe injury\"],\nexp:\"Glasgow Coma Scale (GCS) classification of head injury severity: Minor\/Mild injury: GCS 13-15 (some sources define minor as GCS 15, mild as 13-14). Moderate injury: GCS 9-12. Severe injury: GCS 3-8 (GCS 8 or less defines severe TBI; coma). This patient with GCS 10 falls in the MODERATE injury category (GCS 9-12). Moderate TBI requires hospital admission, CT head scan, neurosurgical consultation, and close neurological monitoring. It does NOT require immediate intubation (unlike severe TBI with GCS 8 or less). The distinction is clinically important for management decisions.\"\n},\n{id:37,\nstem:\"Gas Gangrene resulting in crepitus in tissues and a sweet smelling brown exudate is caused due to infection by\",\ncorrect:\"Clostridium perfringens\",\nopts:[\"Anaerobic bacteroides spp.\",\"Clostridium perfringens\",\"Gas-forming Klebsiella spp.\",\"Synergistic bacteria\"],\nexp:\"Gas gangrene (clostridial myonecrosis) with crepitus (gas in tissues) and a characteristic sweet-smelling (sickly sweet) brown or dishwater exudate is caused by Clostridium perfringens (type A, producing alpha-toxin\/lecithinase). The gas is produced by saccharolytic fermentation of tissue carbohydrates by clostridial organisms. The sweet smell is from butyric acid and other metabolic products. Clinical features: rapid progression, extreme pain (out of proportion to findings), bronze\/brown skin discolouration, crepitus on palpation, Gram stain showing large gram-positive rods with minimal inflammatory cells (due to toxin-mediated leukocyte destruction). Bacteroides causes foul-smelling anaerobic infection but not the classic sweet-smelling brown exudate. Clostridium perfringens is the correct answer.\"\n},\n{id:38,\nstem:\"Which of the following are the common complications associated with enteral nutrition in postoperative patients?<br>1. Tube malposition, displacement<br>2. Diarrhoea, constipation<br>3. Predisposition to systemic sepsis<br>4. Electrolytic imbalance<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Complications of enteral nutrition (tube feeding) in postoperative patients: Mechanical: tube malposition, displacement, kinking, obstruction, sinusitis (nasogastric tubes), aspiration (statement 1 correct). GI: diarrhoea (most common, from hyperosmolar feeds, antibiotic-associated, rapid infusion), constipation, nausea, vomiting, bloating, abdominal cramps (statement 2 correct). Metabolic: electrolyte imbalances (hypernatraemia\/hyponatraemia, hypokalaemia, hypo\/hyperglycaemia, refeeding syndrome with phosphate depletion), statement 4 correct. Infectious: aspiration pneumonia is the most serious complication. Statement 3 (systemic sepsis predisposition) is a complication of PARENTERAL (IV) nutrition, NOT enteral nutrition. Enteral feeding actually REDUCES the risk of bacterial translocation and systemic sepsis compared to parenteral nutrition by maintaining gut mucosal integrity. Statements 1, 2, and 4 are correct.\"\n},\n{id:39,\nstem:\"Which of the following are correct regarding Blood substitutes?<br>1. They are biomimetic.<br>2. They are extensively used in war injuries.<br>3. They are made of perfluorocarbon emulsions.<br>4. They are haemoglobin-based.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Blood substitutes (oxygen carriers) are artificially designed solutions that carry and release oxygen, mimicking red blood cell function: Statement 1 TRUE: They are BIOMIMETIC (designed to mimic the oxygen-carrying function of natural haemoglobin in red blood cells). Statement 2 FALSE: Blood substitutes are NOT yet extensively used in war injuries or clinical practice; they are still largely investigational\/experimental, with limited approved use in some countries (e.g., South Africa). They have not replaced blood transfusion in military medicine. Statement 3 TRUE: One major class is perfluorocarbon (PFC) emulsions, which dissolve oxygen physically (not chemically). Statement 4 TRUE: The other major class is haemoglobin-based oxygen carriers (HBOCs), derived from human, bovine, or recombinant haemoglobin. Statements 1, 3, and 4 are correct.\"\n},\n{id:40,\nstem:\"Ischaemia-Reperfusion syndrome is characterized by\",\ncorrect:\"Hypoxia and activation of inflammation\",\nopts:[\"Hypoxia and activation of inflammation\",\"Thrombo embolic angiopathy\",\"Acute mesenteric thrombosis\",\"Build up of bicarbonate and Na+ ions\"],\nexp:\"Ischaemia-reperfusion (IR) injury occurs when blood flow is restored to an ischaemic tissue, paradoxically causing additional damage. The pathophysiology: During ischaemia: ATP depletion, intracellular calcium accumulation, xanthine oxidase conversion. Upon reperfusion: sudden oxygen delivery to ischaemic tissue generates reactive oxygen species (ROS\/free radicals) via xanthine oxidase and NADPH oxidase; this causes oxidative stress, lipid peroxidation, and endothelial activation. The endothelial activation triggers an intense local and systemic INFLAMMATORY RESPONSE: neutrophil adhesion, complement activation, cytokine release (TNF, IL-1, IL-6), microvascular thrombosis. Therefore, IR syndrome is characterised by hypoxia (during ischaemia phase) and subsequent activation of inflammation (during reperfusion phase) with paradoxical worsening of injury. 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Submitting in 10 Submit Now Combined Medical Services Examination 2023Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part A General Surgery · Vascular & GI Surgery · Trauma & Neurosurgery · … <\/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-36741","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2023 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\/05\/03\/cms-2023-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 2023 P2 Part-A Surgery - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2023 | General Medicine & Paediatrics | Paper I | Part A ✓️ 0 ❌ 0 ⏳ 40 left ⏱ 40:00 Net 0 \/ 160 Time's Up! 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{"id":36741,"date":"2026-05-03T08:08:02","date_gmt":"2026-05-03T02:38:02","guid":{"rendered":"https:\/\/atsixty.com\/?p=36741"},"modified":"2026-05-03T08:08:28","modified_gmt":"2026-05-03T02:38:28","slug":"cms-2023-p2-part-a-surgery","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/03\/cms-2023-p2-part-a-surgery\/","title":{"rendered":"CMS 2023 P2 Part-A Surgery"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2023 | General Medicine & Paediatrics | Paper I | Part A<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n*,*::before,*::after{box-sizing:border-box;margin:0;padding:0}\n:root{\n --blue:#1A5EA8;--blue-lt:#2E82D5;--blue-pale:#EBF3FD;\n --navy:#1A3A5C;--navy-lt:#24527F;--navy-pale:#E8F0F9;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#dde4ed;--bg:#f8fafd;--white:#ffffff;\n 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id=\"qz-sr\">40<\/strong> left<\/div>\n <div class=\"qz-timer-wrap\">\n <div class=\"qz-timer\" id=\"qz-timer\">⏱ <strong id=\"qz-td\">40:00<\/strong><\/div>\n <div class=\"qz-stat net-score\">Net <strong id=\"qz-sn\">0<\/strong> \/ 160<\/div>\n <\/div>\n <\/div>\n <div class=\"qz-prog-track\"><div class=\"qz-prog-fill\" id=\"qz-fill\"><\/div><\/div>\n<\/div>\n\n<div class=\"qz-grace\" id=\"qz-grace\">\n <div class=\"qz-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"qz-grace-n\" id=\"qz-gn\">10<\/div>\n <button class=\"qz-grace-now\" id=\"qz-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-header\">\n <h1>Combined Medical Services Examination 2023<br>Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part A<\/h1>\n <p>General Surgery · Vascular & GI Surgery · Trauma & Neurosurgery · Anaesthesia<\/p>\n <div class=\"qz-meta\">\n <span class=\"qz-badge\">Questions 1–40<\/span>\n <span class=\"qz-badge\">Options reshuffled<\/span>\n <span class=\"qz-badge\">Score = c × 4 − w<\/span>\n <button class=\"qz-timer-btn\" id=\"qz-tbtn\">⏱ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-body\">\n <div id=\"qz-questions\"><\/div>\n <div class=\"qz-submit-wrap\">\n <button class=\"qz-submit\" id=\"qz-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"qz-result\" id=\"qz-result\">\n <div class=\"qz-ring\" id=\"qz-ring\">\n <div class=\"qz-ring-inner\">\n <div class=\"qz-ring-pct\" id=\"qz-rpct\">0%<\/div>\n <div class=\"qz-ring-sub\">score<\/div>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"qz-net\" id=\"qz-rnet\"><\/div>\n <div class=\"qz-verdict\" id=\"qz-rv\"><\/div>\n <div class=\"qz-bands\">\n <span class=\"qz-band bc\" id=\"qz-bc\"><\/span>\n <span class=\"qz-band bw\" id=\"qz-bw\"><\/span>\n <span class=\"qz-band bs\" id=\"qz-bs\"><\/span>\n <\/div>\n <button class=\"qz-retry\" id=\"qz-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n\n<\/div>\n\n<script>\n(function(){\n\nvar TOTAL = 40, MAX = 160;\nvar TSECS = 2400, GSECS = 10;\nvar LTRS = [\"A\",\"B\",\"C\",\"D\"];\n\nvar QQ = [\n{id:1,\nstem:\"The ratio for Type-I to Type-III collagen during maturation of collagen in remodelling phase is\",\ncorrect:\"4:1\",\nopts:[\"1:1\",\"2:1\",\"3:1\",\"4:1\"],\nexp:\"Wound healing progresses through three phases: inflammation, proliferation, and remodelling. During the proliferative phase, Type III collagen (immature, weaker) predominates. During the remodelling phase (from 3 weeks to 2 years), Type III collagen is progressively replaced by Type I collagen (mature, stronger) via collagenase activity and new synthesis. The final ratio of Type I to Type III collagen in the remodelled scar approaches 4:1, which approximates the ratio found in normal unwounded skin (also approximately 4:1). This restoration accounts for the gradual increase in tensile strength during wound maturation.\"\n},\n{id:2,\nstem:\"Which one of the following statements regarding Gas Gangrene Infection is correct?\",\ncorrect:\"It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli.\",\nopts:[\"It is caused by C. perfringens, a gram negative aerobic non-spore-forming bacilli.\",\"It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli.\",\"It is caused by C. tetani, a gram positive anaerobic spore-forming bacilli.\",\"It is caused by C. tetani, a gram negative anaerobic non-spore-forming bacilli.\"],\nexp:\"Gas gangrene (clostridial myonecrosis) is caused by Clostridium perfringens (also known as C. welchii), which is a gram-positive, anaerobic, spore-forming bacillus. It produces alpha-toxin (lecithinase\/phospholipase C), the principal virulence factor, which destroys cell membranes causing extensive myonecrosis. The organism thrives in devitalised, ischaemic tissue with low oxygen tension. Clinical features: severe pain, crepitus (gas in tissues on palpation\/X-ray), sweet-sour odour, bronze skin discolouration, systemic toxaemia. Treatment: urgent surgical debridement\/amputation plus high-dose penicillin G and hyperbaric oxygen.\"\n},\n{id:3,\nstem:\"The term Gompertzian curve is related to which one of the following?\",\ncorrect:\"Tumour\",\nopts:[\"Tumour\",\"Gallstone\",\"Intestinal obstruction\",\"Hernia\"],\nexp:\"The Gompertzian growth curve describes the pattern of tumour growth over time. Initially, when a tumour is small, it grows rapidly (exponential phase). As the tumour enlarges, growth progressively decelerates due to limited blood supply, nutrient deprivation, accumulating waste products, and immune responses. This produces a sigmoid (S-shaped) growth curve that flattens at large tumour sizes, mathematically described by the Gompertz function. Understanding Gompertzian kinetics is important in oncology: small tumours have the highest growth fraction and are most sensitive to chemotherapy; large tumours have slower growth rates but more resistant cells. The model was adapted from actuarial mortality mathematics by Gompertz in the 19th century.\"\n},\n{id:4,\nstem:\"A 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is\",\ncorrect:\"Herniotomy\",\nopts:[\"To leave it alone (masterly inactivity)\",\"Herniotomy\",\"Eversion of sac\",\"Hernioplasty\"],\nexp:\"The described swelling - absent in the morning, appearing by evening, not reducible on examination but historically reducible - is consistent with an indirect inguinal hernia in a child that reduces spontaneously overnight when the child lies flat. In a 5-year-old child, inguinal hernia is due to a patent processus vaginalis. The treatment is HERNIOTOMY (high ligation of the patent processus vaginalis at the deep inguinal ring) without any mesh repair. In children, the posterior wall of the inguinal canal is strong and intact, so hernioplasty (mesh repair) is not required. Masterly inactivity is not appropriate as the risk of incarceration is significant in children. Eversion of sac is treatment for hydrocele.\"\n},\n{id:5,\nstem:\"A 25-year-old gentleman complains of dragging pain in the scrotum. The examination reveals the scrotum full of bag of worms which disappear on lying down. The usual first line option for relief is\",\ncorrect:\"Percutaneous embolization of gonadal veins\",\nopts:[\"Percutaneous embolization of gonadal veins\",\"Radio frequency ablation of testicular veins\",\"Laparoscopic excision of affected testes\",\"Excision of pampiniform plexus\"],\nexp:\"The bag of worms appearance disappearing on lying down is pathognomonic of varicocele (dilatation of the pampiniform venous plexus of the spermatic cord). Left-sided varicocele is most common (90%) due to the right-angle drainage of the left testicular vein into the left renal vein. Percutaneous embolization of the gonadal veins (radiological embolisation under fluoroscopic guidance) is now the preferred first-line minimally invasive treatment for symptomatic varicocele, with success rates of 85-95% and low recurrence. Surgical options (open Palomo\/Ivanissevich operations, laparoscopic ligation) are alternatives. RFA of testicular veins and excision of the pampiniform plexus are not standard treatment modalities.\"\n},\n{id:6,\nstem:\"A malnourished 60-year-old man underwent emergency surgery for Strangulated Sigmoid Volvulus. After resection of the sigmoid colon, a colostomy was fashioned. The postoperative period was stormy and he developed a painful calf swelling in right lower limb. The most probable diagnosis is\",\ncorrect:\"Deep vein thrombosis\",\nopts:[\"Hypoproteinemia\",\"Oedema of renal failure\",\"Myocardial failue due to fluid overload\",\"Deep vein thrombosis\"],\nexp:\"A painful calf swelling in a post-operative patient after major abdominal surgery is deep vein thrombosis (DVT) until proven otherwise. This patient has multiple risk factors for DVT (Virchow's triad): (1) Stasis - post-operative immobility; (2) Hypercoagulability - malignancy, stress response to surgery, malnutrition; (3) Endothelial injury - surgical trauma. DVT typically presents with unilateral painful, swollen, tender calf with Homan's sign (pain on dorsiflexion). Diagnosis is confirmed by duplex ultrasound. Treatment: anticoagulation (LMWH\/heparin then warfarin). Hypoproteinaemia causes bilateral pitting oedema. Renal failure causes bilateral non-tender oedema. The unilateral, painful nature points firmly to DVT.\"\n},\n{id:7,\nstem:\"Consider the following in respect of Salmon patch:<br>1. It is a hemangioma.<br>2. Its usual site is nape of neck.<br>3. It is common in children.<br>4. It needs surgical excision.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Salmon patch (naevus simplex \/ stork bite \/ angel kiss) is a common benign vascular birthmark (capillary haemangioma\/naevus) present in approximately 40-50% of newborns. Statement 1 TRUE: It is a haemangioma (simple capillary haemangioma\/telangiectasia). Statement 2 TRUE: It most commonly appears on the nape of the neck (stork bite), glabella, eyelids, and forehead. Statement 3 TRUE: It is extremely common in neonates and children; facial lesions typically fade by 1-2 years; nuchal lesions may persist lifelong. Statement 4 FALSE: Salmon patches do NOT need surgical excision; they are benign, cause no symptoms, and most fade spontaneously. Treatment (if desired for cosmesis) is laser therapy, not surgery. Statements 1, 2, and 3 are correct.\"\n},\n{id:8,\nstem:\"Which of the following are components of Klippel-Trenaunay syndrome?<br>1. Cutaneous Naevus<br>2. Subcutaneous Lipomas<br>3. Varicose veins<br>4. Soft tissue hypertrophy<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Klippel-Trenaunay syndrome (KTS) is a congenital vascular malformation syndrome characterised by the classic triad: (1) Cutaneous naevus (port-wine stain \/ capillary vascular malformation) - statement 1 correct; (2) Varicose veins (venous malformations, often with absent or hypoplastic deep veins) - statement 3 correct; (3) Bony and soft tissue hypertrophy (limb overgrowth, typically affecting one lower limb) - statement 4 correct. Subcutaneous lipomas are NOT a component of KTS - statement 2 is incorrect. KTS is to be distinguished from Parkes-Weber syndrome (which has arteriovenous fistulae). Statements 1, 3, and 4 are the correct components.\"\n},\n{id:9,\nstem:\"Mickey Mouse Sign during B-mode duplex ultrasound imaging comprises\",\ncorrect:\"Common femoral vein, Common femoral artery and Great Saphenous vein\",\nopts:[\"Popliteal artery, Popliteal vein and Saphenous nerve\",\"Anterior tibial artery, Dorsalis pedis artery and Extensor hallucis tendon\",\"Common femoral vein, Common femoral artery and Great Saphenous vein\",\"Brachial artery, Basilica vein and Biceps tendon\"],\nexp:\"The Mickey Mouse sign is seen on cross-sectional B-mode duplex ultrasound at the femoral triangle (groin). The three circular structures that together resemble Mickey Mouse face are: the large round head = common femoral vein (CFV, medial, compressible); the large ears = common femoral artery (CFA, lateral, pulsatile, non-compressible); the small ear = great saphenous vein (GSV, anteromedial, small, compressible). This sonographic landmark is used to identify the correct position for femoral vein access, DVT assessment, and sapheno-femoral junction evaluation. The three structures are the CFV, CFA, and GSV.\"\n},\n{id:10,\nstem:\"Which of the following statements regarding Thyroglossal duct are correct?<br>1. It is situated in midline of neck.<br>2. It moves upwards on swallowing but not on tongue protrusion.<br>3. It is treated with Sistrunk operation.<br>4. It may be the only functioning thyroid tissue in the body.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Thyroglossal duct cyst is the most common congenital neck swelling. Statement 1 TRUE: It is situated in the midline of the neck (or just off-midline), anywhere along the path of thyroid descent from the foramen caecum to the thyroid gland. Statement 2 FALSE: The pathognomonic feature is that it moves upwards on BOTH swallowing AND on tongue protrusion (because it is attached to the hyoid bone via the thyroglossal tract which is attached to the tongue base via the foramen caecum). This dual movement distinguishes it from other neck swellings. Statement 3 TRUE: The Sistrunk operation (excision of the cyst with the central portion of the hyoid bone and a core of tongue muscle to the foramen caecum) is the standard treatment, with a low recurrence rate. Statement 4 TRUE: In ectopic thyroid, the thyroglossal cyst may contain the only functioning thyroid tissue; pre-operative thyroid scan is essential. Statements 1, 3, and 4 are correct.\"\n},\n{id:11,\nstem:\"A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is\",\ncorrect:\"Erythroplakia\",\nopts:[\"Speckled leucoplakia\",\"Leukoplakia\",\"Erythroplakia\",\"Oral candidiasis\"],\nexp:\"Erythroplakia is defined as a bright red, velvety plaque on the oral mucosa that cannot be characterised clinically or pathologically as any other definable disease. It is a pre-malignant lesion with the HIGHEST malignant transformation rate of all oral potentially malignant disorders (approximately 50% show severe dysplasia or carcinoma in situ at biopsy, and up to 90% undergo malignant transformation over time). The key descriptor is bright red velvety plaque on a background of white mucosa. Erythroplakia carries a much higher risk than leukoplakia (white patches, about 5-17% transformation rate) or speckled leukoplakia (mixed red and white, intermediate risk). Risk factors: tobacco, alcohol, areca nut. Biopsy is mandatory. The velvety red plaque is the diagnostic clue for erythroplakia.\"\n},\n{id:12,\nstem:\"Collar-stud abscess is seen in\",\ncorrect:\"Tuberculosis\",\nopts:[\"Tuberculosis\",\"Lymphomatous degeneration\",\"Streptococcal infection\",\"Pseudomonas infection\"],\nexp:\"Collar-stud (dumbbell) abscess is pathognomonic of tuberculous lymphadenitis (scrofula). The abscess forms when caseous material from a tuberculous lymph node erodes through the deep fascia. The portion in the deep compartment (deep to deep cervical fascia) remains larger, while the superficial portion (subcutaneous) bulges through the fascial defect, creating the characteristic collar-stud or dumbbell shape with a narrow waist at the fascial opening. The two components communicate through the fascial defect. Treatment: anti-tubercular therapy with surgical drainage of the superficial component if needed. Collar-stud abscess is not a feature of streptococcal, pseudomonal, or lymphomatous conditions.\"\n},\n{id:13,\nstem:\"The best cosmetic result following breast reconstruction is achieved with\",\ncorrect:\"Transverse rectus abdominis myocutaneous flap\",\nopts:[\"Latissimus dorsi flap\",\"Silicone gel implant with reconstruction\",\"Transverse rectus abdominis myocutaneous flap\",\"Acellular dermal matrix flap\"],\nexp:\"The TRAM (Transverse Rectus Abdominis Myocutaneous) flap provides the best cosmetic result for breast reconstruction because: (1) It uses autologous tissue (own abdominal skin and fat) that matches the breast texture, warmth, and consistency; (2) It creates a natural-feeling breast mound that ages with the patient; (3) It achieves excellent symmetry; (4) The donor site results in a simultaneous abdominoplasty (aesthetic benefit). The free TRAM or DIEP (Deep Inferior Epigastric Perforator) flap variations further reduce donor site morbidity. Silicone implants may have complications (capsular contracture, implant failure). Latissimus dorsi flap often requires an implant to achieve adequate volume. TRAM flap gives the best long-term cosmetic outcome.\"\n},\n{id:14,\nstem:\"Which of the following are correct regarding Trichobezoar?<br>1. It is a hair ball in the stomach.<br>2. It is common in psychiatric patients.<br>3. Common complications are bleeding, perforation or obstruction.<br>4. Treated with long course of proton pump inhibitors.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Trichobezoar (Rapunzel syndrome) is a bezoar composed of swallowed hair (trichophagia) accumulating in the stomach. Statement 1 TRUE: It is a hairball in the stomach (and sometimes extending into the small intestine in Rapunzel syndrome). Statement 2 TRUE: It is strongly associated with psychiatric conditions, particularly trichotillomania (hair-pulling disorder) and trichophagia, and occurs predominantly in young females with psychiatric disorders. Statement 3 TRUE: Complications include gastric ulceration and bleeding, intestinal obstruction (if the tail extends into the intestine), and rarely perforation. Statement 4 FALSE: Trichobezoar cannot be dissolved pharmacologically (unlike phytobezoars which may respond to cellulase or papain); treatment requires surgical or endoscopic removal. PPIs have no role in dissolving hair. Statements 1, 2, and 3 are correct.\"\n},\n{id:15,\nstem:\"The inferior rectal artery is a branch of\",\ncorrect:\"Internal pudendal artery\",\nopts:[\"Internal iliac artery\",\"Inferior mesenteric artery\",\"Internal pudendal artery\",\"Median sacral artery\"],\nexp:\"The blood supply of the rectum and anal canal comes from three arteries: (1) Superior rectal artery (branch of inferior mesenteric artery) - supplies upper rectum; (2) Middle rectal artery (branch of internal iliac artery) - supplies middle rectum; (3) Inferior rectal artery (branch of internal pudendal artery, which is a branch of internal iliac) - supplies lower anal canal and external anal sphincter. The internal pudendal artery arises from the anterior division of the internal iliac artery, exits the pelvis through the greater sciatic foramen, crosses the ischial spine, and re-enters through the lesser sciatic foramen to travel in the pudendal canal, giving off the inferior rectal artery. The inferior rectal artery is a branch of the internal pudendal artery.\"\n},\n{id:16,\nstem:\"Zollinger Ellison syndrome is characterized by which of the following?<br>1. Fulminating gastric ulcers<br>2. Recurrent ulceration despite treatment<br>3. Non-beta islet cell tumour of pancreas<br>4. Recurrent episodes of dysentery<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Zollinger-Ellison syndrome (ZES) is characterised by: (1) Fulminating peptic ulceration - multiple, large, atypical ulcers (post-bulbar, jejunal) due to massive gastric acid hypersecretion - statement 1 correct. (2) Recurrent ulceration despite standard treatment (PPIs\/H2 blockers) - the hypergastrinaemia drives relentless acid secretion - statement 2 correct. (3) Non-beta islet cell tumour (gastrinoma) of the pancreas (or duodenum) - the non-beta (delta\/G) cells produce excess gastrin - statement 3 correct. (4) Recurrent dysentery is NOT a feature; diarrhoea (secretory, acid-induced) may occur but not dysentery (bloody diarrhoea with mucus) - statement 4 incorrect. Statements 1, 2, and 3 are correct.\"\n},\n{id:17,\nstem:\"Which of the following statements with regard to Meckel's Diverticulum are correct?<br>1. It represents a persistent remnant of the Vitello intestinal duct.<br>2. It is a pseudo diverticulum of gastrointestinal tract.<br>3. It is most commonly found on antimesenteric border of ileum.<br>4. Heterotopic mucosa is present in 20% patients.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"2, 3 and 4\",\"1, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Statement 1 TRUE: Meckel's diverticulum is the most common congenital anomaly of the GI tract, representing a persistent remnant of the vitello-intestinal (omphalomesenteric) duct, which normally obliterates by the 7th week of gestation. Statement 2 FALSE: It is a TRUE diverticulum (contains all layers of the intestinal wall), not a pseudo-diverticulum (which lacks the muscularis propria, as seen in colonic diverticula). Statement 3 TRUE: It is most commonly found on the antimesenteric border of the ileum (opposite the mesenteric attachment), which explains why it may have its own blood supply. Statement 4 TRUE: Heterotopic mucosa (gastric mucosa most common in approximately 60% of symptomatic cases; pancreatic tissue second most common) is present in approximately 20-50% of all Meckel's diverticula. Statements 1, 3, and 4 are correct.\"\n},\n{id:18,\nstem:\"Which of the following statements with regard to Colorectal Carcinoma are correct?<br>1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.<br>2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.<br>3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.<br>4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"2, 3 and 4\",\"1, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Statement 1 TRUE: Left-sided (descending colon, sigmoid, rectum) CRC presents with altered bowel habits, fresh rectal bleeding (haematochezia), tenesmus, and obstructive symptoms (narrower lumen, solid stool). Statement 2 TRUE: Right-sided (caecum, ascending colon) CRC presents with occult blood loss causing iron deficiency anaemia, a right iliac fossa mass, and vague abdominal pain (wider lumen, liquid stool). Statement 3 FALSE: Left-sided CRC is traditionally more common than right-sided; however, there is a trend towards increasing right-sided cancers. Overall, left-sided predominance persists in most epidemiological data. Statement 4 TRUE: Colonoscopy is the investigation of choice for suspected CRC as it allows direct visualisation, biopsy, and simultaneous polypectomy of the entire colon. Statements 1, 2, and 4 are correct.\"\n},\n{id:19,\nstem:\"While managing oesophageal perforations, which of the following factors favour non-operative management?<br>1. Perforation by a flexible endoscope<br>2. Perforation into mediastinum<br>3. Perforation with a small septic load<br>4. Perforation of the abdominal oesophagus<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Non-operative (conservative) management of oesophageal perforation is appropriate when: (1) Perforation by flexible endoscope (iatrogenic, typically smaller, clean perforation in a controlled setting) - statement 1 correct. (2) Perforation contained within the mediastinum (well-contained perforation draining back into the oesophagus, without free mediastinal\/pleural contamination) - statement 2 correct. (3) Small septic load (minimal contamination, patient not systemically unwell) - statement 3 correct. Perforation of the abdominal oesophagus (statement 4) is actually an INDICATION FOR SURGERY because abdominal perforations rapidly contaminate the peritoneum and require urgent laparotomy. Conservative management includes nil by mouth, IV antibiotics, parenteral nutrition, and close monitoring. Statements 1, 2, and 3 favour non-operative management.\"\n},\n{id:20,\nstem:\"Which of the following statements are correct with regard to Familial Adenomatous Polyposis?<br>1. It is associated with mutation of APC gene located on the short arm of chromosome 5.<br>2. It is inherited as an autosomal recessive condition.<br>3. It is associated with 100% lifetime risk for development of Colorectal carcinoma.<br>4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 TRUE: FAP is caused by mutation of the APC (adenomatous polyposis coli) tumour suppressor gene located on chromosome 5q21 (long arm, not short arm, but this is the answer per the question). Statement 2 FALSE: FAP follows autosomal DOMINANT inheritance with near-complete penetrance (one mutated APC allele is sufficient due to second-hit somatic mutation). Statement 3 TRUE: Without prophylactic colectomy, the lifetime risk of developing colorectal carcinoma approaches 100% (by age 40-50 years); FAP patients develop hundreds to thousands of colorectal adenomatous polyps. Statement 4 TRUE: Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is present in approximately 75-80% of classic FAP patients (not just half, but the statement is broadly correct) and is used as an extracolonic marker for the condition. Statements 1, 3, and 4 are correct.\"\n},\n{id:21,\nstem:\"Which one of the following statements regarding Inflammatory Bowel Disease is correct?\",\ncorrect:\"Perianal disease is common in Crohn's disease.\",\nopts:[\"Rectum is always involved in Crohn's disease.\",\"Fistula formation is common in Ulcerative Colitis.\",\"Stricture formation is common in Ulcerative Colitis.\",\"Perianal disease is common in Crohn's disease.\"],\nexp:\"Key distinguishing features of IBD: Option (a) FALSE: Rectal SPARING is characteristic of Crohn's disease; the rectum is almost always involved in UC. Option (b) FALSE: Fistula formation is characteristic of CROHN's disease (transmural inflammation creates fistulous tracts to adjacent organs, skin, or bowel loops); it is uncommon in UC. Option (c) FALSE: Stricture formation is characteristic of CROHN's disease (transmural fibrosis causing bowel stenosis - lead pipe appearance on barium enema is UC but this refers to loss of haustrations, not strictures). Option (d) TRUE: Perianal disease (fissures, fistulae, skin tags, abscesses, rectovaginal fistulae) is a classic and common extra-intestinal manifestation of Crohn's disease, occurring in approximately 35-50% of patients, especially with colonic disease.\"\n},\n{id:22,\nstem:\"A Sengstaken-Blakemore tube is used for the management of\",\ncorrect:\"Variceal bleeding\",\nopts:[\"Corrosive poisoning\",\"Variceal bleeding\",\"Asphyxia\",\"Tension pneumothorax\"],\nexp:\"The Sengstaken-Blakemore (SB) tube is a triple-lumen tube with two inflatable balloons (gastric and oesophageal) used for emergency tamponade of bleeding oesophageal and gastric varices. The gastric balloon is inflated first and pulled up against the gastro-oesophageal junction to tamponade gastric varices and anchor the tube; the oesophageal balloon is inflated second to compress oesophageal varices. It is used as a temporary bridge (maximum 24-48 hours due to risk of oesophageal necrosis and aspiration) to endoscopic or radiological definitive therapy (variceal band ligation, TIPS). It should never be used for corrosive poisoning (would worsen injury), asphyxia, or pneumothorax.\"\n},\n{id:23,\nstem:\"The most common benign tumour of the liver is\",\ncorrect:\"Haemangioma\",\nopts:[\"Adenoma\",\"Haemangioma\",\"Focal nodular hyperplasia\",\"Angiomyolipoma\"],\nexp:\"Hepatic haemangioma (cavernous haemangioma) is the most common benign liver tumour, with a prevalence of approximately 5-20% in the general population. It is a vascular malformation (not a true neoplasm) composed of large endothelium-lined vascular spaces. Most are asymptomatic and discovered incidentally on imaging. On ultrasound: hyperechoic, well-defined lesion. On MRI: characteristic progressive centripetal fill-in with gadolinium. Most haemangiomas require no treatment. Hepatic adenoma is much less common (associated with OCP use). Focal nodular hyperplasia (FNH) is the second most common benign liver lesion. Haemangioma is the correct answer.\"\n},\n{id:24,\nstem:\"The best position to palpate the minimal enlargement of spleen is\",\ncorrect:\"Palpation of left subcostal area in right lateral decubitus position\",\nopts:[\"Supine with lower limbs extended\",\"Palpation of left subcostal area in right lateral decubitus position\",\"Bimanual palpation in supine position\",\"Palpation of left subcostal area in knee-elbow position\"],\nexp:\"The right lateral decubitus position (patient lying on the right side with knees slightly flexed) is the best position to detect minimal splenic enlargement. In this position, gravity brings the spleen forward and downward towards the examiner, making the spleen more accessible to palpation at the left subcostal area. The spleen normally needs to enlarge to approximately 2-3 times its normal size before it becomes palpable in the supine position. Bimanual palpation in supine is the standard technique but misses minimal enlargement. The right lateral decubitus position maximises the chance of detecting early splenomegaly.\"\n},\n{id:25,\nstem:\"A young 28-year-old male was operated for duodenal ulcer perforation peritonitis. After having recovered well for five days, he developed high fever with chills and symptoms of toxemia. He developed right shoulder tip pain and intractable hiccoughs. The most likely diagnosis is\",\ncorrect:\"Subphrenic abscess\",\nopts:[\"Surgical site infection\",\"Postoperative peritonitis\",\"Subphrenic abscess\",\"Right lobe liver abscess\"],\nexp:\"Right shoulder tip pain and intractable hiccoughs following intra-abdominal surgery are PATHOGNOMONIC of subphrenic abscess. The mechanism: pus collection beneath the right hemidiaphragm irritates the diaphragmatic peritoneum; the phrenic nerve (C3,4,5) refers pain to the right shoulder tip (C4 dermatome); diaphragmatic irritation also triggers persistent hiccoughs via phrenic nerve. The fever with chills and toxaemia developing after initial recovery (5 days post-op) represents the typical post-operative collection timeline. Right shoulder tip pain + hiccoughs = subphrenic abscess. Diagnosis: CT abdomen. Treatment: ultrasound or CT-guided percutaneous drainage plus antibiotics.\"\n},\n{id:26,\nstem:\"In seat belt syndrome the most common site of bleeding is from\",\ncorrect:\"Mesentery\",\nopts:[\"Bowel\",\"Mesentery\",\"Liver\",\"Spleen\"],\nexp:\"Seat belt syndrome refers to the constellation of injuries caused by the restraining force of a lap seat belt (without shoulder strap) during sudden deceleration. The abdominal contents are compressed against the spine, causing: (1) Mesenteric injuries (most common) - mesenteric tears and haematomas causing bowel ischaemia; (2) Hollow viscus injuries - bowel contusions, perforations (especially jejunum); (3) Lumbar spine fractures (Chance fracture, flexion-distraction injury). The mesentery is the most common site of bleeding in seat belt syndrome because it is highly vascular and is subject to the shearing forces between the fixed spine and the mobile bowel loops. The 'seat belt sign' (linear ecchymosis across the abdomen) should raise suspicion for these injuries.\"\n},\n{id:27,\nstem:\"Which one of the following is a cause of exudative ascites?\",\ncorrect:\"Peritoneal malignancy\",\nopts:[\"Congestive cardiac failure\",\"Portal vein thrombosis\",\"Peritoneal malignancy\",\"Nephrotic syndrome\"],\nexp:\"Ascites is classified by the SAAG (Serum-Ascites Albumin Gradient) and by transudate\/exudate distinction. Exudative ascites (protein greater than 2.5 g\/dL, or SAAG less than 1.1 g\/dL): Peritoneal malignancy (tumour cells produce protein-rich fluid, inflame the peritoneum, block lymphatics) - correct. Tuberculous peritonitis, pancreatitis, chylous ascites. Transudative ascites (SAAG greater than 1.1 g\/dL, protein less than 2.5 g\/dL): Congestive cardiac failure (portal hypertension from raised venous pressure), Portal vein thrombosis (pre-hepatic portal hypertension), Nephrotic syndrome (hypoalbuminaemia reducing oncotic pressure). Among the options, peritoneal malignancy is the cause of exudative ascites.\"\n},\n{id:28,\nstem:\"Which one of the following statements is correct regarding eFAST in trauma?\",\ncorrect:\"It is a technique to assess free fluid in abdominal cavity, thoracic cavity and pericardium.\",\nopts:[\"It is a technique to assess free fluid in the abdominal cavity only.\",\"It is a technique to assess free fluid in abdominal cavity, thoracic cavity and pericardium.\",\"It is a technique to assess free fluid in pelvic cavity.\",\"It is a technique to assess free fluid in pleural cavity.\"],\nexp:\"eFAST (extended Focused Assessment with Sonography in Trauma) is a rapid bedside ultrasound protocol used in trauma resuscitation to detect free fluid (haemoperitoneum, haemopericardium, haemothorax). The examination includes: (1) Pericardial window (subxiphoid view) - to detect haemopericardium\/tamponade; (2) Right upper quadrant (Morison's pouch) - hepatorenal space; (3) Left upper quadrant (splenorenal recess); (4) Pelvic view (pouch of Douglas\/rectovesical pouch); (5) Bilateral thoracic views (bilateral pleural spaces) - the extended component detecting haemothorax and pneumothorax. eFAST assesses the abdominal cavity, thoracic cavity, AND pericardium. Option (b) is correct.\"\n},\n{id:29,\nstem:\"A 47-year-old man comes to Surgery OPD with history of recurrent episodes of UTI. He gives history of the urine being frothy and occasionally having bubbles. The probable diagnosis is\",\ncorrect:\"Colovesical fistula\",\nopts:[\"Anaerobic bacterial infection\",\"Colovesical fistula\",\"Tubercular cystitis\",\"Urethrocutaneous fistula\"],\nexp:\"Pneumaturia (air\/gas in urine, presenting as frothy urine with bubbles) in the context of recurrent UTIs in a middle-aged man is pathognomonic of a colovesical fistula (fistula between colon and urinary bladder). The gas passes from the colon (where it is produced by bacteria) into the bladder through the fistulous connection. Most common cause: diverticular disease of the sigmoid colon (60-65%), followed by colorectal carcinoma, Crohn's disease, and radiation injury. Patients may also pass faeces in urine (faecaluria) or report recurrent polymicrobial UTIs with enteric organisms. Diagnosis: CT cystography or CT abdomen. Treatment: surgical resection with closure of the bladder defect. Pneumaturia = colovesical fistula.\"\n},\n{id:30,\nstem:\"Which of the following are seen in Normal pressure hydrocephalus?<br>1. Hearing loss<br>2. Gait disturbance<br>3. Incontinence<br>4. Cognitive decline<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Normal Pressure Hydrocephalus (NPH) is characterised by the classic Hakim's triad (wet, wobbly, wacky): (1) Gait disturbance (statement 2) - magnetic gait (wide-based, shuffling, feet appear stuck to floor, earliest and most prominent feature); (2) Urinary incontinence (statement 3) - urge incontinence, later faecal incontinence; (3) Cognitive decline \/ dementia (statement 4) - subcortical dementia pattern (slowed processing, memory impairment, executive dysfunction). Hearing loss (statement 1) is NOT a feature of NPH. The CSF pressure is paradoxically normal (intermittently elevated). Diagnosis: CT\/MRI showing ventriculomegaly disproportionate to sulcal atrophy, with periventricular oedema. Treatment: ventriculoperitoneal shunting. Statements 2, 3, and 4 are correct.\"\n},\n{id:31,\nstem:\"Which of the following are the functions of larynx?<br>1. Fixation of the chest<br>2. Aids in swallowing of food<br>3. Phonation<br>4. Respiration<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Functions of the larynx: (1) Protection of the airway (sphincteric function) - the glottis closes during swallowing (via epiglottis, false cords, true cords) to prevent aspiration. (2) Phonation\/voice production (statement 3 correct) - vibration of the true vocal cords. (3) Respiration (statement 4 correct) - the larynx is the gateway between the pharynx and trachea; it regulates airflow. (4) Aids in swallowing (statement 2 correct) - the larynx elevates and moves anteriorly during swallowing, assisting bolus passage into the oesophagus. (5) Fixation of chest (statement 1) - the glottis closes during Valsalva manoeuvre (straining, coughing, defaecation, lifting), fixing the thorax. Statement 1 IS a function of the larynx; however, the question answer per the paper is statements 2, 3, and 4 as the primary functions. Statement 1 (chest fixation\/Valsalva) is a real function but the UPSC CMS answer is 2, 3 and 4.\"\n},\n{id:32,\nstem:\"Which of the following are included in the classical clinical presentation of pericardial tamponade?<br>1. Tachycardia<br>2. Muffled heart sounds<br>3. Decreased arterial pressure<br>4. Collapsed neck veins<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Beck's triad of cardiac tamponade: (1) Hypotension (decreased arterial pressure - statement 3 correct) - reduced cardiac output due to impaired ventricular filling; (2) Muffled\/distant heart sounds (statement 2 correct) - fluid around the heart dampens sound transmission; (3) Raised\/distended neck veins (elevated JVP, statement 4 is WRONG - it says COLLAPSED, not distended). In tamponade, venous pressure RISES (RAISED\/DISTENDED jugular veins), not collapses. Collapsed neck veins would indicate hypovolaemia (haemorrhagic shock). Tachycardia (statement 1 correct) is a compensatory response to reduced cardiac output. Therefore Beck's triad = hypotension + muffled heart sounds + RAISED JVP + tachycardia. Statements 1, 2, and 3 are part of the classical presentation; statement 4 (collapsed veins) is the distractor.\"\n},\n{id:33,\nstem:\"Masaoka staging is used for staging\",\ncorrect:\"Thymoma\",\nopts:[\"Germ cell tumours\",\"Thymoma\",\"Lymphoma\",\"Neurogenic tumours\"],\nexp:\"The Masaoka staging system (1981, revised as Masaoka-Koga 2011) is specifically used for staging THYMOMA, the most common anterior mediastinal tumour in adults. Stages: I - encapsulated tumour, no microscopic capsular invasion; IIa - microscopic transcapsular invasion; IIb - macroscopic invasion into thymic\/perithymic fat or grossly adherent to pleura\/pericardium; III - invasion of adjacent organs; IVa - pleural or pericardial dissemination; IVb - lymphogenous or haematogenous metastasis. Thymomas are associated with myasthenia gravis (30-45%), pure red cell aplasia, and other paraneoplastic syndromes. Germ cell tumours use the TNM system. Lymphomas use the Ann Arbor system. Masaoka staging is specific to thymoma.\"\n},\n{id:34,\nstem:\"Consider the following clinical features:<br>1. Low back pain<br>2. Saddle anaesthesia<br>3. Motor weakness in the lower extremities<br>4. Variable rectal and urinary symptoms<br>Which of the above features may be present in a patient with Cauda Equina syndrome?\",\ncorrect:\"1, 2, 3 and 4\",\nopts:[\"3 and 4 only\",\"1 and 2 only\",\"1, 2 and 3 only\",\"1, 2, 3 and 4\"],\nexp:\"Cauda equina syndrome (CES) is a surgical emergency caused by compression of the cauda equina nerve roots (L2 to coccyx) in the spinal canal. ALL FOUR features may be present: (1) Low back pain (statement 1) - often severe, radiating to one or both legs (sciatica); (2) Saddle anaesthesia (statement 2) - sensory loss in the perineum, buttocks, inner thighs, and genitalia in the distribution corresponding to a saddle; this is the most specific finding; (3) Motor weakness in the lower extremities (statement 3) - flaccid weakness due to lower motor neuron lesion; (4) Variable rectal and urinary symptoms (statement 4) - urinary retention\/incontinence (commonest presentation), faecal incontinence, erectile dysfunction. Urinary retention (inability to void) is the most common and cardinal finding in CES. All four statements are correct.\"\n},\n{id:35,\nstem:\"Which one of the following drugs is a long acting local anaesthetic agent?\",\ncorrect:\"Bupivacaine\",\nopts:[\"Lignocaine\",\"Bupivacaine\",\"Prilocaine\",\"Ropivacaine\"],\nexp:\"Classification of local anaesthetics by duration of action: Short-acting (30-60 min): procaine, chloroprocaine. Medium-acting (60-120 min): lignocaine (lidocaine), prilocaine, mepivacaine. Long-acting (2-8 hours): bupivacaine (duration 2-8 hours, most widely used long-acting LA), ropivacaine, levobupivacaine. Among the options: Lignocaine is medium-acting. Prilocaine is medium-acting (used in EMLA cream; causes methaemoglobinaemia in high doses). Ropivacaine is also long-acting but is a newer agent with less cardiac toxicity than bupivacaine. Bupivacaine (Marcaine) is the classic and most commonly cited LONG-ACTING local anaesthetic; duration up to 8 hours for nerve blocks. Both bupivacaine and ropivacaine are long-acting, but bupivacaine is the standard examination answer.\"\n},\n{id:36,\nstem:\"A patient with head injury with a Glasgow Coma Scale of 10 is classified as\",\ncorrect:\"Moderate injury\",\nopts:[\"Minor injury\",\"Mild injury\",\"Moderate injury\",\"Severe injury\"],\nexp:\"Glasgow Coma Scale (GCS) classification of head injury severity: Minor\/Mild injury: GCS 13-15 (some sources define minor as GCS 15, mild as 13-14). Moderate injury: GCS 9-12. Severe injury: GCS 3-8 (GCS 8 or less defines severe TBI; coma). This patient with GCS 10 falls in the MODERATE injury category (GCS 9-12). Moderate TBI requires hospital admission, CT head scan, neurosurgical consultation, and close neurological monitoring. It does NOT require immediate intubation (unlike severe TBI with GCS 8 or less). The distinction is clinically important for management decisions.\"\n},\n{id:37,\nstem:\"Gas Gangrene resulting in crepitus in tissues and a sweet smelling brown exudate is caused due to infection by\",\ncorrect:\"Clostridium perfringens\",\nopts:[\"Anaerobic bacteroides spp.\",\"Clostridium perfringens\",\"Gas-forming Klebsiella spp.\",\"Synergistic bacteria\"],\nexp:\"Gas gangrene (clostridial myonecrosis) with crepitus (gas in tissues) and a characteristic sweet-smelling (sickly sweet) brown or dishwater exudate is caused by Clostridium perfringens (type A, producing alpha-toxin\/lecithinase). The gas is produced by saccharolytic fermentation of tissue carbohydrates by clostridial organisms. The sweet smell is from butyric acid and other metabolic products. Clinical features: rapid progression, extreme pain (out of proportion to findings), bronze\/brown skin discolouration, crepitus on palpation, Gram stain showing large gram-positive rods with minimal inflammatory cells (due to toxin-mediated leukocyte destruction). Bacteroides causes foul-smelling anaerobic infection but not the classic sweet-smelling brown exudate. Clostridium perfringens is the correct answer.\"\n},\n{id:38,\nstem:\"Which of the following are the common complications associated with enteral nutrition in postoperative patients?<br>1. Tube malposition, displacement<br>2. Diarrhoea, constipation<br>3. Predisposition to systemic sepsis<br>4. Electrolytic imbalance<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Complications of enteral nutrition (tube feeding) in postoperative patients: Mechanical: tube malposition, displacement, kinking, obstruction, sinusitis (nasogastric tubes), aspiration (statement 1 correct). GI: diarrhoea (most common, from hyperosmolar feeds, antibiotic-associated, rapid infusion), constipation, nausea, vomiting, bloating, abdominal cramps (statement 2 correct). Metabolic: electrolyte imbalances (hypernatraemia\/hyponatraemia, hypokalaemia, hypo\/hyperglycaemia, refeeding syndrome with phosphate depletion), statement 4 correct. Infectious: aspiration pneumonia is the most serious complication. Statement 3 (systemic sepsis predisposition) is a complication of PARENTERAL (IV) nutrition, NOT enteral nutrition. Enteral feeding actually REDUCES the risk of bacterial translocation and systemic sepsis compared to parenteral nutrition by maintaining gut mucosal integrity. Statements 1, 2, and 4 are correct.\"\n},\n{id:39,\nstem:\"Which of the following are correct regarding Blood substitutes?<br>1. They are biomimetic.<br>2. They are extensively used in war injuries.<br>3. They are made of perfluorocarbon emulsions.<br>4. They are haemoglobin-based.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Blood substitutes (oxygen carriers) are artificially designed solutions that carry and release oxygen, mimicking red blood cell function: Statement 1 TRUE: They are BIOMIMETIC (designed to mimic the oxygen-carrying function of natural haemoglobin in red blood cells). Statement 2 FALSE: Blood substitutes are NOT yet extensively used in war injuries or clinical practice; they are still largely investigational\/experimental, with limited approved use in some countries (e.g., South Africa). They have not replaced blood transfusion in military medicine. Statement 3 TRUE: One major class is perfluorocarbon (PFC) emulsions, which dissolve oxygen physically (not chemically). Statement 4 TRUE: The other major class is haemoglobin-based oxygen carriers (HBOCs), derived from human, bovine, or recombinant haemoglobin. Statements 1, 3, and 4 are correct.\"\n},\n{id:40,\nstem:\"Ischaemia-Reperfusion syndrome is characterized by\",\ncorrect:\"Hypoxia and activation of inflammation\",\nopts:[\"Hypoxia and activation of inflammation\",\"Thrombo embolic angiopathy\",\"Acute mesenteric thrombosis\",\"Build up of bicarbonate and Na+ ions\"],\nexp:\"Ischaemia-reperfusion (IR) injury occurs when blood flow is restored to an ischaemic tissue, paradoxically causing additional damage. The pathophysiology: During ischaemia: ATP depletion, intracellular calcium accumulation, xanthine oxidase conversion. Upon reperfusion: sudden oxygen delivery to ischaemic tissue generates reactive oxygen species (ROS\/free radicals) via xanthine oxidase and NADPH oxidase; this causes oxidative stress, lipid peroxidation, and endothelial activation. The endothelial activation triggers an intense local and systemic INFLAMMATORY RESPONSE: neutrophil adhesion, complement activation, cytokine release (TNF, IL-1, IL-6), microvascular thrombosis. Therefore, IR syndrome is characterised by hypoxia (during ischaemia phase) and subsequent activation of inflammation (during reperfusion phase) with paradoxical worsening of injury. 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Submitting in 10 Submit Now Combined Medical Services Examination 2023Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part A General Surgery · Vascular & GI Surgery · Trauma & Neurosurgery · … <\/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-36741","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2023 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\/05\/03\/cms-2023-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 2023 P2 Part-A Surgery - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2023 | General Medicine & Paediatrics | Paper I | Part A ✓️ 0 ❌ 0 ⏳ 40 left ⏱ 40:00 Net 0 \/ 160 Time's Up! 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