Combined Medical Services Examination-2020

Paper-II

1.
Indications for fasciotomy in compartment syndrome include all EXCEPT:

(a) Distal sensory disturbance

(b) Compartment pressure > 30 mm Hg
(c) Pain on passive movement of affected muscles
(d) Palpable distal pulses
2.
Which one of the following statements is NOT correct regarding Necrotising Soft Tissue
infections?

(a) Crepitus, skin blistering and focal skin gangrene are typical presenting features
(b) They are monomicrobial in nature
(c) Treatment consists of wide local excision and appropriate antibiotics
(d) Tissue biopsy is required for culture and diagnosis
3.
Which type of surgery is laparoscopic cholecystectomy classified as?

(a) Clean
(b) Clean contaminated
(c) Contaminated
(d) Dirty
4.
A 22-year female has presented with a history of malaise, cough, alternating constipation and
diarrhoea with intermittent abdominal pain for last 6 months. She also complains of
abdominal distension for last 2 days. On examination her abdomen has a doughy feel along
with an ill defined mass over the right lower quadrant. She is most likely suffering from:

(a) Appendicular lump

(b) Ileocaecal tuberculosis
(c) Carcinoma caecum
(d) Ovarian mass
5.
Consider the following statements regarding needle stick injuries:

1. Injured part should be washed under running water

2. Dominant index finger is the commonest site for needle stick injury
3. All needle stick injuries should be reported
4. Hepatitis/HIV testing should be done after needle stick injury

Which of the statements given above are correct?

(a) 1, 2 and 4
(b) 1, 2 and 3
(c) 1, 3 and 4
(d) 2, 3 and 4
6.
Consider the following statements regarding claudication:

1. It is a marker for silent coronary disease

2. Structured exercise program ( 2 hours per week for 3 months) leads to
improvement in symptoms
3. Diabetes mellitus increases the risk and severity of claudication
4. Beta blockers may exacerbate claudication

Which of the above statements are correct?

(a) 1 and 2 only

(b) 1, 3 and 4 only
(c) 2, 3 and 4 only
(d) 1, 2, 3 and 4
7.
A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third
post operative day, she develops breathless and pulmonary embolism is suspected. The next
investigation to confirm the diagnosis will be:

(a) Echocardiography
(b) Duplex venography
(c) CT pulmonary angiography
(d) MR angiography
8.
Medical management of thyrotoxic crisis includes all of the following EXCEPT:

(a) IV fluids
(b) IV propanolol
(c) IV hydrocortisone
(d) IV antibiotics
9.
A patient operated for a parotid gland tumour developed symptoms of sweating and
erytherma (flushing) over the region of surgical excision while eating. The probable
diagnosis is:

(a) Parotid gland fistula

(b) Sialadenitis
(c) Chronic wound infection
(d) Frey’s syndrome
10.
First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

(a) Tamoxifen
(b) Ovarian suppression by surgery
(c) Antiprogestins
(d) Anastrazole
11.
All of the following are major subtypes of breast cancer based on Gene array analysis
EXCEPT:

(a) Luminal A and Luminal B

(b) Triple negative
(c) Her-2 receptor positive
(d) Oestrogen receptor positive
12.
All of the following are sequelae of peptic ulcer surgery EXCEPT:

(a) Bilious vomiting

(b) Dumping syndrome
(c) Diarrhoea
(d) Increased appetite
13.
The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease
includes all variables EXCEPT:

(a) Serum bilirubin

(b) Serum albumin
(c) Serum creatinine
(d) INR (International Normalised Ratio)
14.
‘Chain of Lakes’ appearance due to sacculation with intervening short strictures of pancreatic
duct is seen on:

(a) ERCP
(b) CECT abdomen
(c) Plain X-ray abdomen
(d) Ultrasonography
15.
Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

(a) Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the
most common presenting features
(b) It is more common in elderly, diabetics and immunocompromised patients
(c) Treatment is with oral antibiotics alone
(d) Streptococcus milleri and escherichia coli are the most common causative
organisms
16.
‘Swiss cheese defects’ are seen during laparoscopic repair of:

(a) Ventral hernia

(b) Inguinal hernia
(c) Obturator hernia
(d) Femoral hernia
17.
Which of the following are correct regarding splenic artery aneurysm?

1. Main arterial trunk is the common site

2. Palpable thrill can be felt
3. It is symptomless unless it ruptures

Select the correct answer using the code given below:

(a) 1 and 2 only

(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
18.
Valentino’s syndrome is:

(a) Pain on per-vaginal examination in pelvic abscess

(b) Pain over left shoulder in left hypochondriac collection
(c) Pain over left groin in perirenal collection
(d) Pain in right iliac fossa in perforated peptic ulcer
19.
Spontaneous bacterial peritonitis occurs due to:

(a) duodenal stump blowout

(b) peptic ulcer perforation
(c) acute bacterial infection of ascites
(d) infection via fallopian tubes
20.
Structure not forming boundaries of the “Triangle of doom” seen during laparoscopic
inguinal hernia surgery dissection is:

(a) Vas deferens

(b) Inferior epigastric artery
(c) Spermatic cord vessels
(d) Peritoneum
21.
The term mid-line shift is associated with:

(a) Head injury

(b) Chest injury
(c) Abdominal injury
(d) Limb injury
22.
Which one of the following cranial nerves does NOT supply to the external ear?

(a) Cranial nerve V

(b) Cranial nerve VI
 (c) Cranial nerve VII
(d) Cranial nerve IX

23.
Left Internal Mammary Artery (LIMA) has become the conduit of choice for Left Anterior
Descending (LAD) artery during coronary artery bypass grafting because:

(a) Long term patency rates are more than 98%

(b) It is close to LAD
(c) Atherosclerosis is never seen in this vessel
(d) It is very easy to harvest
24.
A 50-year old male with significant smoking history presented in the surgical emergency
with sudden severe breathlessness. Chest X-ray shows right sided Pneumothorax. The
appropriate management requires:

(a) Aspiration of air with 16-18 G cannula

(b) Right chest drain of size 8-14 Fr
(c) Oxygen by face mask
(d) Mechanical ventilation
25.
Which one of the following statements regarding Felon is NOT correct?

(a) There is infection of the finger tip between specialised fibrous septa
(b) It is a painless condition
(c) Incision and drainage is the treatment of choice
(d) It is common in diabetics
26.
The most common site for osteosarcoma is:

(a) Proximal femur

(b) Distal femur
(c) Proximal humerus
(d) Distal humerus
27.
Rapid Sequence Induction is indicated in:

(a) Emergency surgery for intestinal obstruction

(b) Elective open hernia surgery
(c) Cardiopulmonary bypass surgery
(d) Elective laparoscopic surgery

28.
Which one of the following statements about Compartment Syndrome is NOT correct?

(a) It is commonest in a closed fracture

(b) Pain is on active movement but not on passive movement of muscles
(c) Fasciotomy is the treatment of choice
(d) Volkmann’s Ischaemic contractive is a late complication
29.
Which one of the following is NOT the strength of ultrasound as a diagnostic modality?

(a) No radiation
(b) Short learning curve
(c) Inexpensive
(d) Allows dynamic studies to be done
30.
Which of the following statements regarding lymphoedema following breast cancer treatment
are correct?

1. Incidence has decreased due to rarely combined therapy of axillary LN dissection and
radiotherapy
2. Precipitating cause like LN metastasis is a major determinant
3. The condition is often painful
4. Oedematous limb is susceptible to bacterial infection

Select the correct answer using the code given below:

(a) 1, 2 and 3
(b) 2, 3 and 4
(c) 1, 3 and 4
(d) 1, 2 and 4
31.
Which one of the following is NOT a risk factor for development of venous thrombosis in
surgical patients?

(a) Age > 60 years

(b) Pregnancy
(c) Obesity (BMI > 30 kg/m2 )
(d) Diabetes ( HbA1c > 7.5%)
32.
Which one of the following is NOT a complication of massive blood transfusion?

(a) Coagulopathy
(b) Hypocalcaemia
(c) Hyperthermia
(d) Hyperkalemia
33.
Stage III “Pressure sore” is full thickness skin loss extending:

(a) into subcutaneous tissue but not through fascia

(b) through subcutaneous tissue into fascia
(c) through subcutaneous tissue into fascia and muscles
(d) through subcutaneous tissue into fascia, muscles and bone
34.
During subclavian vein puncture in a surgical ward suddenly a patient developed severe
breathlessness. On auscultation breath sound was absent and the ipsilateral chest was
tympanitic on percussion. The probable diagnosis is:

(a) Iatrogenic pneumothorax

(b) Introgenic hemothorax
(c) Spontaneous pneumothorax
(d) Tension pneumothorax
35.
Kohler’s disease is avascular necrosis of :

(a) Lunate
(b) Capitellum of humerus
(c) First metatarsal head
(d) Navicular
36.
Which one of the following is NOT true of Pyoderma gangrenosum?

(a) It is characterized by cutaneous ulceration with purple undermined edges

(b) It is often secondary to heightened immunological reactivity from another disease
process
(c) Cultures often show Gram positive Staphylococci
(d) Lesions generally respond to steroids
37.
Which of the following is NOT a tissue repair surgery for inguinal hernia repair?

(a) Bassini’s repair

(b) Shouldice repair
(c) Stoppa’s repair
(d) Desarda repair
38.
Which one of the following type of meshes is recommended for intraperitoneal use in
abdominal wall hernia?
(a) Light weight, porous meshes
(b) Heavy weight, porous meshes
(c) Absorbable meshes
(d) Tissue separating meshes
39.

Which one of the following is NOT correct regarding MEN-1 syndrome?

(a) It involves parathyroid glands

(b) It involves pancreas
(c) It involves pituitary gland
(d) It involves pineal gland