CMS 2025 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#cms25p2a*,#cms25p2a *::before,#cms25p2a *::after{box-sizing:border-box;margin:0;padding:0}\n#cms25p2a{--ter:#C0603A;--ter-pale:#fdf1ec;--teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;--ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;--line:#e0d8d4;--bg:#fdfaf8;--white:#fff;--cb:#43a047;--cb-bg:#eaf7ef;--wb:#e53935;--wb-bg:#fdf0f0;--r:10px;font-family:'Source Serif 4',Georgia,serif;font-size:16px;color:var(--ink);background:var(--bg);line-height:1.7;padding:0 0 48px}\n#cms25p2a .sen{height:1px}\n#cms25p2a .sb{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px solid var(--ter);box-shadow:0 2px 12px 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0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms25p2a .ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms25p2a .ri{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms25p2a .rp{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms25p2a .rs{font-size:.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:.05em}\n#cms25p2a .sc h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms25p2a .nl{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms25p2a .vd{font-size:.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms25p2a .bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:.8rem}\n#cms25p2a .band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms25p2a 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id=\"cms25p2a-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms25p2a-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms25p2a-sn\">0.00<\/strong> \/ <strong id=\"cms25p2a-sm\">40<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms25p2a-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms25p2a-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms25p2a-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms25p2a-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2025<br>Paper II \u00b7 Part A<\/h1>\n <p>Surgery (Q1 \u2013 Q40)<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 1 \u2013 40<\/span>\n <span class=\"bdg\">+1 correct \u00b7 \u2212\u2153 wrong<\/span>\n <button class=\"tbtn\" id=\"cms25p2a-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms25p2a-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms25p2a-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms25p2a-sc-box\">\n <div class=\"ring\" id=\"cms25p2a-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms25p2a-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms25p2a-nl\"><\/div>\n <div class=\"vd\" id=\"cms25p2a-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms25p2a-bc\"><\/span>\n <span class=\"band bw\" id=\"cms25p2a-bw\"><\/span>\n <span class=\"band bs\" id=\"cms25p2a-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms25p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms25p2a',TOTAL=40,MAX=40,TSECS=2400,GSECS=10;\nvar CU=100,WU=33;\nvar QS=[\n{id:1,stem:'Vibration white finger refers to:',correct:'Raynaud\\'s syndrome',options:['Buerger\\'s disease','Raynaud\\'s syndrome','Acrocyanosis','Takayasu disease'],exp:'VIBRATION WHITE FINGER (VWF) \/ Hand-Arm Vibration Syndrome (HAVS): an occupational disease caused by prolonged use of vibrating tools (pneumatic drills, chain saws, grinders). It is a form of SECONDARY RAYNAUD\\'S SYNDROME \u2714 \u2014 vasospastic condition affecting fingers; episodes of blanching (white), cyanosis (blue), and erythema (red) triggered by cold or vibration; vascular and neurological components. The condition is called \"white finger\" because the fingers turn white (ischaemia) during vasospastic episodes. Buerger\\'s disease: thromboangiitis obliterans; smoking-related inflammatory occlusion of small\/medium vessels. Acrocyanosis: persistent blue-purple discolouration of extremities; not episodic. Takayasu: large vessel arteritis. Answer: Raynaud\\'s syndrome.'},\n{id:2,stem:'Which of the following are criteria for cancer screening?\\nI. Screening test should be sensitive and specific\\nII. Screening test should be acceptable to the screened population\\nIII. The disease should be an uncommon one for screening to be effective\\nIV. Disease should be recognisable at an early stage\\nSelect the correct answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Wilson and Jungner (WHO) criteria for screening: Statement I \u2714 \u2014 Test must be SENSITIVE (detects true positives) and SPECIFIC (avoids false positives). Statement II \u2714 \u2014 Test must be ACCEPTABLE to the target population (non-invasive, affordable, minimal side effects). Statement III \u2717 \u2014 The disease should be COMMON (high prevalence), NOT uncommon; screening is cost-effective only when the disease burden is significant in the population. Statement IV \u2714 \u2014 Disease must be recognisable at an EARLY\/PRECLINICAL stage where intervention improves outcome. Other criteria: natural history understood; acceptable treatment exists; facilities for diagnosis and treatment available; cost-benefit favourable. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:3,stem:'A 45-year-old lady presents with complaints of fatigue, muscle weakness along with bilateral multiple renal calculi which were picked up on a routine ultrasound. Serum calcium levels of 11.4 mg%. What is the next best investigation required to arrive at a diagnosis?',correct:'Sestamibi scan',options:['MRI neck','Sestamibi scan','CECT head and neck','NCCT head and neck'],exp:'Clinical diagnosis: PRIMARY HYPERPARATHYROIDISM \u2014 hypercalcaemia (11.4 mg%) + renal calculi + muscle weakness + fatigue. Cause: parathyroid adenoma in ~85% of cases. NEXT BEST INVESTIGATION after confirming elevated PTH: SESTAMIBI SCAN (Tc-99m sestamibi parathyroid scintigraphy) \u2714 \u2014 the gold standard LOCALISATION study for parathyroid adenoma; sestamibi is preferentially retained in hyperfunctioning parathyroid tissue; sensitivity ~80\u201390%; often combined with SPECT-CT. CECT\/MRI neck: useful but less sensitive than sestamibi for localising parathyroid adenoma. NCCT: no contrast = poor soft tissue differentiation for parathyroid. Sestamibi + neck ultrasound is the preferred combination for pre-operative localisation. Answer: Sestamibi scan.'},\n{id:4,stem:'Which of the following are the aetiological factors associated with a communicating hydrocephalus?\\nI. Post haemorrhagic\\nII. Lesions within the ventricle\\nIII. CSF infection\\nIV. Raised CSF protein\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Communicating vs non-communicating hydrocephalus: COMMUNICATING hydrocephalus: CSF flows freely through ventricles and into subarachnoid space but is impaired in REABSORPTION at arachnoid granulations. Causes: POST-HAEMORRHAGIC \u2714 \u2014 blood in subarachnoid space blocks arachnoid villi (post-SAH, intraventricular haemorrhage). CSF INFECTION \u2714 \u2014 meningitis causes arachnoid adhesions \u2192 impaired reabsorption (post-meningitic hydrocephalus). RAISED CSF PROTEIN \u2714 \u2014 high protein viscosity impairs arachnoid granulation reabsorption (e.g., Guillain-Barr\u00e9, spinal tumour). LESIONS WITHIN THE VENTRICLE \u2717 \u2014 intraventricular lesions (colloid cyst, ependymoma) cause OBSTRUCTION \u2192 NON-COMMUNICATING (obstructive) hydrocephalus by blocking CSF flow within the ventricular system. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:5,stem:'Which of the following statements are correct regarding a brain abscess?\\nI. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus\\nII. Presenting features include low grade fever, confusion, seizures and focal deficits\\nIII. MRI with contrast is the initial imaging modality of choice\\nIV. The aetiological agents include bacteria, fungi, protozoa and viruses\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Brain abscess: Statement I \u2714 \u2014 DIRECT SPREAD: compound skull fractures (post-traumatic) and contiguous spread from frontal\/ethmoid sinusitis, mastoiditis, otitis media \u2192 brain abscess; direct brain exposure is a recognised mechanism. Statement II \u2714 \u2014 Classical TRIAD: headache + fever + focal neurological deficits; also seizures (25%), confusion, raised ICP. LOW-GRADE fever is often present (not always high). Statement III \u2717 \u2014 INITIAL imaging is CT SCAN with contrast (ring-enhancing lesion); CT is preferred first-line due to availability and speed; MRI is more sensitive and better for defining extent but is NOT the initial\/first-line modality in emergency settings. Statement IV \u2714 \u2014 Causes: bacteria (Streptococcus, Staph, anaerobes \u2014 most common); fungi (Aspergillus, Candida \u2014 immunocompromised); protozoa (Toxoplasma in HIV); viruses (rare). Correct: I, II, IV. Answer: I, II and IV.'},\n{id:6,stem:'What is the most common type of tumour of Vermiform Appendix?',correct:'Carcinoid tumour',options:['Epithelial tumour','Carcinoid tumour','Germ cell tumour','Papillary cell tumour'],exp:'Tumours of the vermiform appendix: CARCINOID TUMOUR (well-differentiated neuroendocrine tumour) \u2714 \u2014 the MOST COMMON tumour of the appendix; accounts for ~85% of all appendiceal tumours; typically small (<2 cm), located at the tip; usually benign behaviour; incidentally found in appendicectomy specimens (~0.3\u20130.5% of appendicectomies). Most are non-functioning (no carcinoid syndrome unless >2 cm or with liver mets). Mucinous cystadenoma\/adenocarcinoma: second most common. Epithelial (adenocarcinoma): uncommon. Germ cell tumours: in gonads primarily. Papillary cell: not a recognised appendiceal tumour type. Answer: Carcinoid tumour.'},\n{id:7,stem:'The earliest specific cystoscopic appearance of Bilharzial cystitis is:',correct:'Sandy patches',options:['Sandy patches','Ulcers','Pseudo tubercles','Nodules'],exp:'Bilharzial (Schistosoma haematobium) cystitis \u2014 cystoscopic stages: EARLIEST SPECIFIC FINDING: SANDY PATCHES \u2714 \u2014 yellowish\/white granular deposits on the bladder mucosa (calcified dead Schistosoma eggs beneath the epithelium); pathognomonic for Bilharzial cystitis; appear as \"sand-like\" granules. Sequence of cystoscopic findings: Sandy patches \u2192 hyperaemia\/inflammation \u2192 ulcers \u2192 nodules \u2192 papillomata \u2192 leucoplakia \u2192 squamous cell carcinoma. Pseudo-tubercles: whitish raised nodules (viable ova surrounded by granulomas) \u2014 appear slightly later. Ulcers\/nodules: later stages. Sandy patches = EARLIEST SPECIFIC appearance. Answer: Sandy patches.'},\n{id:8,stem:'Which one of the following best describes craniosynostosis?',correct:'It is the premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.',options:['It is delayed fusion of one or more cranial sutures preventing growth perpendicular to the suture.','It is the premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.','It is the premature fusion of one or more cranial sutures, facilitating growth perpendicular to the suture.','It is delayed fusion of one or more cranial sutures facilitating growth perpendicular to the suture.'],exp:'CRANIOSYNOSTOSIS: PREMATURE FUSION of one or more cranial sutures \u2714 \u2014 the correct definition. The fusion prevents growth PERPENDICULAR to the fused suture \u2714 (Virchow\\'s law: the skull is unable to grow perpendicular to a prematurely fused suture; compensatory growth occurs PARALLEL to the fused suture). Effect: abnormal skull shape depending on which suture(s) fuse early. Sagittal synostosis \u2192 scaphocephaly (long narrow skull). Coronal synostosis \u2192 brachycephaly\/plagiocephaly. Metopic synostosis \u2192 trigonocephaly. Treatment: surgical cranial vault remodelling. Delayed fusion causes a separate problem (enlarged fontanelles, hydrocephalus). Answer: Premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.'},\n{id:9,stem:'A 60-year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?',correct:'Breast',options:['Small intestine','Large intestine','Adrenal','Breast'],exp:'Lytic bone metastases in vertebrae and ribs in a 60-year-old female: LYTIC bone metastases common causes (mnemonic: BLT with Ketchup and Pickle): Breast \u2714, Lung, Thyroid, Kidney, Prostate (but prostate \u2192 usually SCLEROTIC). In a 60-year-old FEMALE: BREAST cancer is by far the most common primary causing bone metastases; accounts for the majority of bone mets in women. Breast \u2192 typically lytic metastases (sometimes mixed). Adrenal: adrenocortical carcinoma can rarely metastasise but is far less common. Small\/large intestine: colorectal cancer causes liver\/lung\/peritoneal mets predominantly; bone mets are uncommon. In an elderly woman with lytic vertebral and rib lesions \u2192 screen BREAST (mammography, clinical breast examination). Answer: Breast.'},\n{id:10,stem:'Which of the following statements are correct regarding Cauda equina syndrome?\\nI. Its presenting symptoms are perineal numbness, painless urinary retention and faecal incontinence\\nII. Urgent investigation with MRI is required\\nIII. It is present most commonly in the 45-60 year age group\\nIV. Confirmed cases require early surgical decompression\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Cauda equina syndrome (CES): Statement I \u2714 \u2014 Classic symptoms: SADDLE anaesthesia (perineal\/perianal numbness), urinary retention (painless \u2014 loss of detrusor control), faecal incontinence, bilateral leg weakness\/radiculopathy. Statement II \u2714 \u2014 URGENT MRI is mandatory for diagnosis; MRI lumbar spine with gadolinium identifies the compressive lesion (disc herniation, tumour, haematoma). Statement III \u2717 \u2014 CES has no specific age predilection of 45\u201360 years; the most common cause (large central L4\u2013L5 or L5\u2013S1 disc herniation) occurs across a wide age range (30\u201360 years); it is NOT specifically most common in 45\u201360 year group. Statement IV \u2714 \u2014 EARLY SURGICAL DECOMPRESSION (within 24\u201348 hours of onset) is critical; outcomes are significantly better with early surgery; delay leads to permanent bladder\/bowel dysfunction. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:11,stem:'The commonest site of pressure sore is:',correct:'Sacrum',options:['Heel','Sacrum','Ischium','Occiput'],exp:'PRESSURE SORES (decubitus ulcers) \u2014 common sites by position: SACRUM \u2714 \u2014 the MOST COMMON overall site (in supine patients); the bony prominence of the sacrum bears maximal pressure in the supine position. Other common sites by frequency: Sacrum (most common) \u2192 Heel \u2192 Greater trochanter \u2192 Lateral malleolus \u2192 Ischial tuberosity (sitting patients) \u2192 Occiput (especially in ICU\/neonates). Ischium: most common in wheelchair-bound\/seated patients. Heel: second most common overall. Occiput: less common (elderly, neonates). SACRUM is the number one site across all patients. Answer: Sacrum.'},\n{id:12,stem:'Resection of which part of intestine does NOT significantly affect fluid and electrolyte balance?',correct:'Distal jejunum',options:['Ileum','Proximal jejunum','Distal jejunum','Colon'],exp:'Intestinal resection and fluid\/electrolyte consequences: ILEUM \u2717 (significantly affects): terminal ileum resection \u2192 loss of B12 absorption (intrinsic factor receptor), bile salt absorption \u2192 bile salt diarrhoea\/fat malabsorption; also some fluid\/electrolyte absorption. PROXIMAL JEJUNUM \u2717 (significantly affects): most absorption of water, electrolytes, nutrients, iron, folate, calcium occurs here; resection \u2192 major malabsorption. COLON \u2717 (significantly affects): major site of water\/Na+ absorption; colectomy \u2192 high-output diarrhoea and electrolyte imbalance. DISTAL JEJUNUM \u2714 \u2014 the distal jejunum has significant absorptive capacity but is less critical than the proximal jejunum for fluid\/electrolyte balance; its resection is best tolerated with the least fluid\/electrolyte consequence compared to the others listed. Answer: Distal jejunum.'},\n{id:13,stem:'Good measure of systemic perfusion by ABG is by measurement of:',correct:'Lactate and \/ or the base deficit',options:['Bicarbonate','pH','Lactate and \/ or the base deficit','PCO\u2082'],exp:'Assessment of SYSTEMIC PERFUSION by arterial blood gas (ABG): LACTATE AND\/OR BASE DEFICIT \u2714 \u2014 the best markers of tissue hypoperfusion\/oxygen debt. LACTATE: elevated (>2 mmol\/L) = anaerobic metabolism = inadequate tissue perfusion; lactate clearance is used to monitor resuscitation response. BASE DEFICIT: negative base deficit (base excess <\u22122) = metabolic acidosis from tissue hypoperfusion; correlates with degree of shock and mortality. Together they reflect the adequacy of oxygen delivery to tissues. pH: global acid-base but less specific for perfusion (can be normal in compensated shock). PCO\u2082: reflects ventilation, not perfusion specifically. Bicarbonate: indirect and slower to reflect acute changes. Answer: Lactate and \/ or the base deficit.'},\n{id:14,stem:'Which of the following are congenital abnormalities of the gall bladder?\\nI. The phrygian cap\\nII. Floating gall bladder\\nIII. Absence of gall bladder\\nIV. Spigelian gall bladder\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Congenital anomalies of the gallbladder: PHRYGIAN CAP \u2714 \u2014 most common congenital anomaly; folding of the fundus back on the body creating a cap-like deformity (visible on ultrasound\/cholecystogram); usually asymptomatic. FLOATING GALLBLADDER \u2714 \u2014 excessive mesentery\/peritoneal attachment allows gallbladder to \"float\" freely; predisposes to torsion (Ladd\\'s anomaly). ABSENCE OF GALLBLADDER (agenesis) \u2714 \u2014 rare congenital absence (~1 in 6000\u20137500); important to recognise to avoid unnecessary surgery. SPIGELIAN GALLBLADDER \u2717 \u2014 \"Spigelian\" refers to Spigelian hernia (hernia through the semilunar line of the anterior abdominal wall); there is no recognised \"Spigelian gallbladder\" as a congenital anomaly. Correct: I, II, III. Answer: I, II and III.'},\n{id:15,stem:'Which of the following are functions of the gall bladder?\\nI. Reservoir for bile\\nII. Production of bile\\nIII. Secretion of mucus\\nIV. Concentration of bile\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Functions of the gallbladder: RESERVOIR FOR BILE \u2714 \u2014 stores up to 30\u201350 mL of concentrated bile between meals; releases upon cholecystokinin (CCK) stimulation when fat enters the duodenum. PRODUCTION OF BILE \u2717 \u2014 bile is produced by HEPATOCYTES in the LIVER; the gallbladder does NOT produce bile; it only stores and concentrates it. SECRETION OF MUCUS \u2714 \u2014 goblet cells in the gallbladder mucosa secrete mucus; contributes to the glycoprotein matrix of gallstones. CONCENTRATION OF BILE \u2714 \u2014 the gallbladder concentrates bile 5\u201310\u00d7 by absorbing water and electrolytes (Na+, Cl\u2212, HCO3\u2212) via active transport. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:16,stem:'Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?',correct:'Abdominal discomfort and ascites are the main presenting features.',options:['It principally affects young males.','Venous drainage of the liver is occluded by IVC thrombus.','Quadrate lobe (Segment 4 and 5) undergoes hypertrophy.','Abdominal discomfort and ascites are the main presenting features.'],exp:'Budd-Chiari Syndrome (BCS): HEPATIC VENOUS OUTFLOW obstruction (hepatic veins or IVC) \u2192 hepatic congestion. Option a \u2717 \u2014 BCS affects predominantly YOUNG WOMEN (not males); associated with prothrombotic states, OCP use, pregnancy, myeloproliferative disorders, PNH. Option b \u2717 \u2014 BCS is obstruction of HEPATIC VEINS (small, large) or the supra-hepatic IVC; NOT solely \"IVC thrombus\" \u2014 most BCS is at the hepatic vein level; and even when IVC is involved, it is the hepatic vein outflow not just IVC. Option c \u2717 \u2014 CAUDATE LOBE (Segment 1) undergoes HYPERTROPHY in BCS (it has separate venous drainage directly into the IVC \u2192 unaffected by hepatic vein obstruction \u2192 compensatory hypertrophy); NOT quadrate lobe (segments 4\/5). Option d \u2714 \u2014 Classic presentation: ABDOMINAL DISCOMFORT (right upper quadrant pain from hepatic congestion) + ASCITES (hepatic venous hypertension \u2192 portal hypertension \u2192 ascites) are the main features. Also: hepatomegaly, jaundice, eventually cirrhosis. Answer: Abdominal discomfort and ascites are the main presenting features.'},\n{id:17,stem:'Which one of the following is correct regarding splenic artery aneurysm?',correct:'It is generally multiple in number.',options:['It is twice as common in men.','It is usually situated in the main arterial trunk.','It is caused due to blunt trauma to the abdomen.','It is generally multiple in number.'],exp:'Splenic artery aneurysm (SAA) \u2014 the most common visceral artery aneurysm: Option a \u2717 \u2014 SAA is 4\u00d7 more common in WOMEN (not men); associated with multiparity, portal hypertension, fibromuscular dysplasia. Option b \u2717 \u2014 SAA is typically located at BIFURCATION points of the splenic artery (mid-distal portion), NOT the main arterial trunk; the distal splenic artery at bifurcations is the classic site. Option c \u2717 \u2014 SAA is NOT primarily caused by blunt trauma; main causes are fibromuscular dysplasia, portal hypertension (splenomegaly \u2192 hyperdynamic flow), pregnancy, atherosclerosis, pancreatitis. Option d \u2714 \u2014 SAA tends to be MULTIPLE in about 20\u201325% of cases. Management: treat if symptomatic, pregnant, or >2 cm diameter. Answer: It is generally multiple in number.'},\n{id:18,stem:'Which of the following statements are correct regarding primary survey\/management of traumatic head injury patient?\\nI. Ensure adequate oxygenation and circulation\\nII. Exclude hypoglycaemia\\nIII. Check for mechanism of injury\\nIV. Check pupil size and response\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','II, III and IV','I, II and IV','I, III and IV'],exp:'Primary survey of traumatic brain injury (TBI) \u2014 ABCDE approach: Statement I \u2714 \u2014 AIRWAY + oxygenation + CIRCULATION are the first priorities; hypoxia and hypotension are the two most devastating secondary insults in TBI; SpO2 >95%, MAP >80 mmHg. Statement II \u2714 \u2014 EXCLUDE HYPOGLYCAEMIA: glucose must be checked; hypoglycaemia mimics neurological dysfunction and is rapidly correctable; part of \"Don\\'t ever forget glucose\" (DEFG). Statement III \u2717 \u2014 Mechanism of injury is part of HISTORY-TAKING and SECONDARY SURVEY, not the primary survey; primary survey focuses on life-threatening physiological derangements, not mechanism. Statement IV \u2714 \u2014 PUPIL SIZE AND RESPONSE is assessed in the DISABILITY (D) component of primary survey (GCS, pupils, lateralising signs); unequal\/dilated fixed pupil indicates herniation = emergency. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:19,stem:'Which of the following statements are correct regarding ABCDE of trauma care?\\nI. A stands for Airway with cervical spine protection\\nII. B stands for Breathing and ventilation\\nIII. C stands for Control of massive external haemorrhage\\nIV. D stands for Disability (Neurological status)\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, III and IV','I, II and IV','II, III and IV'],exp:'ATLS Primary Survey \u2014 ABCDE: A = AIRWAY with cervical spine protection \u2714 (Statement I correct). B = BREATHING and ventilation \u2714 (Statement II correct). C = CIRCULATION with haemorrhage control \u2014 NOT \"Control of massive external haemorrhage\" specifically; C covers all circulation assessment (BP, pulse, haemorrhage control including external and internal). Statement III \u2717 \u2014 while haemorrhage control is part of C, \"Control of massive external haemorrhage\" is sometimes listed separately as \"C-ABCDE\" (catastrophic haemorrhage as the zeroth step) in newer TCCC\/military guidelines; in classic ATLS, C = Circulation. This makes statement III debatable but in ATLS C includes haemorrhage control. D = DISABILITY (neurological status: GCS, pupils, lateralising signs) \u2714 (Statement IV correct). E = Exposure\/Environment. Per official key: I, II, IV. Answer: I, II and IV.'},\n{id:20,stem:'Which of the following statements are correct regarding inguinal hernias in children?\\nI. It is more common in full-term boys\\nII. It should be repaired promptly\\nIII. It is always indirect\\nIV. It may frequently be transilluminant\\nSelect the answer:',correct:'I, II, III and IV',options:['I, II and III','II, III and IV','I, II and IV','I, II, III and IV'],exp:'Inguinal hernia in children: Statement I \u2714 \u2014 more common in MALES (male:female 4\u20138:1); full-term boys commonly affected; also premature infants (higher rate). Statement II \u2714 \u2014 Should be REPAIRED PROMPTLY (electively soon after diagnosis); high risk of INCARCERATION in infants (up to 30%); do not delay. Statement III \u2714 \u2014 Paediatric inguinal hernias are ALWAYS INDIRECT (congenital patent processus vaginalis \u2192 peritoneal sac); direct hernias are extremely rare in children. Statement IV \u2714 \u2014 Indirect hernias in children may TRANSILLUMINATE (light passes through the fluid\/bowel-containing sac); helpful in distinguishing from solid scrotal masses; particularly if the sac contains fluid (communicating hydrocele component). All four correct. Answer: I, II, III and IV.'},\n{id:21,stem:'The most common site of urethral opening in cases of hypospadias is:',correct:'Just proximal to the glans',options:['Just proximal to the glans','On the penile shaft','At the junction of penile shaft and stratum','On the perineum'],exp:'HYPOSPADIAS: congenital anomaly where the urethral meatus opens on the VENTRAL (underside) surface of the penis proximal to its normal position. Most common sites (frequency, distal to proximal): Glanular\/subcoronal (just proximal to glans) \u2714 \u2014 MOST COMMON (~50\u201360% of cases). Distal penile shaft (~20%). Mid-shaft (~10%). Proximal\/penoscrotal\/perineal (severe, ~20% combined). The MAJORITY of hypospadias cases are ANTERIOR (glanular, coronal, subcoronal) \u2014 i.e., JUST PROXIMAL TO THE GLANS. Answer: Just proximal to the glans.'},\n{id:22,stem:'Which of the following about Minimal Access Surgery are correct?\\nI. Decreased intraoperative heat loss\\nII. Improved visualisation\\nIII. Increased chances of herniation\\nIV. Improved mobility\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, III and IV','II, III and IV','I, II and IV'],exp:'Minimal Access Surgery (MAS\/Laparoscopic surgery) advantages: Statement I \u2714 \u2014 DECREASED INTRAOPERATIVE HEAT LOSS: smaller incisions \u2192 less body surface exposure \u2192 reduced heat loss compared to open surgery; warm CO2 insufflation also contributes. Statement II \u2714 \u2014 IMPROVED VISUALISATION: magnified, illuminated view of operative field; camera can access areas difficult to see in open surgery; HD\/3D optics. Statement III \u2717 \u2014 INCREASED CHANCES OF HERNIATION is a DISADVANTAGE, specifically PORT-SITE HERNIATION; trocar sites (especially \u226510 mm) can develop incisional hernias; this is a complication, not an advantage. Statement IV \u2714 \u2014 IMPROVED MOBILITY\/PATIENT RECOVERY: reduced post-operative pain, earlier return to activity, shorter hospital stay, improved cosmesis. Correct advantages: I, II, IV. Answer: I, II and IV.'},\n{id:23,stem:'The maximum safe dose for Lignocaine (without adrenaline) as a local anaesthetic drug is:',correct:'3 mg\/kg',options:['3 mg\/kg','5 mg\/kg','7 mg\/kg','9 mg\/kg'],exp:'Maximum safe doses of local anaesthetics: LIGNOCAINE (LIDOCAINE) WITHOUT adrenaline: 3 mg\/kg \u2714 (maximum 200 mg). WITH adrenaline: 7 mg\/kg (maximum 500 mg) \u2014 adrenaline causes local vasoconstriction \u2192 slower absorption \u2192 higher dose possible. BUPIVACAINE: 2 mg\/kg (without adrenaline); 2.5 mg\/kg (with adrenaline). PRILOCAINE: 6 mg\/kg (without); 9 mg\/kg (with). Adrenaline approximately doubles the maximum safe dose by reducing systemic absorption rate. Lignocaine toxicity: initially CNS (perioral tingling, tinnitus, seizures), then cardiovascular (arrhythmias, cardiac arrest). Answer: 3 mg\/kg.'},\n{id:24,stem:'Which of the following are the symptoms commonly experienced by patients with lymphoedema?\\nI. Swelling\\nII. Burning sensation\\nIII. Intolerance to cold\\nIV. Cramps\\nSelect the correct answer:',correct:'I, II and IV',options:['I, II and IV','I, II and III','II, III and IV','I, III and IV'],exp:'Lymphoedema symptoms: SWELLING \u2714 \u2014 the cardinal feature; progressive, non-pitting (later stages), typically affects a limb; starts distally and progresses proximally. BURNING SENSATION \u2714 \u2014 patients frequently report burning, aching, heaviness, and discomfort; the stretching of skin and inflammation causes burning\/stinging sensations. CRAMPS \u2714 \u2014 muscle cramps are commonly reported in lymphoedema; possibly due to tissue congestion, reduced blood flow, and nerve compression. INTOLERANCE TO COLD \u2717 \u2014 cold intolerance is NOT a typical lymphoedema symptom; it is associated with Raynaud\\'s phenomenon, hypothyroidism, peripheral vascular disease (arterial). Lymphoedema: heaviness, tightness, aching, swelling, burning, cramps. Answer: I, II and IV.'},\n{id:25,stem:'Which of the following are the malignancies associated with lymphoedema?\\nI. Kaposi Sarcoma\\nII. Squamous cell carcinoma\\nIII. Malignant melanoma\\nIV. Leukaemia\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Malignancies associated with lymphoedema: KAPOSI SARCOMA \u2714 \u2014 arises in lymphoedematous tissues; associated with immunodeficiency (HIV); the lymphatic endothelial origin means it preferentially occurs in lymphoedema areas. SQUAMOUS CELL CARCINOMA \u2714 \u2014 Stewart-Treves syndrome classically; SCC can arise in chronically lymphoedematous skin; also lymphangiosarcoma (originally described in post-mastectomy arm lymphoedema). MALIGNANT MELANOMA \u2714 \u2014 can develop in chronically lymphoedematous skin; lymphoedema is a risk factor for melanoma development in affected limbs. LEUKAEMIA \u2717 \u2014 leukaemia is not specifically associated with lymphoedema as a complication; while leukaemic infiltration can cause lymphadenopathy\/secondary lymphoedema, leukaemia itself is not considered a malignancy arising in or specifically associated with lymphoedema. Correct: I, II, III. Answer: I, II and III.'},\n{id:26,stem:'Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound?\\nI. Limberg procedure\\nII. Y-V plasty\\nIII. Z-plasty\\nIV. Karydakis procedure\\nSelect the correct answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Off-midline closure techniques for pilonidal sinus excision \u2014 to avoid midline wounds (which have higher recurrence due to deep natal cleft): LIMBERG FLAP (rhomboid flap) \u2714 \u2014 rotational fasciocutaneous flap that shifts the natal cleft laterally; excellent results; avoids midline. Y-V PLASTY \u2714 \u2014 Y-V advancement flap; flattens the natal cleft; off-midline closure; reduces recurrence. KARYDAKIS PROCEDURE \u2714 \u2014 the most widely used technique; excises the sinus + creates an asymmetric flap that moves the suture line off the midline; reduces recurrence dramatically compared to midline closure. Z-PLASTY \u2717 \u2014 while Z-plasty is a plastic surgery technique, it is not specifically used for pilonidal sinus closure to achieve off-midline wound. The three standard off-midline techniques are Limberg, Karydakis, and Bascom\/cleft-lift; Y-V is also used. Answer: I, II and IV.'},\n{id:27,stem:'A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3\u00d74 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is:',correct:'cT\u2082N\u2081M\u2093',options:['cT\u2081N\u2081M\u2093','cT\u2082N\u2081M\u2093','cT\u2083N\u2081M\u2093','cT\u2083N\u2082M\u2093'],exp:'AJCC 8th edition breast cancer TNM staging: T stage (tumour size): T1: \u226420 mm. T2: >20 mm and \u226450 mm. T3: >50 mm. T4: any size with chest wall\/skin involvement. This tumour: 3\u00d74 cm = 40 mm \u2192 T2 \u2714 (>20 mm, \u226450 mm). N stage (regional nodes): N0: no nodes. N1: mobile ipsilateral axillary nodes (level I-II) \u2714 \u2014 firm MOBILE level I nodes = N1 (not fixed, not matted = not N2). N2: fixed\/matted axillary nodes or internal mammary. M: M\u2093 = cannot be assessed (no systemic workup done yet). Clinical stage: cT\u2082N\u2081M\u2093. Answer: cT\u2082N\u2081M\u2093.'},\n{id:28,stem:'Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?',correct:'High resolution manometry',options:['Upper GI endoscopy','Barium swallow','High resolution manometry','Contrast enhanced CT scan (CECT) oesophagus'],exp:'Diagnosis of oesophageal motility disorders: HIGH RESOLUTION MANOMETRY (HRM) \u2714 \u2014 the GOLD STANDARD for oesophageal motility assessment. HRM: multiple pressure sensors (22\u201336) measure intraluminal pressure simultaneously along the entire length of the oesophagus; generates a topographic \"Clouse plot\" (pressure-time-space map). Diagnoses: achalasia (absent relaxation of LOS, failed peristalsis), diffuse oesophageal spasm, nutcracker oesophagus, jackhammer oesophagus, hypertensive LOS, scleroderma oesophagus. Chicago Classification (v4.0) uses HRM findings. Barium swallow: useful screening but less specific. Upper GI endoscopy: assesses mucosal pathology, not motility. CECT: structural, not functional. Answer: High resolution manometry.'},\n{id:29,stem:'Which of the following are considered aetiological factors for Adenocarcinoma oesophagus?\\nI. Barrett\\'s oesophagus\\nII. Gastro-oesophageal reflux\\nIII. Obesity\\nIV. Alcohol intake\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Adenocarcinoma of the oesophagus \u2014 risk factors: BARRETT\\'S OESOPHAGUS \u2714 \u2014 the single most important risk factor; intestinal metaplasia of lower oesophageal epithelium due to chronic reflux \u2192 dysplasia \u2192 adenocarcinoma. GASTRO-OESOPHAGEAL REFLUX (GORD) \u2714 \u2014 chronic acid\/bile reflux \u2192 Barrett\\'s oesophagus \u2192 adenocarcinoma; 6\u20138\u00d7 increased risk. OBESITY \u2714 \u2014 central adiposity increases intra-abdominal pressure \u2192 promotes reflux; also independent metabolic\/inflammatory risk factor; strongly associated with lower oesophageal\/GOJ adenocarcinoma. ALCOHOL \u2717 \u2014 alcohol is a major risk factor for SQUAMOUS CELL carcinoma of the oesophagus (along with smoking); it is NOT a significant risk factor for ADENOCARCINOMA. Contrast: SCC risk factors = smoking + alcohol; ADC risk factors = GORD + Barrett\\'s + obesity. Answer: I, II and III.'},\n{id:30,stem:'Consider the following statements regarding Plummer-Vinson syndrome:\\nI. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia\\nII. It is a rare disease, mainly affecting middle-aged women\\nIII. There is predisposition to postcricoid, cervical oesophageal cancer\\nIV. Treatment is usually surgical\\nWhich of the statements given above are correct?',correct:'I, II and III',options:['II, III and IV','I, II and IV','I, III and IV','I, II and III'],exp:'Plummer-Vinson (Paterson-Brown-Kelly) syndrome: Statement I \u2714 \u2014 TRIAD: post-cricoid\/upper oesophageal WEB + IRON DEFICIENCY ANAEMIA + DYSPHAGIA (initially to solids). Statement II \u2714 \u2014 affects predominantly MIDDLE-AGED WOMEN (females >> males); rare condition; associated with iron deficiency. Statement III \u2714 \u2014 PREDISPOSES TO POSTCRICOID CARCINOMA (hypopharyngeal\/upper oesophageal squamous cell carcinoma); considered a pre-malignant condition; regular surveillance recommended. Statement IV \u2717 \u2014 Treatment is NOT primarily surgical; management is IRON REPLACEMENT (treats the underlying deficiency and often resolves the web) + oesophageal DILATATION (endoscopic) for the web; surgery is rarely needed. Correct: I, II, III. Answer: I, II and III.'},\n{id:31,stem:'Which of the following are correct regarding late dumping?\\nI. It usually occurs during the second hour after meal\\nII. It lasts for 30-40 minutes\\nIII. Major symptoms are tremor, faintness, prostration\\nIV. It is relieved by lying down\\nSelect the answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'LATE DUMPING syndrome (post-gastrectomy): TIMING \u2714 (Statement I): occurs 1\u20133 hours after meals (typically around 2nd hour); caused by reactive HYPOGLYCAEMIA. PATHOPHYSIOLOGY: rapid carbohydrate delivery to small bowel \u2192 excessive GLP-1\/insulin release \u2192 rebound hypoglycaemia. SYMPTOMS \u2714 (Statement III): HYPOGLYCAEMIC symptoms \u2014 sweating, tremor, faintness, palpitations, weakness, PROSTRATION (collapse); adrenergic response to hypoglycaemia. DURATION \u2717 (Statement II): lasts 20\u201330 minutes (not 30\u201340 minutes specifically; some sources say 20\u201345 min; 30-40 is close but the options make this the wrong one). RELIEVED BY LYING DOWN \u2714 (Statement IV): lying down\/food intake (carbohydrate snack) relieves symptoms. Also distinguish from EARLY dumping (within 30 min; osmotic; vasomotor + GI). Answer: I, III and IV.'},\n{id:32,stem:'Which one of the following statements is NOT correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?',correct:'Medical therapy has no role in the treatment of this condition.',options:['Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.','Endoscopic biopsy is essential to exclude malignancy.','Medical therapy has no role in the treatment of this condition.','Operation is frequently required along with a drainage procedure.'],exp:'Gastric outlet obstruction (GOO) from peptic ulcer disease \u2014 evaluating the options: HYPOCHLORAEMIC ALKALOSIS \u2714 \u2014 correct statement; GOO \u2192 prolonged vomiting of HCl \u2192 hypochloraemic, hypokalaemic metabolic alkalosis (\"contraction alkalosis\"). ENDOSCOPIC BIOPSY \u2714 \u2014 correct; essential to exclude carcinoma causing GOO; multiple biopsies from the obstructing area mandatory. OPERATION frequently required with drainage procedure \u2714 \u2014 correct; after medical optimisation, surgical options include truncal vagotomy + gastrojejunostomy or pyloplasty; drainage procedure prevents re-obstruction. MEDICAL THERAPY HAS NO ROLE \u2717 \u2014 FALSE = the incorrect statement. Medical therapy DOES have a role: nasogastric decompression, IV fluids\/electrolyte correction, PPI therapy; endoscopic balloon dilatation for fibrotic strictures; H. pylori eradication. Medical treatment is essential for pre-operative optimisation. Answer: Medical therapy has no role in the treatment of this condition.'},\n{id:33,stem:'The commonly used muscle relaxant with quickest onset of action and spontaneous recovery is:',correct:'Suxamethonium',options:['Suxamethonium','Vecuronium','Atracurium','Rocuronium'],exp:'Neuromuscular blocking agents \u2014 onset and recovery: SUXAMETHONIUM (succinylcholine) \u2714 \u2014 DEPOLARISING muscle relaxant; QUICKEST ONSET (45\u201360 seconds \u2014 \"rapid sequence induction\"); SHORTEST DURATION with SPONTANEOUS RECOVERY (~10\u201315 min); metabolised by plasma cholinesterase; used for RSI and when quick recovery needed. NON-DEPOLARISING agents: Rocuronium: fast onset (60\u201390 sec with intubating dose); longer duration (30\u201360 min); reversible with sugammadex. Vecuronium: intermediate onset (3\u20135 min); intermediate duration. Atracurium: intermediate onset (2\u20133 min); ~25\u201335 min; Hofmann elimination. SUXAMETHONIUM has the fastest onset AND spontaneous recovery \u2014 ideal for RSI and difficult airway. Answer: Suxamethonium.'},\n{id:34,stem:'The first imaging modality of choice for a 35-year-old lady, presenting to surgical emergency with complaints of colicky pain in right lower quadrant of abdomen and vomiting since last 2 days is:',correct:'Ultrasound abdomen',options:['Contrast CT abdomen','Non-contrast CT abdomen','Ultrasound abdomen','Plain X-ray abdomen erect view'],exp:'35-year-old lady with right lower quadrant colicky pain + vomiting: FIRST-LINE IMAGING: ULTRASOUND ABDOMEN \u2714 \u2014 reasons: (1) NO RADIATION \u2014 important in reproductive-age female (possible pregnancy); (2) First-line for appendicitis in women (rules out gynaecological causes simultaneously \u2014 ovarian cysts, ectopic pregnancy, torsion); (3) Widely available, rapid, cost-effective. If USG inconclusive \u2192 CT abdomen. CT (contrast\/non-contrast): reserved for equivocal cases or when USG is non-diagnostic; significant radiation dose for young female. Plain X-ray: limited diagnostic value for soft tissue pathology (appendicitis); used to detect perforation (free air) or obstruction. Answer: Ultrasound abdomen.'},\n{id:35,stem:'Mallampati test is used for the assessment of:',correct:'Airway',options:['Tongue size','Ability to protrude jaw','Breath hold time','Airway'],exp:'MALLAMPATI TEST (modified by Samsoon and Young): pre-operative assessment of the AIRWAY \u2714 \u2014 specifically predicts difficulty in LARYNGOSCOPY and INTUBATION. Patient opens mouth maximally and protrudes tongue: visualisation of oropharynx graded I\u2013IV. Class I: faucial pillars, soft palate, uvula visible (easy intubation). Class IV: only hard palate visible (difficult intubation). While it involves TONGUE SIZE indirectly (large tongue obscures oropharyngeal view), the TEST itself assesses the overall AIRWAY geometry and predicts intubation difficulty \u2014 not tongue size per se, not jaw protrusion (that is the thyromental distance\/jaw mobility tests). Answer: Airway.'},\n{id:36,stem:'Consider the following:\\nI. Diabetes\\nII. Hypertension\\nIII. Renal failure\\nIV. Jaundice\\nWhich of the above are the risk factors for post-operative wound dehiscence?',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Risk factors for wound DEHISCENCE (failure of wound to remain closed): DIABETES \u2714 \u2014 impaired wound healing (hyperglycaemia \u2192 impaired neutrophil function, poor collagen synthesis, microangiopathy \u2192 reduced tissue oxygenation). RENAL FAILURE \u2714 \u2014 uraemia \u2192 impaired platelet function, malnutrition, anaemia \u2192 poor healing; also immunosuppression. JAUNDICE \u2714 \u2014 bile salts impair fibroblast function; coagulopathy; malnutrition; endotoxaemia \u2192 impaired collagen synthesis and wound healing. HYPERTENSION \u2717 \u2014 well-controlled hypertension is NOT a significant independent risk factor for wound dehiscence per se; while severe\/uncontrolled hypertension may affect microcirculation, it is not classically listed as a wound dehiscence risk factor. Other dehiscence risks: malnutrition, obesity, steroids, infection, poor surgical technique, emergency surgery, anaemia. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:37,stem:'If faced with a surgical emergency in a child of 15 years for whom no consent is available for life-saving surgery and no time for seeking authority from someone, the next step should be:',correct:'Go ahead with surgery without consent',options:['Conservative management till lawyer is available','Search for relatives or neighbours','Consent arrangement through Hospital Social Worker','Go ahead with surgery without consent'],exp:'SURGICAL ETHICS \u2014 emergency consent for minors: In a LIFE-THREATENING EMERGENCY where: (1) a minor (under 18) cannot give consent; (2) parents\/guardians are unavailable; (3) there is NO TIME to seek authority. The legal and ethical principle is: DOCTRINE OF NECESSITY \u2014 the surgeon is legally and ethically justified in proceeding with LIFE-SAVING treatment WITHOUT consent. This is recognised under common law and medical ethics; withholding treatment would be negligent. The primary duty is to preserve life when the alternative is death or serious harm. Option d \u2714: \"Go ahead with surgery without consent\" \u2014 the correct ethical\/legal answer. Document clearly in medical records. Answer: Go ahead with surgery without consent.'},\n{id:38,stem:'Which of the following information needs to be disclosed in order to establish valid consent for surgical treatment?\\nI. Condition and reasons why it warrants surgery\\nII. Type of surgery proposed\\nIII. Unexpected hazards of proposed surgery\\nIV. The surgical experience and expertise of the operating surgeon\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Valid\/informed consent \u2014 essential information to disclose: Statement I \u2714 \u2014 The DIAGNOSIS\/CONDITION and WHY surgery is recommended (indication). Statement II \u2714 \u2014 TYPE\/NATURE of the proposed surgery (procedure details). Statement III \u2714 \u2014 RISKS AND HAZARDS (common and serious complications; material risks; both expected and unexpected hazards). Also: benefits, alternatives (including non-surgical), consequences of not having surgery. Statement IV \u2717 \u2014 The specific surgical EXPERIENCE and EXPERTISE of the operating surgeon is NOT routinely required to be disclosed as part of standard informed consent; while patients may ask and should be answered honestly, it is not a mandatory element. Landmark case (Montgomery v Lanarkshire): disclose \"material risks\" a reasonable patient would want to know. Answer: I, II and III.'},\n{id:39,stem:'A surgical department of a premier medical college conducted a study on rates of post-operative wound infection. The results of the study were negative for the proposed hypothesis. What should the department do with the results?',correct:'Report the negative results',options:['Label them as worthless','Redo the study with a new hypothesis','Report the negative results','Redesign the study and increase the sample size'],exp:'RESEARCH ETHICS \u2014 handling negative results: REPORT THE NEGATIVE RESULTS \u2714 \u2014 the correct and ethically mandated action. Reasons: PUBLICATION BIAS: negative results are as scientifically valid as positive results; failure to publish negative results leads to publication bias (overestimation of treatment effects in literature). SCIENTIFIC INTEGRITY: suppressing negative findings violates research ethics; all valid research should be communicated. CLINICAL RELEVANCE: knowing that a proposed intervention does NOT reduce wound infection is valuable to clinical practice. Labelling negative results as worthless = scientifically and ethically wrong. Automatically redoing or redesigning without cause = HARKing (Hypothesising After Results are Known) or fishing for significant results = unethical. Answer: Report the negative results.'},\n{id:40,stem:'Which of the following statements are correct regarding sutures in surgery?\\nI. Barbed sutures have the advantage of eliminating the need for knots\\nII. Vertical mattress sutures help in eversion of wound edges\\nIII. Aberdeen knot is used for continuous suturing\\nIV. Silk is preferred for subcuticular suturing\\nSelect the answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Suture facts: Statement I \u2714 \u2014 BARBED SUTURES (knotless sutures): have helical barbs cut into the suture material; barbs grip tissue from multiple directions \u2192 no knot required; used in laparoscopic\/robotic surgery for running suture lines. Statement II \u2714 \u2014 VERTICAL MATTRESS SUTURES: specifically designed to produce WOUND EDGE EVERSION (important for cosmesis and tension relief); full thickness bite + superficial bite causes eversion; also reduces dead space. Statement III \u2714 \u2014 ABERDEEN KNOT: used to TERMINATE a continuous (running) suture; a locking knot that secures the end of a continuous suture without a separate knot; widely used in surgery. Statement IV \u2717 \u2014 SILK is NOT preferred for subcuticular (intradermal) suturing; silk is multifilament, non-absorbable, causes tissue reaction \u2192 not ideal for intradermal sutures. PREFERRED subcuticular sutures: monofilament absorbable (Monocryl\/Vicryl Rapide) or non-absorbable (Prolene\/nylon). Correct: I, II, III. 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Submitting in 10 Submit Now Combined Medical Services Examination 2025Paper II \u00b7 Part A Surgery (Q1 \u2013 Q40) Questions 1 \u2013 40 +1 correct \u00b7 \u2212\u2153 wrong \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-36842","post","type-post","status-publish","format-standard","hentry","category-cms","category-surgery"],"yoast_head":"\n<title>CMS 2025 P2 Part-A - 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\/16\/cms-2025-p2-part-a\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2025 P2 Part-A - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2025 Paper II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0.00 \/ 40 Time's Up! 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var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms25p2a .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms25p2a .hdr h1{font-size:1.15rem}#cms25p2a .qt{font-size:.88rem}#cms25p2a .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms25p2a\">\n<div class=\"sen\" id=\"cms25p2a-sen\"><\/div>\n<div class=\"sb\" id=\"cms25p2a-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms25p2a-ti\">\u23f1 <strong id=\"cms25p2a-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms25p2a-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms25p2a-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms25p2a-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms25p2a-sn\">0.00<\/strong> \/ <strong id=\"cms25p2a-sm\">40<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms25p2a-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms25p2a-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms25p2a-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms25p2a-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2025<br>Paper II \u00b7 Part A<\/h1>\n <p>Surgery (Q1 \u2013 Q40)<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 1 \u2013 40<\/span>\n <span class=\"bdg\">+1 correct \u00b7 \u2212\u2153 wrong<\/span>\n <button class=\"tbtn\" id=\"cms25p2a-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms25p2a-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms25p2a-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms25p2a-sc-box\">\n <div class=\"ring\" id=\"cms25p2a-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms25p2a-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms25p2a-nl\"><\/div>\n <div class=\"vd\" id=\"cms25p2a-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms25p2a-bc\"><\/span>\n <span class=\"band bw\" id=\"cms25p2a-bw\"><\/span>\n <span class=\"band bs\" id=\"cms25p2a-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms25p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms25p2a',TOTAL=40,MAX=40,TSECS=2400,GSECS=10;\nvar CU=100,WU=33;\nvar QS=[\n{id:1,stem:'Vibration white finger refers to:',correct:'Raynaud\\'s syndrome',options:['Buerger\\'s disease','Raynaud\\'s syndrome','Acrocyanosis','Takayasu disease'],exp:'VIBRATION WHITE FINGER (VWF) \/ Hand-Arm Vibration Syndrome (HAVS): an occupational disease caused by prolonged use of vibrating tools (pneumatic drills, chain saws, grinders). It is a form of SECONDARY RAYNAUD\\'S SYNDROME \u2714 \u2014 vasospastic condition affecting fingers; episodes of blanching (white), cyanosis (blue), and erythema (red) triggered by cold or vibration; vascular and neurological components. The condition is called \"white finger\" because the fingers turn white (ischaemia) during vasospastic episodes. Buerger\\'s disease: thromboangiitis obliterans; smoking-related inflammatory occlusion of small\/medium vessels. Acrocyanosis: persistent blue-purple discolouration of extremities; not episodic. Takayasu: large vessel arteritis. Answer: Raynaud\\'s syndrome.'},\n{id:2,stem:'Which of the following are criteria for cancer screening?\\nI. Screening test should be sensitive and specific\\nII. Screening test should be acceptable to the screened population\\nIII. The disease should be an uncommon one for screening to be effective\\nIV. Disease should be recognisable at an early stage\\nSelect the correct answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Wilson and Jungner (WHO) criteria for screening: Statement I \u2714 \u2014 Test must be SENSITIVE (detects true positives) and SPECIFIC (avoids false positives). Statement II \u2714 \u2014 Test must be ACCEPTABLE to the target population (non-invasive, affordable, minimal side effects). Statement III \u2717 \u2014 The disease should be COMMON (high prevalence), NOT uncommon; screening is cost-effective only when the disease burden is significant in the population. Statement IV \u2714 \u2014 Disease must be recognisable at an EARLY\/PRECLINICAL stage where intervention improves outcome. Other criteria: natural history understood; acceptable treatment exists; facilities for diagnosis and treatment available; cost-benefit favourable. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:3,stem:'A 45-year-old lady presents with complaints of fatigue, muscle weakness along with bilateral multiple renal calculi which were picked up on a routine ultrasound. Serum calcium levels of 11.4 mg%. What is the next best investigation required to arrive at a diagnosis?',correct:'Sestamibi scan',options:['MRI neck','Sestamibi scan','CECT head and neck','NCCT head and neck'],exp:'Clinical diagnosis: PRIMARY HYPERPARATHYROIDISM \u2014 hypercalcaemia (11.4 mg%) + renal calculi + muscle weakness + fatigue. Cause: parathyroid adenoma in ~85% of cases. NEXT BEST INVESTIGATION after confirming elevated PTH: SESTAMIBI SCAN (Tc-99m sestamibi parathyroid scintigraphy) \u2714 \u2014 the gold standard LOCALISATION study for parathyroid adenoma; sestamibi is preferentially retained in hyperfunctioning parathyroid tissue; sensitivity ~80\u201390%; often combined with SPECT-CT. CECT\/MRI neck: useful but less sensitive than sestamibi for localising parathyroid adenoma. NCCT: no contrast = poor soft tissue differentiation for parathyroid. Sestamibi + neck ultrasound is the preferred combination for pre-operative localisation. Answer: Sestamibi scan.'},\n{id:4,stem:'Which of the following are the aetiological factors associated with a communicating hydrocephalus?\\nI. Post haemorrhagic\\nII. Lesions within the ventricle\\nIII. CSF infection\\nIV. Raised CSF protein\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Communicating vs non-communicating hydrocephalus: COMMUNICATING hydrocephalus: CSF flows freely through ventricles and into subarachnoid space but is impaired in REABSORPTION at arachnoid granulations. Causes: POST-HAEMORRHAGIC \u2714 \u2014 blood in subarachnoid space blocks arachnoid villi (post-SAH, intraventricular haemorrhage). CSF INFECTION \u2714 \u2014 meningitis causes arachnoid adhesions \u2192 impaired reabsorption (post-meningitic hydrocephalus). RAISED CSF PROTEIN \u2714 \u2014 high protein viscosity impairs arachnoid granulation reabsorption (e.g., Guillain-Barr\u00e9, spinal tumour). LESIONS WITHIN THE VENTRICLE \u2717 \u2014 intraventricular lesions (colloid cyst, ependymoma) cause OBSTRUCTION \u2192 NON-COMMUNICATING (obstructive) hydrocephalus by blocking CSF flow within the ventricular system. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:5,stem:'Which of the following statements are correct regarding a brain abscess?\\nI. Abscesses arise when the brain is exposed directly as a result of fracture or infection of air sinus\\nII. Presenting features include low grade fever, confusion, seizures and focal deficits\\nIII. MRI with contrast is the initial imaging modality of choice\\nIV. The aetiological agents include bacteria, fungi, protozoa and viruses\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Brain abscess: Statement I \u2714 \u2014 DIRECT SPREAD: compound skull fractures (post-traumatic) and contiguous spread from frontal\/ethmoid sinusitis, mastoiditis, otitis media \u2192 brain abscess; direct brain exposure is a recognised mechanism. Statement II \u2714 \u2014 Classical TRIAD: headache + fever + focal neurological deficits; also seizures (25%), confusion, raised ICP. LOW-GRADE fever is often present (not always high). Statement III \u2717 \u2014 INITIAL imaging is CT SCAN with contrast (ring-enhancing lesion); CT is preferred first-line due to availability and speed; MRI is more sensitive and better for defining extent but is NOT the initial\/first-line modality in emergency settings. Statement IV \u2714 \u2014 Causes: bacteria (Streptococcus, Staph, anaerobes \u2014 most common); fungi (Aspergillus, Candida \u2014 immunocompromised); protozoa (Toxoplasma in HIV); viruses (rare). Correct: I, II, IV. Answer: I, II and IV.'},\n{id:6,stem:'What is the most common type of tumour of Vermiform Appendix?',correct:'Carcinoid tumour',options:['Epithelial tumour','Carcinoid tumour','Germ cell tumour','Papillary cell tumour'],exp:'Tumours of the vermiform appendix: CARCINOID TUMOUR (well-differentiated neuroendocrine tumour) \u2714 \u2014 the MOST COMMON tumour of the appendix; accounts for ~85% of all appendiceal tumours; typically small (<2 cm), located at the tip; usually benign behaviour; incidentally found in appendicectomy specimens (~0.3\u20130.5% of appendicectomies). Most are non-functioning (no carcinoid syndrome unless >2 cm or with liver mets). Mucinous cystadenoma\/adenocarcinoma: second most common. Epithelial (adenocarcinoma): uncommon. Germ cell tumours: in gonads primarily. Papillary cell: not a recognised appendiceal tumour type. Answer: Carcinoid tumour.'},\n{id:7,stem:'The earliest specific cystoscopic appearance of Bilharzial cystitis is:',correct:'Sandy patches',options:['Sandy patches','Ulcers','Pseudo tubercles','Nodules'],exp:'Bilharzial (Schistosoma haematobium) cystitis \u2014 cystoscopic stages: EARLIEST SPECIFIC FINDING: SANDY PATCHES \u2714 \u2014 yellowish\/white granular deposits on the bladder mucosa (calcified dead Schistosoma eggs beneath the epithelium); pathognomonic for Bilharzial cystitis; appear as \"sand-like\" granules. Sequence of cystoscopic findings: Sandy patches \u2192 hyperaemia\/inflammation \u2192 ulcers \u2192 nodules \u2192 papillomata \u2192 leucoplakia \u2192 squamous cell carcinoma. Pseudo-tubercles: whitish raised nodules (viable ova surrounded by granulomas) \u2014 appear slightly later. Ulcers\/nodules: later stages. Sandy patches = EARLIEST SPECIFIC appearance. Answer: Sandy patches.'},\n{id:8,stem:'Which one of the following best describes craniosynostosis?',correct:'It is the premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.',options:['It is delayed fusion of one or more cranial sutures preventing growth perpendicular to the suture.','It is the premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.','It is the premature fusion of one or more cranial sutures, facilitating growth perpendicular to the suture.','It is delayed fusion of one or more cranial sutures facilitating growth perpendicular to the suture.'],exp:'CRANIOSYNOSTOSIS: PREMATURE FUSION of one or more cranial sutures \u2714 \u2014 the correct definition. The fusion prevents growth PERPENDICULAR to the fused suture \u2714 (Virchow\\'s law: the skull is unable to grow perpendicular to a prematurely fused suture; compensatory growth occurs PARALLEL to the fused suture). Effect: abnormal skull shape depending on which suture(s) fuse early. Sagittal synostosis \u2192 scaphocephaly (long narrow skull). Coronal synostosis \u2192 brachycephaly\/plagiocephaly. Metopic synostosis \u2192 trigonocephaly. Treatment: surgical cranial vault remodelling. Delayed fusion causes a separate problem (enlarged fontanelles, hydrocephalus). Answer: Premature fusion of one or more cranial sutures, preventing growth perpendicular to the suture.'},\n{id:9,stem:'A 60-year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?',correct:'Breast',options:['Small intestine','Large intestine','Adrenal','Breast'],exp:'Lytic bone metastases in vertebrae and ribs in a 60-year-old female: LYTIC bone metastases common causes (mnemonic: BLT with Ketchup and Pickle): Breast \u2714, Lung, Thyroid, Kidney, Prostate (but prostate \u2192 usually SCLEROTIC). In a 60-year-old FEMALE: BREAST cancer is by far the most common primary causing bone metastases; accounts for the majority of bone mets in women. Breast \u2192 typically lytic metastases (sometimes mixed). Adrenal: adrenocortical carcinoma can rarely metastasise but is far less common. Small\/large intestine: colorectal cancer causes liver\/lung\/peritoneal mets predominantly; bone mets are uncommon. In an elderly woman with lytic vertebral and rib lesions \u2192 screen BREAST (mammography, clinical breast examination). Answer: Breast.'},\n{id:10,stem:'Which of the following statements are correct regarding Cauda equina syndrome?\\nI. Its presenting symptoms are perineal numbness, painless urinary retention and faecal incontinence\\nII. Urgent investigation with MRI is required\\nIII. It is present most commonly in the 45-60 year age group\\nIV. Confirmed cases require early surgical decompression\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Cauda equina syndrome (CES): Statement I \u2714 \u2014 Classic symptoms: SADDLE anaesthesia (perineal\/perianal numbness), urinary retention (painless \u2014 loss of detrusor control), faecal incontinence, bilateral leg weakness\/radiculopathy. Statement II \u2714 \u2014 URGENT MRI is mandatory for diagnosis; MRI lumbar spine with gadolinium identifies the compressive lesion (disc herniation, tumour, haematoma). Statement III \u2717 \u2014 CES has no specific age predilection of 45\u201360 years; the most common cause (large central L4\u2013L5 or L5\u2013S1 disc herniation) occurs across a wide age range (30\u201360 years); it is NOT specifically most common in 45\u201360 year group. Statement IV \u2714 \u2014 EARLY SURGICAL DECOMPRESSION (within 24\u201348 hours of onset) is critical; outcomes are significantly better with early surgery; delay leads to permanent bladder\/bowel dysfunction. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:11,stem:'The commonest site of pressure sore is:',correct:'Sacrum',options:['Heel','Sacrum','Ischium','Occiput'],exp:'PRESSURE SORES (decubitus ulcers) \u2014 common sites by position: SACRUM \u2714 \u2014 the MOST COMMON overall site (in supine patients); the bony prominence of the sacrum bears maximal pressure in the supine position. Other common sites by frequency: Sacrum (most common) \u2192 Heel \u2192 Greater trochanter \u2192 Lateral malleolus \u2192 Ischial tuberosity (sitting patients) \u2192 Occiput (especially in ICU\/neonates). Ischium: most common in wheelchair-bound\/seated patients. Heel: second most common overall. Occiput: less common (elderly, neonates). SACRUM is the number one site across all patients. Answer: Sacrum.'},\n{id:12,stem:'Resection of which part of intestine does NOT significantly affect fluid and electrolyte balance?',correct:'Distal jejunum',options:['Ileum','Proximal jejunum','Distal jejunum','Colon'],exp:'Intestinal resection and fluid\/electrolyte consequences: ILEUM \u2717 (significantly affects): terminal ileum resection \u2192 loss of B12 absorption (intrinsic factor receptor), bile salt absorption \u2192 bile salt diarrhoea\/fat malabsorption; also some fluid\/electrolyte absorption. PROXIMAL JEJUNUM \u2717 (significantly affects): most absorption of water, electrolytes, nutrients, iron, folate, calcium occurs here; resection \u2192 major malabsorption. COLON \u2717 (significantly affects): major site of water\/Na+ absorption; colectomy \u2192 high-output diarrhoea and electrolyte imbalance. DISTAL JEJUNUM \u2714 \u2014 the distal jejunum has significant absorptive capacity but is less critical than the proximal jejunum for fluid\/electrolyte balance; its resection is best tolerated with the least fluid\/electrolyte consequence compared to the others listed. Answer: Distal jejunum.'},\n{id:13,stem:'Good measure of systemic perfusion by ABG is by measurement of:',correct:'Lactate and \/ or the base deficit',options:['Bicarbonate','pH','Lactate and \/ or the base deficit','PCO\u2082'],exp:'Assessment of SYSTEMIC PERFUSION by arterial blood gas (ABG): LACTATE AND\/OR BASE DEFICIT \u2714 \u2014 the best markers of tissue hypoperfusion\/oxygen debt. LACTATE: elevated (>2 mmol\/L) = anaerobic metabolism = inadequate tissue perfusion; lactate clearance is used to monitor resuscitation response. BASE DEFICIT: negative base deficit (base excess <\u22122) = metabolic acidosis from tissue hypoperfusion; correlates with degree of shock and mortality. Together they reflect the adequacy of oxygen delivery to tissues. pH: global acid-base but less specific for perfusion (can be normal in compensated shock). PCO\u2082: reflects ventilation, not perfusion specifically. Bicarbonate: indirect and slower to reflect acute changes. Answer: Lactate and \/ or the base deficit.'},\n{id:14,stem:'Which of the following are congenital abnormalities of the gall bladder?\\nI. The phrygian cap\\nII. Floating gall bladder\\nIII. Absence of gall bladder\\nIV. Spigelian gall bladder\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Congenital anomalies of the gallbladder: PHRYGIAN CAP \u2714 \u2014 most common congenital anomaly; folding of the fundus back on the body creating a cap-like deformity (visible on ultrasound\/cholecystogram); usually asymptomatic. FLOATING GALLBLADDER \u2714 \u2014 excessive mesentery\/peritoneal attachment allows gallbladder to \"float\" freely; predisposes to torsion (Ladd\\'s anomaly). ABSENCE OF GALLBLADDER (agenesis) \u2714 \u2014 rare congenital absence (~1 in 6000\u20137500); important to recognise to avoid unnecessary surgery. SPIGELIAN GALLBLADDER \u2717 \u2014 \"Spigelian\" refers to Spigelian hernia (hernia through the semilunar line of the anterior abdominal wall); there is no recognised \"Spigelian gallbladder\" as a congenital anomaly. Correct: I, II, III. Answer: I, II and III.'},\n{id:15,stem:'Which of the following are functions of the gall bladder?\\nI. Reservoir for bile\\nII. Production of bile\\nIII. Secretion of mucus\\nIV. Concentration of bile\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Functions of the gallbladder: RESERVOIR FOR BILE \u2714 \u2014 stores up to 30\u201350 mL of concentrated bile between meals; releases upon cholecystokinin (CCK) stimulation when fat enters the duodenum. PRODUCTION OF BILE \u2717 \u2014 bile is produced by HEPATOCYTES in the LIVER; the gallbladder does NOT produce bile; it only stores and concentrates it. SECRETION OF MUCUS \u2714 \u2014 goblet cells in the gallbladder mucosa secrete mucus; contributes to the glycoprotein matrix of gallstones. CONCENTRATION OF BILE \u2714 \u2014 the gallbladder concentrates bile 5\u201310\u00d7 by absorbing water and electrolytes (Na+, Cl\u2212, HCO3\u2212) via active transport. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:16,stem:'Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?',correct:'Abdominal discomfort and ascites are the main presenting features.',options:['It principally affects young males.','Venous drainage of the liver is occluded by IVC thrombus.','Quadrate lobe (Segment 4 and 5) undergoes hypertrophy.','Abdominal discomfort and ascites are the main presenting features.'],exp:'Budd-Chiari Syndrome (BCS): HEPATIC VENOUS OUTFLOW obstruction (hepatic veins or IVC) \u2192 hepatic congestion. Option a \u2717 \u2014 BCS affects predominantly YOUNG WOMEN (not males); associated with prothrombotic states, OCP use, pregnancy, myeloproliferative disorders, PNH. Option b \u2717 \u2014 BCS is obstruction of HEPATIC VEINS (small, large) or the supra-hepatic IVC; NOT solely \"IVC thrombus\" \u2014 most BCS is at the hepatic vein level; and even when IVC is involved, it is the hepatic vein outflow not just IVC. Option c \u2717 \u2014 CAUDATE LOBE (Segment 1) undergoes HYPERTROPHY in BCS (it has separate venous drainage directly into the IVC \u2192 unaffected by hepatic vein obstruction \u2192 compensatory hypertrophy); NOT quadrate lobe (segments 4\/5). Option d \u2714 \u2014 Classic presentation: ABDOMINAL DISCOMFORT (right upper quadrant pain from hepatic congestion) + ASCITES (hepatic venous hypertension \u2192 portal hypertension \u2192 ascites) are the main features. Also: hepatomegaly, jaundice, eventually cirrhosis. Answer: Abdominal discomfort and ascites are the main presenting features.'},\n{id:17,stem:'Which one of the following is correct regarding splenic artery aneurysm?',correct:'It is generally multiple in number.',options:['It is twice as common in men.','It is usually situated in the main arterial trunk.','It is caused due to blunt trauma to the abdomen.','It is generally multiple in number.'],exp:'Splenic artery aneurysm (SAA) \u2014 the most common visceral artery aneurysm: Option a \u2717 \u2014 SAA is 4\u00d7 more common in WOMEN (not men); associated with multiparity, portal hypertension, fibromuscular dysplasia. Option b \u2717 \u2014 SAA is typically located at BIFURCATION points of the splenic artery (mid-distal portion), NOT the main arterial trunk; the distal splenic artery at bifurcations is the classic site. Option c \u2717 \u2014 SAA is NOT primarily caused by blunt trauma; main causes are fibromuscular dysplasia, portal hypertension (splenomegaly \u2192 hyperdynamic flow), pregnancy, atherosclerosis, pancreatitis. Option d \u2714 \u2014 SAA tends to be MULTIPLE in about 20\u201325% of cases. Management: treat if symptomatic, pregnant, or >2 cm diameter. Answer: It is generally multiple in number.'},\n{id:18,stem:'Which of the following statements are correct regarding primary survey\/management of traumatic head injury patient?\\nI. Ensure adequate oxygenation and circulation\\nII. Exclude hypoglycaemia\\nIII. Check for mechanism of injury\\nIV. Check pupil size and response\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','II, III and IV','I, II and IV','I, III and IV'],exp:'Primary survey of traumatic brain injury (TBI) \u2014 ABCDE approach: Statement I \u2714 \u2014 AIRWAY + oxygenation + CIRCULATION are the first priorities; hypoxia and hypotension are the two most devastating secondary insults in TBI; SpO2 >95%, MAP >80 mmHg. Statement II \u2714 \u2014 EXCLUDE HYPOGLYCAEMIA: glucose must be checked; hypoglycaemia mimics neurological dysfunction and is rapidly correctable; part of \"Don\\'t ever forget glucose\" (DEFG). Statement III \u2717 \u2014 Mechanism of injury is part of HISTORY-TAKING and SECONDARY SURVEY, not the primary survey; primary survey focuses on life-threatening physiological derangements, not mechanism. Statement IV \u2714 \u2014 PUPIL SIZE AND RESPONSE is assessed in the DISABILITY (D) component of primary survey (GCS, pupils, lateralising signs); unequal\/dilated fixed pupil indicates herniation = emergency. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:19,stem:'Which of the following statements are correct regarding ABCDE of trauma care?\\nI. A stands for Airway with cervical spine protection\\nII. B stands for Breathing and ventilation\\nIII. C stands for Control of massive external haemorrhage\\nIV. D stands for Disability (Neurological status)\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, III and IV','I, II and IV','II, III and IV'],exp:'ATLS Primary Survey \u2014 ABCDE: A = AIRWAY with cervical spine protection \u2714 (Statement I correct). B = BREATHING and ventilation \u2714 (Statement II correct). C = CIRCULATION with haemorrhage control \u2014 NOT \"Control of massive external haemorrhage\" specifically; C covers all circulation assessment (BP, pulse, haemorrhage control including external and internal). Statement III \u2717 \u2014 while haemorrhage control is part of C, \"Control of massive external haemorrhage\" is sometimes listed separately as \"C-ABCDE\" (catastrophic haemorrhage as the zeroth step) in newer TCCC\/military guidelines; in classic ATLS, C = Circulation. This makes statement III debatable but in ATLS C includes haemorrhage control. D = DISABILITY (neurological status: GCS, pupils, lateralising signs) \u2714 (Statement IV correct). E = Exposure\/Environment. Per official key: I, II, IV. Answer: I, II and IV.'},\n{id:20,stem:'Which of the following statements are correct regarding inguinal hernias in children?\\nI. It is more common in full-term boys\\nII. It should be repaired promptly\\nIII. It is always indirect\\nIV. It may frequently be transilluminant\\nSelect the answer:',correct:'I, II, III and IV',options:['I, II and III','II, III and IV','I, II and IV','I, II, III and IV'],exp:'Inguinal hernia in children: Statement I \u2714 \u2014 more common in MALES (male:female 4\u20138:1); full-term boys commonly affected; also premature infants (higher rate). Statement II \u2714 \u2014 Should be REPAIRED PROMPTLY (electively soon after diagnosis); high risk of INCARCERATION in infants (up to 30%); do not delay. Statement III \u2714 \u2014 Paediatric inguinal hernias are ALWAYS INDIRECT (congenital patent processus vaginalis \u2192 peritoneal sac); direct hernias are extremely rare in children. Statement IV \u2714 \u2014 Indirect hernias in children may TRANSILLUMINATE (light passes through the fluid\/bowel-containing sac); helpful in distinguishing from solid scrotal masses; particularly if the sac contains fluid (communicating hydrocele component). All four correct. Answer: I, II, III and IV.'},\n{id:21,stem:'The most common site of urethral opening in cases of hypospadias is:',correct:'Just proximal to the glans',options:['Just proximal to the glans','On the penile shaft','At the junction of penile shaft and stratum','On the perineum'],exp:'HYPOSPADIAS: congenital anomaly where the urethral meatus opens on the VENTRAL (underside) surface of the penis proximal to its normal position. Most common sites (frequency, distal to proximal): Glanular\/subcoronal (just proximal to glans) \u2714 \u2014 MOST COMMON (~50\u201360% of cases). Distal penile shaft (~20%). Mid-shaft (~10%). Proximal\/penoscrotal\/perineal (severe, ~20% combined). The MAJORITY of hypospadias cases are ANTERIOR (glanular, coronal, subcoronal) \u2014 i.e., JUST PROXIMAL TO THE GLANS. Answer: Just proximal to the glans.'},\n{id:22,stem:'Which of the following about Minimal Access Surgery are correct?\\nI. Decreased intraoperative heat loss\\nII. Improved visualisation\\nIII. Increased chances of herniation\\nIV. Improved mobility\\nSelect the answer:',correct:'I, II and IV',options:['I, II and III','I, III and IV','II, III and IV','I, II and IV'],exp:'Minimal Access Surgery (MAS\/Laparoscopic surgery) advantages: Statement I \u2714 \u2014 DECREASED INTRAOPERATIVE HEAT LOSS: smaller incisions \u2192 less body surface exposure \u2192 reduced heat loss compared to open surgery; warm CO2 insufflation also contributes. Statement II \u2714 \u2014 IMPROVED VISUALISATION: magnified, illuminated view of operative field; camera can access areas difficult to see in open surgery; HD\/3D optics. Statement III \u2717 \u2014 INCREASED CHANCES OF HERNIATION is a DISADVANTAGE, specifically PORT-SITE HERNIATION; trocar sites (especially \u226510 mm) can develop incisional hernias; this is a complication, not an advantage. Statement IV \u2714 \u2014 IMPROVED MOBILITY\/PATIENT RECOVERY: reduced post-operative pain, earlier return to activity, shorter hospital stay, improved cosmesis. Correct advantages: I, II, IV. Answer: I, II and IV.'},\n{id:23,stem:'The maximum safe dose for Lignocaine (without adrenaline) as a local anaesthetic drug is:',correct:'3 mg\/kg',options:['3 mg\/kg','5 mg\/kg','7 mg\/kg','9 mg\/kg'],exp:'Maximum safe doses of local anaesthetics: LIGNOCAINE (LIDOCAINE) WITHOUT adrenaline: 3 mg\/kg \u2714 (maximum 200 mg). WITH adrenaline: 7 mg\/kg (maximum 500 mg) \u2014 adrenaline causes local vasoconstriction \u2192 slower absorption \u2192 higher dose possible. BUPIVACAINE: 2 mg\/kg (without adrenaline); 2.5 mg\/kg (with adrenaline). PRILOCAINE: 6 mg\/kg (without); 9 mg\/kg (with). Adrenaline approximately doubles the maximum safe dose by reducing systemic absorption rate. Lignocaine toxicity: initially CNS (perioral tingling, tinnitus, seizures), then cardiovascular (arrhythmias, cardiac arrest). Answer: 3 mg\/kg.'},\n{id:24,stem:'Which of the following are the symptoms commonly experienced by patients with lymphoedema?\\nI. Swelling\\nII. Burning sensation\\nIII. Intolerance to cold\\nIV. Cramps\\nSelect the correct answer:',correct:'I, II and IV',options:['I, II and IV','I, II and III','II, III and IV','I, III and IV'],exp:'Lymphoedema symptoms: SWELLING \u2714 \u2014 the cardinal feature; progressive, non-pitting (later stages), typically affects a limb; starts distally and progresses proximally. BURNING SENSATION \u2714 \u2014 patients frequently report burning, aching, heaviness, and discomfort; the stretching of skin and inflammation causes burning\/stinging sensations. CRAMPS \u2714 \u2014 muscle cramps are commonly reported in lymphoedema; possibly due to tissue congestion, reduced blood flow, and nerve compression. INTOLERANCE TO COLD \u2717 \u2014 cold intolerance is NOT a typical lymphoedema symptom; it is associated with Raynaud\\'s phenomenon, hypothyroidism, peripheral vascular disease (arterial). Lymphoedema: heaviness, tightness, aching, swelling, burning, cramps. Answer: I, II and IV.'},\n{id:25,stem:'Which of the following are the malignancies associated with lymphoedema?\\nI. Kaposi Sarcoma\\nII. Squamous cell carcinoma\\nIII. Malignant melanoma\\nIV. Leukaemia\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Malignancies associated with lymphoedema: KAPOSI SARCOMA \u2714 \u2014 arises in lymphoedematous tissues; associated with immunodeficiency (HIV); the lymphatic endothelial origin means it preferentially occurs in lymphoedema areas. SQUAMOUS CELL CARCINOMA \u2714 \u2014 Stewart-Treves syndrome classically; SCC can arise in chronically lymphoedematous skin; also lymphangiosarcoma (originally described in post-mastectomy arm lymphoedema). MALIGNANT MELANOMA \u2714 \u2014 can develop in chronically lymphoedematous skin; lymphoedema is a risk factor for melanoma development in affected limbs. LEUKAEMIA \u2717 \u2014 leukaemia is not specifically associated with lymphoedema as a complication; while leukaemic infiltration can cause lymphadenopathy\/secondary lymphoedema, leukaemia itself is not considered a malignancy arising in or specifically associated with lymphoedema. Correct: I, II, III. Answer: I, II and III.'},\n{id:26,stem:'Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound?\\nI. Limberg procedure\\nII. Y-V plasty\\nIII. Z-plasty\\nIV. Karydakis procedure\\nSelect the correct answer:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Off-midline closure techniques for pilonidal sinus excision \u2014 to avoid midline wounds (which have higher recurrence due to deep natal cleft): LIMBERG FLAP (rhomboid flap) \u2714 \u2014 rotational fasciocutaneous flap that shifts the natal cleft laterally; excellent results; avoids midline. Y-V PLASTY \u2714 \u2014 Y-V advancement flap; flattens the natal cleft; off-midline closure; reduces recurrence. KARYDAKIS PROCEDURE \u2714 \u2014 the most widely used technique; excises the sinus + creates an asymmetric flap that moves the suture line off the midline; reduces recurrence dramatically compared to midline closure. Z-PLASTY \u2717 \u2014 while Z-plasty is a plastic surgery technique, it is not specifically used for pilonidal sinus closure to achieve off-midline wound. The three standard off-midline techniques are Limberg, Karydakis, and Bascom\/cleft-lift; Y-V is also used. Answer: I, II and IV.'},\n{id:27,stem:'A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3\u00d74 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is:',correct:'cT\u2082N\u2081M\u2093',options:['cT\u2081N\u2081M\u2093','cT\u2082N\u2081M\u2093','cT\u2083N\u2081M\u2093','cT\u2083N\u2082M\u2093'],exp:'AJCC 8th edition breast cancer TNM staging: T stage (tumour size): T1: \u226420 mm. T2: >20 mm and \u226450 mm. T3: >50 mm. T4: any size with chest wall\/skin involvement. This tumour: 3\u00d74 cm = 40 mm \u2192 T2 \u2714 (>20 mm, \u226450 mm). N stage (regional nodes): N0: no nodes. N1: mobile ipsilateral axillary nodes (level I-II) \u2714 \u2014 firm MOBILE level I nodes = N1 (not fixed, not matted = not N2). N2: fixed\/matted axillary nodes or internal mammary. M: M\u2093 = cannot be assessed (no systemic workup done yet). Clinical stage: cT\u2082N\u2081M\u2093. Answer: cT\u2082N\u2081M\u2093.'},\n{id:28,stem:'Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?',correct:'High resolution manometry',options:['Upper GI endoscopy','Barium swallow','High resolution manometry','Contrast enhanced CT scan (CECT) oesophagus'],exp:'Diagnosis of oesophageal motility disorders: HIGH RESOLUTION MANOMETRY (HRM) \u2714 \u2014 the GOLD STANDARD for oesophageal motility assessment. HRM: multiple pressure sensors (22\u201336) measure intraluminal pressure simultaneously along the entire length of the oesophagus; generates a topographic \"Clouse plot\" (pressure-time-space map). Diagnoses: achalasia (absent relaxation of LOS, failed peristalsis), diffuse oesophageal spasm, nutcracker oesophagus, jackhammer oesophagus, hypertensive LOS, scleroderma oesophagus. Chicago Classification (v4.0) uses HRM findings. Barium swallow: useful screening but less specific. Upper GI endoscopy: assesses mucosal pathology, not motility. CECT: structural, not functional. Answer: High resolution manometry.'},\n{id:29,stem:'Which of the following are considered aetiological factors for Adenocarcinoma oesophagus?\\nI. Barrett\\'s oesophagus\\nII. Gastro-oesophageal reflux\\nIII. Obesity\\nIV. Alcohol intake\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Adenocarcinoma of the oesophagus \u2014 risk factors: BARRETT\\'S OESOPHAGUS \u2714 \u2014 the single most important risk factor; intestinal metaplasia of lower oesophageal epithelium due to chronic reflux \u2192 dysplasia \u2192 adenocarcinoma. GASTRO-OESOPHAGEAL REFLUX (GORD) \u2714 \u2014 chronic acid\/bile reflux \u2192 Barrett\\'s oesophagus \u2192 adenocarcinoma; 6\u20138\u00d7 increased risk. OBESITY \u2714 \u2014 central adiposity increases intra-abdominal pressure \u2192 promotes reflux; also independent metabolic\/inflammatory risk factor; strongly associated with lower oesophageal\/GOJ adenocarcinoma. ALCOHOL \u2717 \u2014 alcohol is a major risk factor for SQUAMOUS CELL carcinoma of the oesophagus (along with smoking); it is NOT a significant risk factor for ADENOCARCINOMA. Contrast: SCC risk factors = smoking + alcohol; ADC risk factors = GORD + Barrett\\'s + obesity. Answer: I, II and III.'},\n{id:30,stem:'Consider the following statements regarding Plummer-Vinson syndrome:\\nI. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia\\nII. It is a rare disease, mainly affecting middle-aged women\\nIII. There is predisposition to postcricoid, cervical oesophageal cancer\\nIV. Treatment is usually surgical\\nWhich of the statements given above are correct?',correct:'I, II and III',options:['II, III and IV','I, II and IV','I, III and IV','I, II and III'],exp:'Plummer-Vinson (Paterson-Brown-Kelly) syndrome: Statement I \u2714 \u2014 TRIAD: post-cricoid\/upper oesophageal WEB + IRON DEFICIENCY ANAEMIA + DYSPHAGIA (initially to solids). Statement II \u2714 \u2014 affects predominantly MIDDLE-AGED WOMEN (females >> males); rare condition; associated with iron deficiency. Statement III \u2714 \u2014 PREDISPOSES TO POSTCRICOID CARCINOMA (hypopharyngeal\/upper oesophageal squamous cell carcinoma); considered a pre-malignant condition; regular surveillance recommended. Statement IV \u2717 \u2014 Treatment is NOT primarily surgical; management is IRON REPLACEMENT (treats the underlying deficiency and often resolves the web) + oesophageal DILATATION (endoscopic) for the web; surgery is rarely needed. Correct: I, II, III. Answer: I, II and III.'},\n{id:31,stem:'Which of the following are correct regarding late dumping?\\nI. It usually occurs during the second hour after meal\\nII. It lasts for 30-40 minutes\\nIII. Major symptoms are tremor, faintness, prostration\\nIV. It is relieved by lying down\\nSelect the answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'LATE DUMPING syndrome (post-gastrectomy): TIMING \u2714 (Statement I): occurs 1\u20133 hours after meals (typically around 2nd hour); caused by reactive HYPOGLYCAEMIA. PATHOPHYSIOLOGY: rapid carbohydrate delivery to small bowel \u2192 excessive GLP-1\/insulin release \u2192 rebound hypoglycaemia. SYMPTOMS \u2714 (Statement III): HYPOGLYCAEMIC symptoms \u2014 sweating, tremor, faintness, palpitations, weakness, PROSTRATION (collapse); adrenergic response to hypoglycaemia. DURATION \u2717 (Statement II): lasts 20\u201330 minutes (not 30\u201340 minutes specifically; some sources say 20\u201345 min; 30-40 is close but the options make this the wrong one). RELIEVED BY LYING DOWN \u2714 (Statement IV): lying down\/food intake (carbohydrate snack) relieves symptoms. Also distinguish from EARLY dumping (within 30 min; osmotic; vasomotor + GI). Answer: I, III and IV.'},\n{id:32,stem:'Which one of the following statements is NOT correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?',correct:'Medical therapy has no role in the treatment of this condition.',options:['Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.','Endoscopic biopsy is essential to exclude malignancy.','Medical therapy has no role in the treatment of this condition.','Operation is frequently required along with a drainage procedure.'],exp:'Gastric outlet obstruction (GOO) from peptic ulcer disease \u2014 evaluating the options: HYPOCHLORAEMIC ALKALOSIS \u2714 \u2014 correct statement; GOO \u2192 prolonged vomiting of HCl \u2192 hypochloraemic, hypokalaemic metabolic alkalosis (\"contraction alkalosis\"). ENDOSCOPIC BIOPSY \u2714 \u2014 correct; essential to exclude carcinoma causing GOO; multiple biopsies from the obstructing area mandatory. OPERATION frequently required with drainage procedure \u2714 \u2014 correct; after medical optimisation, surgical options include truncal vagotomy + gastrojejunostomy or pyloplasty; drainage procedure prevents re-obstruction. MEDICAL THERAPY HAS NO ROLE \u2717 \u2014 FALSE = the incorrect statement. Medical therapy DOES have a role: nasogastric decompression, IV fluids\/electrolyte correction, PPI therapy; endoscopic balloon dilatation for fibrotic strictures; H. pylori eradication. Medical treatment is essential for pre-operative optimisation. Answer: Medical therapy has no role in the treatment of this condition.'},\n{id:33,stem:'The commonly used muscle relaxant with quickest onset of action and spontaneous recovery is:',correct:'Suxamethonium',options:['Suxamethonium','Vecuronium','Atracurium','Rocuronium'],exp:'Neuromuscular blocking agents \u2014 onset and recovery: SUXAMETHONIUM (succinylcholine) \u2714 \u2014 DEPOLARISING muscle relaxant; QUICKEST ONSET (45\u201360 seconds \u2014 \"rapid sequence induction\"); SHORTEST DURATION with SPONTANEOUS RECOVERY (~10\u201315 min); metabolised by plasma cholinesterase; used for RSI and when quick recovery needed. NON-DEPOLARISING agents: Rocuronium: fast onset (60\u201390 sec with intubating dose); longer duration (30\u201360 min); reversible with sugammadex. Vecuronium: intermediate onset (3\u20135 min); intermediate duration. Atracurium: intermediate onset (2\u20133 min); ~25\u201335 min; Hofmann elimination. SUXAMETHONIUM has the fastest onset AND spontaneous recovery \u2014 ideal for RSI and difficult airway. Answer: Suxamethonium.'},\n{id:34,stem:'The first imaging modality of choice for a 35-year-old lady, presenting to surgical emergency with complaints of colicky pain in right lower quadrant of abdomen and vomiting since last 2 days is:',correct:'Ultrasound abdomen',options:['Contrast CT abdomen','Non-contrast CT abdomen','Ultrasound abdomen','Plain X-ray abdomen erect view'],exp:'35-year-old lady with right lower quadrant colicky pain + vomiting: FIRST-LINE IMAGING: ULTRASOUND ABDOMEN \u2714 \u2014 reasons: (1) NO RADIATION \u2014 important in reproductive-age female (possible pregnancy); (2) First-line for appendicitis in women (rules out gynaecological causes simultaneously \u2014 ovarian cysts, ectopic pregnancy, torsion); (3) Widely available, rapid, cost-effective. If USG inconclusive \u2192 CT abdomen. CT (contrast\/non-contrast): reserved for equivocal cases or when USG is non-diagnostic; significant radiation dose for young female. Plain X-ray: limited diagnostic value for soft tissue pathology (appendicitis); used to detect perforation (free air) or obstruction. Answer: Ultrasound abdomen.'},\n{id:35,stem:'Mallampati test is used for the assessment of:',correct:'Airway',options:['Tongue size','Ability to protrude jaw','Breath hold time','Airway'],exp:'MALLAMPATI TEST (modified by Samsoon and Young): pre-operative assessment of the AIRWAY \u2714 \u2014 specifically predicts difficulty in LARYNGOSCOPY and INTUBATION. Patient opens mouth maximally and protrudes tongue: visualisation of oropharynx graded I\u2013IV. Class I: faucial pillars, soft palate, uvula visible (easy intubation). Class IV: only hard palate visible (difficult intubation). While it involves TONGUE SIZE indirectly (large tongue obscures oropharyngeal view), the TEST itself assesses the overall AIRWAY geometry and predicts intubation difficulty \u2014 not tongue size per se, not jaw protrusion (that is the thyromental distance\/jaw mobility tests). Answer: Airway.'},\n{id:36,stem:'Consider the following:\\nI. Diabetes\\nII. Hypertension\\nIII. Renal failure\\nIV. Jaundice\\nWhich of the above are the risk factors for post-operative wound dehiscence?',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Risk factors for wound DEHISCENCE (failure of wound to remain closed): DIABETES \u2714 \u2014 impaired wound healing (hyperglycaemia \u2192 impaired neutrophil function, poor collagen synthesis, microangiopathy \u2192 reduced tissue oxygenation). RENAL FAILURE \u2714 \u2014 uraemia \u2192 impaired platelet function, malnutrition, anaemia \u2192 poor healing; also immunosuppression. JAUNDICE \u2714 \u2014 bile salts impair fibroblast function; coagulopathy; malnutrition; endotoxaemia \u2192 impaired collagen synthesis and wound healing. HYPERTENSION \u2717 \u2014 well-controlled hypertension is NOT a significant independent risk factor for wound dehiscence per se; while severe\/uncontrolled hypertension may affect microcirculation, it is not classically listed as a wound dehiscence risk factor. Other dehiscence risks: malnutrition, obesity, steroids, infection, poor surgical technique, emergency surgery, anaemia. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:37,stem:'If faced with a surgical emergency in a child of 15 years for whom no consent is available for life-saving surgery and no time for seeking authority from someone, the next step should be:',correct:'Go ahead with surgery without consent',options:['Conservative management till lawyer is available','Search for relatives or neighbours','Consent arrangement through Hospital Social Worker','Go ahead with surgery without consent'],exp:'SURGICAL ETHICS \u2014 emergency consent for minors: In a LIFE-THREATENING EMERGENCY where: (1) a minor (under 18) cannot give consent; (2) parents\/guardians are unavailable; (3) there is NO TIME to seek authority. The legal and ethical principle is: DOCTRINE OF NECESSITY \u2014 the surgeon is legally and ethically justified in proceeding with LIFE-SAVING treatment WITHOUT consent. This is recognised under common law and medical ethics; withholding treatment would be negligent. The primary duty is to preserve life when the alternative is death or serious harm. Option d \u2714: \"Go ahead with surgery without consent\" \u2014 the correct ethical\/legal answer. Document clearly in medical records. Answer: Go ahead with surgery without consent.'},\n{id:38,stem:'Which of the following information needs to be disclosed in order to establish valid consent for surgical treatment?\\nI. Condition and reasons why it warrants surgery\\nII. Type of surgery proposed\\nIII. Unexpected hazards of proposed surgery\\nIV. The surgical experience and expertise of the operating surgeon\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Valid\/informed consent \u2014 essential information to disclose: Statement I \u2714 \u2014 The DIAGNOSIS\/CONDITION and WHY surgery is recommended (indication). Statement II \u2714 \u2014 TYPE\/NATURE of the proposed surgery (procedure details). Statement III \u2714 \u2014 RISKS AND HAZARDS (common and serious complications; material risks; both expected and unexpected hazards). Also: benefits, alternatives (including non-surgical), consequences of not having surgery. Statement IV \u2717 \u2014 The specific surgical EXPERIENCE and EXPERTISE of the operating surgeon is NOT routinely required to be disclosed as part of standard informed consent; while patients may ask and should be answered honestly, it is not a mandatory element. Landmark case (Montgomery v Lanarkshire): disclose \"material risks\" a reasonable patient would want to know. Answer: I, II and III.'},\n{id:39,stem:'A surgical department of a premier medical college conducted a study on rates of post-operative wound infection. The results of the study were negative for the proposed hypothesis. What should the department do with the results?',correct:'Report the negative results',options:['Label them as worthless','Redo the study with a new hypothesis','Report the negative results','Redesign the study and increase the sample size'],exp:'RESEARCH ETHICS \u2014 handling negative results: REPORT THE NEGATIVE RESULTS \u2714 \u2014 the correct and ethically mandated action. Reasons: PUBLICATION BIAS: negative results are as scientifically valid as positive results; failure to publish negative results leads to publication bias (overestimation of treatment effects in literature). SCIENTIFIC INTEGRITY: suppressing negative findings violates research ethics; all valid research should be communicated. CLINICAL RELEVANCE: knowing that a proposed intervention does NOT reduce wound infection is valuable to clinical practice. Labelling negative results as worthless = scientifically and ethically wrong. Automatically redoing or redesigning without cause = HARKing (Hypothesising After Results are Known) or fishing for significant results = unethical. Answer: Report the negative results.'},\n{id:40,stem:'Which of the following statements are correct regarding sutures in surgery?\\nI. Barbed sutures have the advantage of eliminating the need for knots\\nII. Vertical mattress sutures help in eversion of wound edges\\nIII. Aberdeen knot is used for continuous suturing\\nIV. Silk is preferred for subcuticular suturing\\nSelect the answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Suture facts: Statement I \u2714 \u2014 BARBED SUTURES (knotless sutures): have helical barbs cut into the suture material; barbs grip tissue from multiple directions \u2192 no knot required; used in laparoscopic\/robotic surgery for running suture lines. Statement II \u2714 \u2014 VERTICAL MATTRESS SUTURES: specifically designed to produce WOUND EDGE EVERSION (important for cosmesis and tension relief); full thickness bite + superficial bite causes eversion; also reduces dead space. Statement III \u2714 \u2014 ABERDEEN KNOT: used to TERMINATE a continuous (running) suture; a locking knot that secures the end of a continuous suture without a separate knot; widely used in surgery. Statement IV \u2717 \u2014 SILK is NOT preferred for subcuticular (intradermal) suturing; silk is multifilament, non-absorbable, causes tissue reaction \u2192 not ideal for intradermal sutures. PREFERRED subcuticular sutures: monofilament absorbable (Monocryl\/Vicryl Rapide) or non-absorbable (Prolene\/nylon). Correct: I, II, III. 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Submitting in 10 Submit Now Combined Medical Services Examination 2025Paper II \u00b7 Part A Surgery (Q1 \u2013 Q40) Questions 1 \u2013 40 +1 correct \u00b7 \u2212\u2153 wrong \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-36842","post","type-post","status-publish","format-standard","hentry","category-cms","category-surgery"],"yoast_head":"\n<title>CMS 2025 P2 Part-A - 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\/16\/cms-2025-p2-part-a\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2025 P2 Part-A - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2025 Paper II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0.00 \/ 40 Time's Up! 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