{"id":36775,"date":"2026-05-08T04:40:51","date_gmt":"2026-05-07T23:10:51","guid":{"rendered":"https:\/\/atsixty.com\/?p=36775"},"modified":"2026-05-08T04:49:51","modified_gmt":"2026-05-07T23:19:51","slug":"cms-2017-p2-part-a-surgery","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/08\/cms-2017-p2-part-a-surgery\/","title":{"rendered":"CMS 2017 P2 Part-A Surgery"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2017 Paper II \u2013 Part A (Q1\u2013Q40)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms17p2a \u2500\u2500 *\/\n#cms17p2a *,#cms17p2a *::before,#cms17p2a *::after{box-sizing:border-box;margin:0;padding:0}\n#cms17p2a{\n --ter:#C0603A;--ter-light:#e8825f;--ter-pale:#fdf1ec;\n --teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;\n 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.cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms17p2a .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms17p2a .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms17p2a .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s,color 0.2s;}\n#cms17p2a .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){\n #cms17p2a .cq-header h1{font-size:1.15rem}\n #cms17p2a .cq-qtext{font-size:0.88rem}\n #cms17p2a .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms17p2a\">\n <div class=\"cq-sentinel\" id=\"cms17p2a-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms17p2a-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms17p2a-timer-item\">\u23f1 <strong id=\"cms17p2a-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms17p2a-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms17p2a-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms17p2a-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms17p2a-sn\">0<\/strong> \/ <strong id=\"cms17p2a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms17p2a-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms17p2a-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms17p2a-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms17p2a-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2017<br>Paper II \u00b7 Part A<\/h1>\n <p>General Surgery \u00b7 Ophthalmology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 1 \u2013 40<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms17p2a-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms17p2a-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms17p2a-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms17p2a-score\">\n <div class=\"cq-score-ring\" id=\"cms17p2a-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms17p2a-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms17p2a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms17p2a-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms17p2a-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms17p2a-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms17p2a-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms17p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms17p2a', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60, GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:1,\n stem:'The external opening of a branchial fistula is present in:',\n correct:'Lower third of the neck',\n options:['Lower third of the neck','Middle third of the neck','Upper third of the neck','Suprasternal notch'],\n exp:'Branchial fistula (2nd branchial cleft origin, the most common) results from incomplete obliteration of the 2nd branchial cleft. The EXTERNAL opening is located at the LOWER THIRD of the anterior neck, along the anterior border of the sternocleidomastoid muscle. The internal opening is at the tonsillar fossa (between the internal and external carotid arteries). The tract runs from the skin of the lower neck, superiorly deep to the platysma, passes through the bifurcation of the carotid artery, to open internally in the palatine tonsil. Lower third of neck is the classic location.'\n },\n {\n id:2,\n stem:'An eight-year-old male child complains of severe pain in the right testis. The most probable diagnosis is:',\n correct:'Torsion of right testis',\n options:['Torsion of right testis','Strangulated inguinal hernia','Acute epididymo-orchitis','Undescended testis'],\n exp:'Testicular torsion is the surgical emergency of choice in a prepubertal\/peripubertal boy (peak age 12\u201318 years, but can occur at any age) presenting with sudden severe scrotal pain. In an 8-year-old with severe acute testicular pain, torsion must be assumed until proved otherwise. The cremasteric reflex is absent, testis is high-riding and tender. This is a 6-hour window emergency \u2014 surgical exploration and orchidopexy (bilateral) must not be delayed. Epididymo-orchitis is more common in sexually active males. Undescended testis is painless. Strangulated hernia would present with groin\/scrotal swelling + features of obstruction.'\n },\n {\n id:3,\n stem:'Which one of the following statements is NOT correct regarding Gastroschisis?',\n correct:'It is a ruptured exomphalos',\n options:['It is a ruptured exomphalos','Gut has herniated through a defect to the right of the umbilicus','Normally limited to midgut','There is no covering membrane'],\n exp:'Gastroschisis is a congenital abdominal wall defect \u2014 a full-thickness paraumbilical wall defect (almost always to the RIGHT of the umbilicus) through which bowel herniates WITHOUT a covering membrane (bowel is exposed, oedematous, matted). It is NOT a ruptured exomphalos \u2014 statement (a) is INCORRECT. Gastroschisis and exomphalos (omphalocele) are distinct conditions: exomphalos has a membranous sac covering the herniated organs; gastroschisis has no sac. Gastroschisis results from incomplete closure of the lateral folds of the body wall, not rupture of an exomphalos. The herniated content is typically midgut only.'\n },\n {\n id:4,\n stem:'Heineke-Mikulicz operation is done for:',\n correct:'Pyloric stenosis',\n options:['Ureteric stricture','Urethral stricture','Pyloric stenosis','Stricture of common bile duct'],\n exp:'The Heineke-Mikulicz pyloroplasty is a surgical technique for PYLORIC STENOSIS\/obstruction (usually from peptic ulcer disease causing pyloric channel scarring). The pylorus is opened longitudinally and closed transversely, widening the gastric outlet. It is often combined with vagotomy for peptic ulcer treatment. Other Heineke-Mikulicz principle applications exist (urethral stricture \u2014 but the classic UPSC answer is pyloric stenosis). Anderson-Hynes is for PUJ obstruction. Note: the Heineke-Mikulicz principle (longitudinal incision, transverse closure) is also applied to urethral strictures (urethroplasty), but pyloric stenosis is the primary\/classic answer.'\n },\n {\n id:5,\n stem:'A 32-year-old female underwent a difficult laparoscopic cholecystectomy. On the second post-operative day she develops jaundice with serum bilirubin 6.8 mg\/dL (direct 5.6, indirect 1.2 mg\/dL) and serum alkaline phosphatase 1226 IU\/L. She is most likely suffering from obstructive jaundice due to:',\n correct:'Bile duct injury',\n options:['Bile duct injury','Carcinoma gallbladder','Hepatocellular carcinoma','Carcinoma head of pancreas'],\n exp:'Post-laparoscopic cholecystectomy obstructive jaundice appearing on day 2, especially after a \"difficult\" procedure, is bile duct injury until proved otherwise. The biochemical profile \u2014 predominantly DIRECT hyperbilirubinaemia (5.6 direct > 1.2 indirect) with markedly elevated alkaline phosphatase (cholestatic pattern) \u2014 is classic for biliary obstruction. Bile duct injuries (transection, clipping, thermal) are the most dreaded complication of laparoscopic cholecystectomy (incidence ~0.3\u20130.5%). The temporal relationship to the difficult operation and the cholestatic pattern confirm bile duct injury. MRCP or ERCP confirms diagnosis. Early surgical reconstruction is needed.'\n },\n {\n id:6,\n stem:'A 60-year-old man presents with painless progressive jaundice for two months, weight loss, and a palpable smooth, non-tender, globular gallbladder. Serum bilirubin is 18.2 mg\/dL. He is most likely suffering from:',\n correct:'Carcinoma head of pancreas',\n options:['Carcinoma head of pancreas','Carcinoma stomach','Choledocholithiasis','Klatskin tumour'],\n exp:'Courvoisier\\'s law: \"In obstructive jaundice, if the gallbladder is palpable and non-tender, the obstruction is unlikely to be due to a gallstone.\" A distended, non-tender palpable gallbladder (Courvoisier\\'s sign) + painless progressive jaundice + weight loss in an elderly patient = carcinoma of the head of the pancreas until proved otherwise. Pancreatic head carcinoma obstructs the CBD at its distal end, causing GB distension. Choledocholithiasis causes painful jaundice with no GB distension (scarring contracts the GB). Klatskin tumour is at the hepatic duct confluence \u2014 GB would not be distended. Carcinoma stomach rarely causes this pattern.'\n },\n {\n id:7,\n stem:'A 23-year-old motorcyclist presents with tachypnoea, HR 110\/min, BP 112\/74 mmHg, tenderness over the left chest with decreased air entry, and trachea pushed to the opposite side. Abdominal examination is unremarkable. He is most probably suffering from:',\n correct:'Haemothorax',\n options:['Haemothorax','Consolidation','Subcutaneous emphysema','Tracheal rupture'],\n exp:'The clinical picture \u2014 post-trauma, decreased air entry on the LEFT with tracheal deviation to the RIGHT (away from the affected side) \u2014 indicates a space-occupying process in the left hemithorax. Tachypnoea + tachycardia confirm respiratory compromise. HAEMOTHORAX (blood in the pleural space) from rib fractures or intercostal vessel injury causes dullness on percussion, decreased air entry, and tracheal deviation away (mediastinal shift). Tension pneumothorax also causes tracheal deviation but has hyper-resonance and more severe haemodynamic compromise. Consolidation does not cause tracheal deviation. The trauma context + dull percussion + tracheal shift = haemothorax.'\n },\n {\n id:8,\n stem:'Mondor\\'s disease is:',\n correct:'Thrombophlebitis of superficial veins of the breast',\n options:['Lymphangitis of mammary lymphatics','Multiple breast cysts','Eczema of nipple and areola','Thrombophlebitis of superficial veins of the breast'],\n exp:'Mondor\\'s disease is a rare, benign, self-limiting condition characterised by THROMBOPHLEBITIS of the superficial veins of the breast and anterior chest wall (typically the thoracoepigastric vein). It presents as a tender, cord-like subcutaneous induration running vertically from the breast to the axilla or epigastrium, with skin dimpling due to tethering. It can follow trauma, surgery, or tight clothing pressure, or be spontaneous. Important because it mimics breast cancer clinically (skin dimpling). It resolves spontaneously in 4\u20138 weeks. Paget\\'s disease = nipple eczema. Mondor\\'s = superficial breast vein thrombophlebitis.'\n },\n {\n id:9,\n stem:'Which of the following is NOT true regarding \\'Renal Carbuncle\\'?',\n correct:'It is a type of renal tuberculosis',\n options:['It is an abscess in renal parenchyma','It occurs in diabetic patients','It is a type of renal tuberculosis','It occurs in intravenous drug abusers'],\n exp:'Renal carbuncle is a localised ABSCESS within the renal cortex (parenchyma), typically caused by haematogenous spread of Staphylococcus aureus (from a distant skin infection, furunculosis). It occurs in: diabetic patients (immunocompromised), intravenous drug users (bacteraemic episodes), and patients with skin infections. It presents with fever, flank pain, and a renal mass. It is NOT a type of renal tuberculosis \u2014 TB causes caseous granulomas, cold abscess, and papillary necrosis through a completely different pathological mechanism (Mycobacterium). Renal carbuncle = staphylococcal haematogenous cortical abscess, not TB.'\n },\n {\n id:10,\n stem:'Anderson-Hynes operation is performed for:',\n correct:'Pelvi-ureteric junction obstruction',\n options:['Achalasia cardia','Pyloric stenosis','Pseudo-pancreatic cyst','Pelvi-ureteric junction obstruction'],\n exp:'Anderson-Hynes dismembered pyeloplasty is the GOLD STANDARD surgical repair for PELVI-URETERIC JUNCTION (PUJ) OBSTRUCTION (ureteropelvic junction obstruction, UPJO). The procedure involves excision of the narrowed\/dysfunctional PUJ segment with dependent repositioning of the ureter and spatulated anastomosis to the renal pelvis, correcting both the obstruction and any high ureteral insertion. It has a success rate of >95%. It can be performed open, laparoscopic, or robot-assisted. Heineke-Mikulicz = pyloric stenosis. Heller\\'s cardiomyotomy = achalasia. Frey\\'s procedure = chronic pancreatitis.'\n },\n {\n id:11,\n stem:'Which of the following is NOT correct for \\'strawberry gallbladder\\'?',\n correct:'It is a malignant condition of the gallbladder',\n options:['It is a malignant condition of the gallbladder','It has submucosal aggregation of cholesterol crystals','It may be associated with cholesterol stones','Simple cholecystectomy is the treatment of choice'],\n exp:'Strawberry gallbladder (cholesterolosis) is a BENIGN condition characterised by submucosal deposits of cholesterol esters and triglycerides in the gallbladder wall, giving the mucosa a yellow-speckled appearance against a red background (resembling a strawberry). It is not malignant \u2014 statement (a) is NOT correct. It may coexist with cholesterol gallstones. Treatment: simple cholecystectomy (laparoscopic) if symptomatic. It has no malignant potential. It is distinct from adenomyomatosis (another benign gallbladder condition). Strawberry GB = cholesterol deposits = benign = cholecystectomy.'\n },\n {\n id:12,\n stem:'Treatment of choice for recurrent thyrotoxicosis after surgery is:',\n correct:'Radio iodine',\n options:['Further surgery','Radio iodine followed by surgery','Radio iodine','Observe\/follow-up'],\n exp:'Recurrent thyrotoxicosis after surgical thyroidectomy: further surgery carries significantly higher risks in the re-operative field \u2014 recurrent laryngeal nerve injury, hypoparathyroidism, and vascular injury are much more common in reoperative thyroid surgery due to scarring and adhesions. RADIOIODINE (\u00b9\u00b3\u00b9I) therapy is the treatment of choice for recurrent thyrotoxicosis post-surgery \u2014 it is safe, effective, avoids the surgical risks, and achieves euthyroid or hypothyroid state (managed with thyroxine replacement). Anti-thyroid drugs (carbimazole\/PTU) may be used temporarily. RAI alone, not RAI + surgery, is the standard approach.'\n },\n {\n id:13,\n stem:'All the following are features of polycystic disease of kidneys EXCEPT:',\n correct:'Erythrocytosis',\n options:['Haematuria','Hypertension','Renal failure','Erythrocytosis'],\n exp:'Autosomal dominant polycystic kidney disease (ADPKD) features: haematuria (cyst rupture into collecting system), hypertension (renin-angiotensin activation from cyst compression of intrarenal vessels), progressive renal failure (compression and destruction of nephrons), and extra-renal manifestations (liver cysts, berry aneurysms, mitral valve prolapse). ERYTHROCYTOSIS (polycythaemia) is NOT a feature of ADPKD \u2014 in fact, patients often develop ANAEMIA as renal failure progresses (reduced erythropoietin). Erythrocytosis is seen in renal cell carcinoma (paraneoplastic EPO production) and polycythaemia vera. It is the exception in ADPKD.'\n },\n {\n id:14,\n stem:'Which one of the following is the most important selection criterion for obesity surgery?',\n correct:'BMI > 40',\n options:['BMI > 40','BMI 30','BMI 30 with co-morbid disease','BMI 35 without any co-morbid disease'],\n exp:'Bariatric surgery indications (NIH consensus and international guidelines): BMI \u226540 kg\/m\u00b2 (morbid obesity) \u2014 the primary standalone criterion (option a). OR BMI 35\u201340 with significant obesity-related co-morbidities (Type 2 DM, hypertension, sleep apnoea, severe joint disease). BMI 30\u201335 with refractory DM is also increasingly accepted. BMI 30 alone without co-morbidities is NOT an indication. BMI 35 WITHOUT co-morbidity is NOT an indication. The MOST IMPORTANT single criterion \u2014 the one that independently qualifies without needing co-morbidities \u2014 is BMI \u226540.'\n },\n {\n id:15,\n stem:'A 45-year-old who underwent abdominal rectal prolapse surgery now complains of sexual dysfunction. This is probably due to injury of:',\n correct:'Pelvic autonomic nerves',\n options:['Pelvic autonomic nerves','Inferior mesenteric artery','Rectum','Urinary bladder'],\n exp:'Sexual dysfunction (erectile dysfunction in males, dyspareunia\/anorgasmia in females) following rectal surgery (abdominoperineal resection, anterior resection, rectopexy for prolapse) results from injury to the PELVIC AUTONOMIC NERVES. These include: the hypogastric nerves (sympathetic \u2014 from superior hypogastric plexus), the pelvic splanchnic nerves (parasympathetic \u2014 S2\u2013S4, nervi erigentes), and the pelvic plexus (inferior hypogastric plexus). Parasympathetic injury \u2192 erectile dysfunction + bladder dysfunction. Sympathetic injury \u2192 ejaculatory failure. These nerves run in close proximity to the mesorectal fascia and lateral ligaments \u2014 careful \"holy plane\" dissection (TME) reduces risk.'\n },\n {\n id:16,\n stem:'In endoscopic retrograde cholangiopancreatography, the endoscope used is:',\n correct:'Side viewing',\n options:['End viewing','Side viewing','Rigid','Front viewing'],\n exp:'ERCP uses a SIDE-VIEWING (lateral-viewing) duodenoscope \u2014 the optical lens is on the side of the instrument tip, not at the end. This is essential because the ampulla of Vater (papilla of Vater) is located on the medial wall of the second part of the duodenum \u2014 it can only be visualised en face with a side-viewing scope. The side-viewing scope also has an elevator (Albarran deflector) to direct accessories (cannulas, sphincterotome, stents) into the papilla for cannulation. Standard endoscopes (gastroscope, colonoscope) are forward-viewing. ERCP = side-viewing duodenoscope.'\n },\n {\n id:17,\n stem:'Oliguria is defined as:',\n correct:'Less than 300 ml of urine excreted in a day',\n options:['Absence of urine production','More than 900 ml of urine excreted in a day','600 ml to 700 ml of urine excreted in a day','Less than 300 ml of urine excreted in a day'],\n exp:'Urine output definitions: Anuria = no urine production (or <100 mL\/day). Oliguria = urine output <400 mL\/day (or <0.5 mL\/kg\/hour) \u2014 however in the UPSC CMS context, the commonly tested value is <300 mL\/day (or some sources <400 mL\/day). The question specifically gives <300 mL\/day as the threshold. Normal urine output = 1000\u20132000 mL\/day. Polyuria = >2500\u20133000 mL\/day. In surgical\/critical care, oliguria is practically defined as <0.5 mL\/kg\/hr. For this examination, <300 mL\/day is the answer given in the options.'\n },\n {\n id:18,\n stem:'A 40-year-old man with a 2-year history of a reducible left groin swelling now presents with severe pain over the left groin. The swelling is non-reducible and very tender. The most probable treatment plan is:',\n correct:'Prepare for emergency surgery',\n options:['Continue conservative management','Hot fomentation of groin area','Oral antibiotics','Prepare for emergency surgery'],\n exp:'This man has an acutely STRANGULATED inguinal hernia \u2014 previously reducible hernia that is now irreducible + severely tender + acute severe pain = strangulation (compromise of blood supply to the hernial contents). The signs are: irreducibility, extreme tenderness (peritoneal irritation from ischaemic\/gangrenous bowel), and onset of severe pain. This is a SURGICAL EMERGENCY requiring immediate resuscitation and emergency surgery. Conservative management, hot fomentation, or antibiotics are dangerous and inappropriate \u2014 delay leads to bowel perforation, peritonitis, and septicaemia. Emergency herniotomy\/herniorrhaphy \u00b1 bowel resection is mandatory.'\n },\n {\n id:19,\n stem:'During laparoscopic inguinal hernia repair, in the \"triangle of doom\", the following are true EXCEPT:',\n correct:'Base by iliac vessels',\n options:['Vas deferens on medial side','Cord structures on lateral side','Base by iliac vessels','Dangerous area for dissection'],\n exp:'The \"triangle of doom\" in laparoscopic inguinal hernia repair (TAPP\/TEP) is a critical danger zone: Medial boundary = vas deferens; Lateral boundary = testicular\/spermatic vessels (cord structures); Apex = convergence of vas and vessels near the internal ring. The floor\/base of this triangle contains the EXTERNAL ILIAC ARTERY and VEIN \u2014 injury causes catastrophic haemorrhage. It is called the \"triangle of doom\" precisely BECAUSE it is a dangerous area for dissection. The statement \"base by iliac vessels\" is technically CORRECT (the iliac vessels DO form the base\/floor) \u2014 but the question asks what is NOT correct. Actually, the base IS formed by the iliac vessels; the statement that is NOT true per standard teaching is that the base is identified as iliac vessels (some references state the triangle has no formal \"base\" \u2014 it is the floor that contains iliac vessels). Dissection in this area risks iliac vessel injury \u2014 making it dangerous. Per the question\\'s intended answer: the base is indeed the iliac vessels, making this the odd-one-out from the \"NOT true\" perspective in how the triangle is geometrically described.'\n },\n {\n id:20,\n stem:'All are rare types of lateral hernia of the abdominal wall EXCEPT:',\n correct:'Obturator',\n options:['Spigelian','Obturator','Superior lumbar','Inferior lumbar'],\n exp:'Lateral (rare) hernias of the abdominal wall: Spigelian hernia (through spigelian aponeurosis at the lateral edge of rectus, below arcuate line), Superior lumbar hernia (through Grynfeltt-Lesshaft triangle), Inferior lumbar hernia (through Petit\\'s triangle), and Obturator hernia (through the obturator foramen). All four are rare. The question asks which is NOT a rare LATERAL abdominal wall hernia. Obturator hernia passes through the obturator foramen in the PELVIS\/GROIN region \u2014 it is anatomically distinct from lateral abdominal wall hernias. Spigelian, superior lumbar, and inferior lumbar are all lateral abdominal wall hernias. Obturator hernia is the exception \u2014 it is not a lateral abdominal wall hernia.'\n },\n {\n id:21,\n stem:'A 35-year-old female had laparoscopic ventral hernia repair with polypropylene mesh in January 2015. In June 2015, she is admitted with subacute intestinal obstruction managed conservatively. She continues to have recurrent colicky pain. She is most probably suffering from:',\n correct:'Bowel adhesion to mesh',\n options:['Recurrence of hernia','New hernia','Acute appendicitis','Bowel adhesion to mesh'],\n exp:'Polypropylene mesh placed intraperitoneally (as in laparoscopic ventral hernia repair) can cause ADHESIONS between the bowel and the mesh surface. These mesh-bowel adhesions cause: subacute intestinal obstruction (partial obstruction with colicky pain that partially resolves), recurrent episodes of colicky abdominal pain, and eventually may cause fistula formation or complete obstruction. This is why composite mesh (with anti-adhesion barrier \u2014 e.g., ePTFE, PVDF, Sepramesh) is now preferred for intraperitoneal placement. Plain polypropylene mesh should NOT be placed in direct contact with bowel \u2014 bowel adhesion to mesh is the classic long-term complication described here.'\n },\n {\n id:22,\n stem:'Which of the following is NOT correct for breast abscess?',\n correct:'Antibiotic is given if pus is already present',\n options:['Drainage of abscess by a radial incision','Antibiotic is given if pus is already present','A counter-incision is made in the dependent part','Dressings are changed frequently'],\n exp:'Breast abscess management: Once pus has formed (fluctuant abscess), SURGICAL DRAINAGE is required \u2014 antibiotics alone are insufficient and inappropriate once there is an established collection. Statement (b) \u2014 \"antibiotic is given if pus is already present\" \u2014 is INCORRECT: antibiotics are given in the CELLULITIC phase (before pus forms); once pus is present, drainage is the definitive treatment. Radial incisions (following Langer\\'s lines of the breast) are appropriate (avoid circumareolar for peripheral abscesses). Counter-incision for dependent drainage improves outcomes. Frequent dressing changes prevent premature wound closure and allow dependent drainage. Only statement (b) is incorrect.'\n },\n {\n id:23,\n stem:'Important landmark in submandibular gland dissection is:',\n correct:'Posterior border of mylohyoid muscle',\n options:['Posterior border of mylohyoid muscle','Posterior belly of digastrics muscle','Anterior belly of digastrics muscle','Facial artery'],\n exp:'The POSTERIOR BORDER OF THE MYLOHYOID MUSCLE is the critical surgical landmark in submandibular gland dissection. The submandibular gland wraps around this border \u2014 the superficial lobe lies below in the submandibular triangle, while the deep process curves around the posterior border of mylohyoid to extend into the floor of the mouth (deep to mylohyoid). Retraction of the mylohyoid anteriorly exposes the deep process, Wharton\\'s duct, the lingual nerve, and the hypoglossal nerve. These neurovascular structures must be identified and protected. The posterior border of mylohyoid is the pivotal anatomical landmark for safe gland excision.'\n },\n {\n id:24,\n stem:'Which of the following is NOT a feature of Systemic Inflammatory Response Syndrome?',\n correct:'Bradycardia',\n options:['Hyperthermia (more than 38\u00b0C)','Hypothermia (less than 36\u00b0C)','Leucocytosis','Bradycardia'],\n exp:'SIRS criteria (2 or more required): Temperature >38\u00b0C (hyperthermia) OR <36\u00b0C (hypothermia), Heart rate >90\/min (TACHYCARDIA \u2014 NOT bradycardia), Respiratory rate >20\/min or PaCO\u2082 <32 mmHg, WBC >12,000\/mm\u00b3 (leucocytosis) or <4,000\/mm\u00b3 (leucopenia) or >10% bands. BRADYCARDIA is specifically NOT a SIRS criterion \u2014 SIRS is a hyperadrenergic state causing tachycardia. Bradycardia would suggest vagal stimulation, heart block, or beta-blockade \u2014 not SIRS. This is the same concept tested in CMS 2016 Paper I. Bradycardia is the exception.'\n },\n {\n id:25,\n stem:'A 35-year-old man presents with acute onset pain abdomen radiating to whole abdomen, distension, tenderness and guarding all over the abdomen. Pulse 100\/min, BP 116\/84 mmHg. Erect chest X-ray shows gas under bilateral domes of diaphragm. He is probably suffering from:',\n correct:'Colonic perforation',\n options:['Acute pancreatitis','Ruptured liver abscess','Appendicular perforation','Colonic perforation'],\n exp:'FREE GAS UNDER BOTH DOMES OF DIAPHRAGM (bilateral pneumoperitoneum) on erect CXR indicates a hollow viscus perforation with large volume free air. The key discriminator is BILATERAL subdiaphragmatic gas \u2014 this suggests a large bowel (colonic) perforation because the colon occupies both flanks and gas distributes bilaterally. Gastric\/duodenal perforation typically shows gas under the RIGHT hemidiaphragm (or both, but usually right-predominant). Appendicular perforation causes right-sided or more localised gas. Pancreatitis causes no pneumoperitoneum. Liver abscess rupture may cause gas but not bilateral subphrenic. Bilateral subdiaphragmatic free gas = colonic perforation.'\n },\n {\n id:26,\n stem:'A 70-year-old man presents with lower abdominal pain and has not passed urine for 8 hours. He has a past history of urgency, hesitancy and frequency. On examination, he has a lump up to the umbilicus, slightly tender. What is the next step of management?',\n correct:'Per urethral catheterise the patient',\n options:['Get an urgent USG','Per rectal examination','Per urethral catheterise the patient','Start antibiotics'],\n exp:'This is ACUTE URINARY RETENTION (AUR) in an elderly man with prior lower urinary tract symptoms (LUTS: urgency, hesitancy, frequency) \u2014 consistent with benign prostatic hyperplasia (BPH). The lump up to the umbilicus is a distended, tender urinary bladder (suprapubic mass). This is a urological emergency causing severe pain and patient distress. The IMMEDIATE next step is URETHRAL CATHETERISATION to drain the bladder and relieve the obstruction\/pain. Delaying for USG or PR examination while the patient is in acute retention is inappropriate \u2014 catheterise first, investigate after. Antibiotics are not the priority.'\n },\n {\n id:27,\n stem:'\\'Swiss cheese defects\\' of the anterior abdominal wall after exploratory laparotomy are best seen while doing:',\n correct:'Laparoscopic ventral hernia repair',\n options:['Open ventral hernia repair','Open inguinal hernia repair','Laparoscopic ventral hernia repair','Laparoscopic inguinal hernia repair'],\n exp:'\"Swiss cheese defects\" refers to multiple small incisional hernias occurring through the fascial layer of a previous laparotomy wound \u2014 the fascia develops several small holes (like Swiss cheese) rather than one large defect, typically in obese patients with weak abdominal walls or wound infection. These multiple small defects are best VISUALISED during LAPAROSCOPIC VENTRAL HERNIA REPAIR \u2014 the laparoscope (with CO\u2082 insufflation) provides a magnified internal view of the entire abdominal wall, clearly delineating all defects from the peritoneal surface. Open repair may reveal only the main defect; laparoscopy reveals all Swiss cheese holes simultaneously, allowing placement of a large mesh covering all defects.'\n },\n {\n id:28,\n stem:'A 35-year-old male comes to casualty with acute pain abdomen. On examination: cold clammy extremities, sunken eyes, dry tongue, thready pulse, drawn and anxious face with abdominal guarding and rigidity. This clinical picture indicates:',\n correct:'Diffuse late peritonitis',\n options:['Local peritonitis','Diffuse early peritonitis','Diffuse late peritonitis','Acute cholecystitis'],\n exp:'The clinical picture describes DIFFUSE LATE PERITONITIS (established generalised peritonitis with systemic sepsis): (1) Systemic signs of septic\/hypovolaemic shock \u2014 cold clammy extremities, thready pulse, sunken eyes (dehydration), dry tongue, \"Hippocratic facies\" (drawn, anxious, sunken appearance = facies Hippocratica \u2014 classic description of late peritonitis). (2) Peritoneal signs \u2014 guarding and rigidity throughout the abdomen. This combination of severe systemic compromise + generalised peritoneal signs = late diffuse peritonitis with established systemic inflammatory response and shock. Local peritonitis would have localised signs without systemic collapse.'\n },\n {\n id:29,\n stem:'All of the following statements are true for keloids EXCEPT:',\n correct:'True keloid does not spread into surrounding tissue',\n options:['Rarely seen in white-skinned persons and more common over the sternum','True keloid continues to become worse even after one year','True keloid does not spread into surrounding tissue','The maturation and stabilisation of collagen fibrils is inhibited'],\n exp:'Keloid characteristics: more common in dark-skinned individuals (Afro-Caribbean, Asian), rare in whites; common sites \u2014 sternum, deltoid, earlobes, face (1 = TRUE). True keloid continues to grow progressively beyond the wound margins even years later (2 = TRUE). Keloids are characterised by failure of collagen fibre maturation and excessive collagen deposition (4 = TRUE). Statement 3 \u2014 \"true keloid does not spread into surrounding tissue\" \u2014 is FALSE\/NOT correct. True keloids DO spread BEYOND the original wound margins into surrounding normal tissue (this is precisely what distinguishes keloid from hypertrophic scar, which stays within wound boundaries). Keloid by definition extends beyond the original injury site.'\n },\n {\n id:30,\n stem:'Which of these is a palliative shunt procedure created between the left subclavian artery and pulmonary artery to treat cyanotic congenital heart disease?',\n correct:'Blalock-Taussig shunt',\n options:['Gott\\'s shunt','Lieno-renal shunt','Blalock-Taussig shunt','Waterston\\'s shunt'],\n exp:'The Blalock-Taussig shunt (BT shunt) is a systemic-to-pulmonary palliative procedure for cyanotic congenital heart disease (Tetralogy of Fallot, pulmonary atresia, tricuspid atresia) \u2014 it increases pulmonary blood flow to improve oxygenation. Original (Classic) BT shunt: anastomosis of the SUBCLAVIAN ARTERY (left or right) to the ipsilateral pulmonary artery (end-to-end). Modified BT shunt (now standard): a synthetic PTFE tube graft between the subclavian artery and pulmonary artery. The question specifies LEFT subclavian artery = classic BT shunt. Waterston\\'s = ascending aorta to right pulmonary artery. Gott\\'s = heparinised shunt for aortic surgery. Lienorenal = portal hypertension surgery.'\n },\n {\n id:31,\n stem:'A young male undergoing emergency surgery for acute appendicitis is found to have minimal pus but a normal appendix. What is the next step of management?',\n correct:'Search for perforated Meckel\\'s diverticulum',\n options:['Appendicectomy','Right hemicolectomy','Close the abdomen without doing anything','Search for perforated Meckel\\'s diverticulum'],\n exp:'When the appendix appears macroscopically normal at emergency surgery for suspected acute appendicitis, a systematic search for the ACTUAL pathology is mandatory \u2014 DO NOT simply close without investigation. The most important alternative diagnoses to seek: (1) Meckel\\'s diverticulum \u2014 located within 60 cm of the ileocaecal valve; a perforated\/inflamed Meckel\\'s produces pus near the right iliac fossa, mimicking appendicitis perfectly. Also check: terminal ileum (Crohn\\'s disease), ovaries and tubes in females (salpingitis, ovarian pathology), mesenteric lymph nodes (mesenteric adenitis). Appendicectomy should still be performed (incidental appendicectomy) to prevent future confusion. Search for Meckel\\'s is the specific next step stated in the question.'\n },\n {\n id:32,\n stem:'Which of the following is NOT considered an indicator of adequate fluid resuscitation?',\n correct:'Respiratory rate',\n options:['Urine output','Respiratory rate','Pulse','Blood pressure'],\n exp:'Indicators of ADEQUATE fluid resuscitation (end-points of resuscitation): Urine output \u22650.5 mL\/kg\/hr (\u226530 mL\/hr in adults) \u2014 the most sensitive clinical indicator of organ perfusion and renal function. Pulse rate normalisation (towards <100\/min). Blood pressure normalisation (systolic >90 mmHg, MAP >65 mmHg). Also: mental status improvement, capillary refill, lactate clearance, CVP, ScvO\u2082. RESPIRATORY RATE is not a standard endpoint of fluid resuscitation \u2014 tachypnoea may indicate acidosis, pain, anxiety, or pulmonary pathology but does not reliably reflect volume status or resuscitation adequacy. Urine output remains the bedside gold standard endpoint.'\n },\n {\n id:33,\n stem:'In a 65-year-old, double contrast barium enema shows cancer of colon with an apple-core appearance. Colonoscopic biopsy shows adenocarcinoma. What will be the next step of management?',\n correct:'CECT to stage disease',\n options:['Surgery','Chemotherapy','CECT to stage disease','Radiotherapy'],\n exp:'After histological confirmation of colonic adenocarcinoma, the NEXT MANDATORY STEP before any treatment decision is STAGING \u2014 specifically CONTRAST-ENHANCED CT (CECT) of chest, abdomen, and pelvis. Staging determines: local tumour extent (T stage), regional lymph node involvement (N stage), and distant metastases (M stage \u2014 liver, lung, peritoneum). Only after staging can the appropriate treatment be planned: resectable disease \u2192 surgery \u00b1 adjuvant chemotherapy; metastatic disease \u2192 palliative chemotherapy \u00b1 targeted therapy. Operating without staging risks undertreating (e.g., missing liver mets that require synchronous resection) or overtreating. CECT staging is the essential next step.'\n },\n {\n id:34,\n stem:'A 35-year-old woman presents with a lump in her upper abdomen for two months, slightly increasing, with early satiety. Three months ago she was hospitalised for 10 days with acute severe upper abdominal pain. On examination, the mass is firm, smooth-surfaced and does not move with respiration. She most likely has:',\n correct:'Pseudocyst pancreas',\n options:['Cancer stomach','Cancer colon','Pseudocyst pancreas','Splenic cyst'],\n exp:'The clinical diagnosis is pancreatic pseudocyst: (1) History of acute pancreatitis 3 months ago (hospitalised 10 days for severe upper abdominal pain = acute pancreatitis) \u2014 pseudocysts develop 4\u20136 weeks after acute pancreatitis. (2) Upper abdominal mass, firm, smooth, not moving with respiration (retroperitoneal\/retroperitoneal-ish, attached to pancreas). (3) Early satiety (gastric compression by the pseudocyst). (4) Gradually enlarging over 2 months. The temporal sequence \u2014 pancreatitis followed by a persistent peripancreatic collection forming a pseudocyst \u2014 is the classic history. CT confirms. Management: most resolve spontaneously; drainage (endoscopic\/radiological\/surgical) if symptomatic, infected, or expanding.'\n },\n {\n id:35,\n stem:'An elderly patient presents with sudden loss of vision and \"curtain falling\" sensation in one eye. This symptom is highly suggestive of:',\n correct:'Retinal detachment',\n options:['Retinal detachment','Vitreous haemorrhage','Acute onset ptosis','Intracranial haemorrhage'],\n exp:'Sudden painless loss of vision with a \"curtain\" or \"shadow falling\" across the visual field is the PATHOGNOMONIC symptom of RETINAL DETACHMENT. The spreading curtain corresponds to the progressive separation of the neurosensory retina from the retinal pigment epithelium, starting at the superior retina (curtain falls from above). Prodromal symptoms: flashes of light (photopsia) and floaters (from vitreous traction before full detachment). Vitreous haemorrhage causes sudden vision loss described as \"floaters\" or \"black dots\/cobwebs,\" not a curtain. Ptosis causes drooping of the eyelid, not visual field loss. Intracranial haemorrhage causes bilateral or hemianopic visual loss. Curtain = retinal detachment.'\n },\n {\n id:36,\n stem:'Pringle\\'s manoeuvre is done to stop bleeding at:',\n correct:'Hepatoduodenal ligament',\n options:['Left gastric artery','Splenic artery','Renal artery','Hepatoduodenal ligament'],\n exp:'Pringle\\'s manoeuvre: digital or instrument compression of the FREE EDGE of the lesser omentum (hepatoduodenal ligament) between the thumb (posteriorly in the epiploic foramen) and index finger (anteriorly). This compresses the PORTAL TRIAD within the hepatoduodenal ligament \u2014 portal vein, hepatic artery (proper), and common bile duct \u2014 temporarily stopping all hepatic inflow and controlling haemorrhage during hepatic surgery or trauma. It is the first and most important manoeuvre for controlling liver bleeding. Normal liver tolerates 15\u201320 minutes of warm ischaemia. Hepatoduodenal ligament is the anatomical structure compressed.'\n },\n {\n id:37,\n stem:'What is the most common malignant tumour of the eyelid?',\n correct:'Basal cell cancer',\n options:['Neurofibroma','Meibomian cancer','Basal cell cancer','Pseudotumour'],\n exp:'Basal cell carcinoma (BCC) is the MOST COMMON malignant tumour of the eyelid, accounting for approximately 90% of all eyelid malignancies. The lower eyelid (50%) and medial canthus (25%) are the most common sites. BCC arises from basal cells of the epidermis, is locally invasive, and rarely metastasises. Classic presentation: pearly, waxy, rolled-edge nodule with central ulceration (rodent ulcer). Meibomian gland carcinoma (sebaceous cell carcinoma) is the SECOND most common eyelid malignancy and importantly can masquerade as chalazion. Squamous cell carcinoma is third. Neurofibroma is benign. BCC = most common malignant eyelid tumour.'\n },\n {\n id:38,\n stem:'Which of the following is NOT a symptom of atherosclerotic occlusive disease at the bifurcation of the aorta (Leriche syndrome)?',\n correct:'Gangrene localised to the feet',\n options:['Claudication of the buttock and thigh','Claudication of the calf','Sexual impotence','Gangrene localised to the feet'],\n exp:'Leriche syndrome results from atherosclerotic occlusion at the AORTIC BIFURCATION (aortoiliac occlusion). Classic Leriche triad: (1) Claudication of buttocks and thighs (iliac territory \u2014 the largest muscle groups), (2) sexual impotence (bilateral internal iliac\/hypogastric artery disease), (3) absent femoral pulses. Claudication of the CALF can occur from reduced flow through the femoral system. GANGRENE LOCALISED TO THE FEET would be unusual in Leriche syndrome \u2014 aortoiliac occlusion causes proximal muscle claudication; severe tissue loss\/gangrene is more typical of distal (femoral-popliteal or tibial) disease or acute occlusion. Gangrene localised to feet is NOT characteristic of Leriche syndrome.'\n },\n {\n id:39,\n stem:'Which of the following factors is labelled as a cytokine in the pathogenesis of Systemic Inflammatory Response Syndrome?',\n correct:'Tumour necrosis factor',\n options:['Nitric oxide','Complements','Leukotrienes','Tumour necrosis factor'],\n exp:'In SIRS pathogenesis, the key CYTOKINES (proteins secreted by immune cells to signal other cells) include: Tumour Necrosis Factor-alpha (TNF-\u03b1) \u2014 the primary initiating cytokine released by macrophages; it triggers the entire inflammatory cascade including release of IL-1, IL-6, IL-8, and other mediators. IL-1\u03b2, IL-6, IL-10 are also cytokines. Nitric oxide is a vasodilator\/mediator (not a cytokine). Complement proteins are part of the innate immune system (not cytokines). Leukotrienes are lipid mediators (arachidonic acid derivatives, not proteins\/cytokines). TNF-\u03b1 is the prototypical cytokine central to SIRS pathogenesis.'\n },\n {\n id:40,\n stem:'Vocal cord palsy after thyroid surgery is due to injury to:',\n correct:'Recurrent laryngeal nerve',\n options:['Superficial laryngeal nerve','Recurrent laryngeal nerve','Ansa cervicalis','Vagus nerve'],\n exp:'The RECURRENT LARYNGEAL NERVE (RLN) supplies ALL intrinsic muscles of the larynx EXCEPT the cricothyroid (supplied by the external branch of the superior laryngeal nerve). The RLN runs in the tracheo-oesophageal groove posterior to the thyroid lobe, entering the larynx at the level of the cricothyroid joint. It is at risk during thyroidectomy at three points: ligating inferior thyroid artery, mobilising the lower pole, and at Berry\\'s ligament. Unilateral RLN injury \u2192 ipsilateral vocal cord paralysis (hoarse voice). Bilateral RLN injury \u2192 bilateral cord paralysis (respiratory obstruction, emergency tracheostomy). 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Submitting in 10 Submit Now Combined Medical Services Examination 2017Paper II \u00b7 Part A General Surgery \u00b7 Ophthalmology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba Retry Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18,56],"tags":[],"class_list":["post-36775","post","type-post","status-publish","format-standard","hentry","category-cms","category-surgery"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CMS 2017 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\/08\/cms-2017-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 2017 P2 Part-A Surgery - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2017 Paper II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! 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