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UPSC Combined Medical Services CMS Examination question paper

1. The external opening of branchial fistula is present in :
(a) Lower third of the neck
(b) Middle third of the neck
(c) Upper third of the neck
(d) Suprasternal notch

2. A eight year old male child complains of severe pain in right testes. The most
probable diagnosis is
(a) Torsion of right testis
(b) Strangulated Inguinal hernia
(c) Acute epididym‐orchitis
(d) Undescended testis

3. Which one of the following statements is NOT correct regarding Gastroschisis?
(a) It is a ruptured exomphalos
(b) Gut has herniated through a defect to right of umbilicus
(c) Normally limited to midgut
(d) There is no covering membrane
4. Heineke‐Mikulicz operation is done for:
(a) Ureteric stricture
(b) Urethral stricture
(c) Pyloric stenosis
(d) Stricture common bile duct

5. A 32 year old female underwent laparoscopic cholecystectomy which was difficult.
On her second post operative day, she develops jaundice. Her LFT parameters show
serum bilirubin 6.8 mg/dL; direct bilirubin 5.6 and indirect bilirubin 1.2 mg/dL; and
serum alkaline phosphatase 1226 IU/L. She is most likely suffering from obstructive
jaundice due to:
(a) Bile duct injury
(b) Carcinoma gallbladder
(c) Hepatocellular carcinoma
(d) Carcinoma head of pancreas

6. A 60 year old man presents with painless progressive jaundice for two months. He
has a history of weight loss. On examination, his gallbladder is palpable which is
smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely
suffering from:
(a) Carcinoma head of pancreas
(b) Carcinoma stomach
(c) Choledocholithiasis
(d) Klatskin tumour

7. A young 23 year old male riding his motorcycle meets with a road accident. He is
tachypnoeic with HR 110/m and BP 112/74 mmHg. On examination, he has
tenderness over left side of chest with decreased air entry. His trachea is pushed to
opposite side. Abdominal examination is unremarkable. Most probably he is suffering
from:
(a) Haemothorax
(b) Consolidation
(c) Subcutaneous emphysema
(d) Tracheal rupture

8. Mondor’s disease is
(a) Lymphangitis of mammary lymphatics
(b) Multiple breast cysts
(c) Eczema by nipple and areola
(d) Thrombophlebitis of superficial veins of breast

9. Which of the following is NOT true regarding ‘Renal Carbuncle’?
(a) It is an abscess in renal parenchyma
(b) It occurs in diabetic patient
(c) It is a type of renal tuberculosis
(d) It occurs in intravenous drug abusers

10. Anderson‐Hynes operation is performed for:
(a) Achalasia cardia
(b) Pyloric stenosis
(c) Pseudo‐pancreatic cyst
(d) Pelvi‐ureteric junction obstruction

11. Which of the following is NOT correct for ‘strawberry gall bladder’?
(a) It is a malignant condition of gall bladder
(b) It has sub mucous aggregation of cholesterol crystals
(c) It may be associated with cholesterol Stones
(d) Simple cholecystectomy is the treatment of choice

12. Treatment of choice for Recurrent Thyrotoxicosis after surgery is
(a) Further surgery
(b) Radio iodine followed by surgery
(c) Radio iodine
(d) Observe/follow –up

13. All the following are features of Polycystic disease of kidneys EXCEPT:
(a) Haematuria
(b) Hypertension
(c) Renal failure
(d) Erythrocytosis

14. Which one of the following is the most important selection criteria for obesity
surgery ?
(a) BMI > 40
(b) BMI 30
(c) BMI 30 with co‐morbid disease
(d) BMI 35 without any co‐morbid disease
15. A 45 year old underwent abdominal rectal prolapse surgery. At present, he
complains of sexual dysfunction which is probably due to the injury of:
(a) Pelvic autonomic nerves
(b) Inferior mesenteric artery
(c) Rectum
(d) Urinary bladder
16. In endoscopic retrograde cholangiopancreatography endoscope used is:
(a) End viewing
(b) Side viewing
(c) Rigid
(d) Front viewing
17. Oliguria is defined as:
(a) Absence of urine production
(b) More than 900 ml of urine excreted in a day
(c) 600 ml to 700 ml of urine excreted in a day
(d) Less than 300 ml of urine excreted in a day
18. A 40 year old man, with a history of a reducible left groin swelling of two years,
comes with severe pain over left groin. The swelling is now non‐reducible and is very
tender to touch. The most probable treatment plan for this patient would be:
(a) Continue conservative management
(b) Hot fomentation of groin area
(c) Oral antibiotics
(d) Prepare for emergency surgery
19. During laparoscopic inguinal hernia repair, in the ‘triangle of doom’, the following are
true EXCEPT:
(a) Vas deferens on medial side
(b) Cord structures on lateral side
(c) Base by iliac vessels
(d) Dangerous area for dissection
20. All are rare type of lateral Hernia of abdominal wall, EXCEPT:
(a) Spigelian
(b) Obturator
(c) Superior lumbar
(d) Inferior lumbar

14. Which one of the following is the most important selection criteria for obesity
surgery ?
(a) BMI > 40
(b) BMI 30
(c) BMI 30 with co‐morbid disease
(d) BMI 35 without any co‐morbid disease
15. A 45 year old underwent abdominal rectal prolapse surgery. At present, he
complains of sexual dysfunction which is probably due to the injury of:
(a) Pelvic autonomic nerves
(b) Inferior mesenteric artery
(c) Rectum
(d) Urinary bladder
16. In endoscopic retrograde cholangiopancreatography endoscope used is:
(a) End viewing
(b) Side viewing
(c) Rigid
(d) Front viewing
17. Oliguria is defined as:
(a) Absence of urine production
(b) More than 900 ml of urine excreted in a day
(c) 600 ml to 700 ml of urine excreted in a day
(d) Less than 300 ml of urine excreted in a day
18. A 40 year old man, with a history of a reducible left groin swelling of two years,
comes with severe pain over left groin. The swelling is now non‐reducible and is very
tender to touch. The most probable treatment plan for this patient would be:
(a) Continue conservative management
(b) Hot fomentation of groin area
(c) Oral antibiotics
(d) Prepare for emergency surgery
19. During laparoscopic inguinal hernia repair, in the ‘triangle of doom’, the following are
true EXCEPT:
(a) Vas deferens on medial side
(b) Cord structures on lateral side
(c) Base by iliac vessels
(d) Dangerous area for dissection
20. All are rare type of lateral Hernia of abdominal wall, EXCEPT:
(a) Spigelian
(b) Obturator
(c) Superior lumbar
(d) Inferior lumbar
27. ‘Swiss cheese defects’ of anterior abdominal wall after exploratory laparotomy is
best seen while doing:
(a) Open ventral hernia repair
(b) Open inguinal hernia repair
(c) Laparoscopic ventral hernia repair
(d) Laparoscopic inguinal hernia repair
28. A 35 year old male patient comes to casualty with acute pain abdomen; and on
examination found to have cold, clammy extremities, sunken eyes, dry tongue,
thready pulse, drawn and anxious face with abdominal guarding and rigidity. This
clinical picture indicates:
(a) Local peritonitis
(b) Diffuse early peritonitis
(c) Diffuse late peritonitis
(d) Acute cholecystitis
29. All of the following statements are true for keloids EXCEPT:
(a) It is rarely seen in white skinned persons and is more common over the
sternum
(b) True keloid continues to become worse even after one year
(c) True keloid does not spread into surrounding tissue
(d) The maturation and stabilization of the collagen fibrils is inhibited
30. Which of these is a palliative shunt procedure created between the left subclavian
artery and pulmonary artery to treat cyanotic congenital heart disease?
(a) Gott’s shunt
(b) Lieno renal shunt
(c) Blalock‐Taussig shunt
(d) Waterstons shunt
31. A young male is undergoing emergency surgery for a clinical diagnosis of acute
appendicitis. Intraoperatively minimal pus was found but the appendix was normal.
What is the next step of management?
(a) Appendectomy
(b) Right hemicolectomy
(c) Close the abdomen without doing anything
(d) Search for perforated Meckel’s diverticulum
32. Which of the following is NOT considered as an indicator of adequate fluid
resuscitation?
(a) Urine output
(b) Respiratory rate
(c) Pulse
(d) Blood pressure
33. In a 65 year old, double contrast barium enema shows cancer of colon with an apple
core appearance. Colonoscopic biopsy shows adenocarcinoma. What will be the next
step of management?
(a) Surgery
(b) Chemotherapy
(c) CECT to stage disease
(d) Radiotherapy
34. A 35 year old woman presented with a lump in her upper abdomen for two months
which was slightly increasing. She also complained of early satiety. She gave a history
of acute severe pain in upper abdomen for which she was admitted in hospital for 10
days, about three months ago. On examination, the mass was firm, smooth surfaced
and not moving with respiration. She was most likely suffering from:
(a) Cancer stomach
(b) Cancer colon
(c) Pseudocyst pancreas
(d) Splenic cyst
35. While working in a primary health centre, an elderly patient presents with a history
of sudden loss of vision and curtain falling sensation in one eye. This symptom is
highly suggestive that the patient has the following condition:
(a) Retinal detachment
(b) Vitreous haemorrhage
(c) Acute onset ptosis
(d) Intracranial haemorrhage
36. Pringle’s manoeuvre is done to stop bleeding at:
(a) Left gastric artery
(b) Splenic artery
(c) Renal artery
(d) Hepatoduodenal ligament
37. What is the most common malignant tumour of eyelid?
(a) Neurofibroma
(b) Meibomian cancer
(c) Basal cell cancer
(d) Pseudotumour
38. Which of the following is NOT a symptom of atherosclerotic occlusive disease at the
bifurcation of aorta (Leriche syndrome)?
(a) Claudication of the buttock and thigh
(b) Claudication of the calf
(c) Sexual impotence
(d) Gangrene localised to the feet
33. In a 65 year old, double contrast barium enema shows cancer of colon with an apple
core appearance. Colonoscopic biopsy shows adenocarcinoma. What will be the next
step of management?
(a) Surgery
(b) Chemotherapy
(c) CECT to stage disease
(d) Radiotherapy
34. A 35 year old woman presented with a lump in her upper abdomen for two months
which was slightly increasing. She also complained of early satiety. She gave a history
of acute severe pain in upper abdomen for which she was admitted in hospital for 10
days, about three months ago. On examination, the mass was firm, smooth surfaced
and not moving with respiration. She was most likely suffering from:
(a) Cancer stomach
(b) Cancer colon
(c) Pseudocyst pancreas
(d) Splenic cyst
35. While working in a primary health centre, an elderly patient presents with a history
of sudden loss of vision and curtain falling sensation in one eye. This symptom is
highly suggestive that the patient has the following condition:
(a) Retinal detachment
(b) Vitreous haemorrhage
(c) Acute onset ptosis
(d) Intracranial haemorrhage
36. Pringle’s manoeuvre is done to stop bleeding at:
(a) Left gastric artery
(b) Splenic artery
(c) Renal artery
(d) Hepatoduodenal ligament
37. What is the most common malignant tumour of eyelid?
(a) Neurofibroma
(b) Meibomian cancer
(c) Basal cell cancer
(d) Pseudotumour
38. Which of the following is NOT a symptom of atherosclerotic occlusive disease at the
bifurcation of aorta (Leriche syndrome)?
(a) Claudication of the buttock and thigh
(b) Claudication of the calf
(c) Sexual impotence
(d) Gangrene localised to the feet
46. A seven year old girl with precocious puberty is found to be having a 10 cm. ovarian
cyst on USG. The most likely etiology is
(a) Benign cystic teratoma
(b) Brenner tumour
(c) Choriocarcinoma
(d) Granulosa cell tumour
47. A 17 year old girl presents with an ovarian cyst of 5cm. The cyst is echo free,
unilocular and CA 125 of 8U/ml. What is most appropriate management?
(a) Laproscopy for cyst removal
(b) Laparotomy for cyst removal
(c) Conservative with follow up ultrasound
(d) Medical treatment
48. The contraceptive choice for a 38 year old P1L1 woman having chronic hypertension,
dysmenorrhoea and menorrhagia is:
(a) Copper intrauterine device
(b) Sterilization
(c) Levenorgestrel intrauterine device
(d) Combined oral contraceptive pills
49. Most probable cause of heavy bleeding in a P2L2 during tenth day post partum is:
(a) Retained bits of cotyledons and membranes
(b) Subinvolution of placental site
(c) Resumption of menstruation
(d) Infected episiotomy wound
50. A woman with which of the following health problems should avoid centchromen?
(a) Polycystic ovarian syndrome
(b) Woman with dysfunctional uterine bleeding
(c) Endometrial hyperplasia
(d) Endometriosis

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