Combined Medical Services (CMS)

Paper – II
(2024 to 2009)

Year Wise Papers with Full Explanation

MEDINK
CMS Paper II
Edition March 2025
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 Contents
PAPER 2024 5-34

PAPER 2023 35-64

PAPER 2022 65-95

PAPER 2021 96-123

PAPER 2020 124-150

PAPER 2019 151-177

PAPER 2018 178-205

PAPER 2017 206-232

PAPER 2016 233-259

PAPER 2015 260-285

PAPER 2014 286-312

PAPER 2013 313-337

PAPER 2012 338-364

PAPER 2011 365-390

PAPER 2010 391-417

PAPER 2009 418-440

**********
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MEDINK Question Paper 2024 page 5

Question Paper 2024

1. Which of the following are risk factors for wound 4. A 48-year-old smoker presents to the OPD with
infection? complaints of cramping pain in both the calves on
1. Malnutrition walking to about 100–150 metres. The pain is relieved
2. Poor perfusion on taking rest for about 2–3 minutes and the patient is
3. Antibodies able to walk for some more distance again before the
4. Foreign body material pain appears. This presentation is suggestive of
Select the correct answer using the code given below. (a) muscular fatigue
(a) 1, 2 and 3 (b) osteoarthritis of the knee
(b) 1, 2 and 4 (c) intermittent claudication
(c) 1, 3 and 4 (d) neurogenic claudication
(d) 2, 3 and 4
(c)

Sol
intermittent claudication

Intermittent claudication is characterized by ischemic muscle pain brought on by exertion (walking a fixed distance) and relieved by a short rest. This occurs due to peripheral arterial disease, often linked to atherosclerotic changes that reduce blood flow to the leg muscles. Smoking is a major risk factor for arterial disease, which fits this patient’s history. The brief rest typically restores enough circulation to allow the person to walk again for a similar distance, reinforcing the diagnosis of intermittent claudication.

(b)

Sol
1, 2 and 4 (Malnutrition, poor perfusion, and foreign body material)

5.
Malnutrition impairs overall immunity and wound healing because of inadequate protein and micronutrient stores. Poor perfusion lowers oxygen and nutrient delivery to tissues, hindering the healing process and increasing susceptibility to infection. The presence of foreign body material creates a surface where bacteria can adhere and proliferate, further compromising wound integrity. In contrast, antibodies actually help in fighting infection and are not a risk factor. Therefore, items 1, 2, and 4 accurately represent risk factors for wound infection.

A midline neck swelling just below the hyoid bone

2. Which types of cancer are associated with exposure and managed by Sistrunk’s operation leads to
to ionizing radiation? postoperative need for thyroxine replacement. The
1. Leukaemia most likely diagnosis is
2. Lung cancer (a) lateral aberrant thyroid
3. Breast cancer (b) thyroglossal cyst
4. Lymphoma (c) solitary thyroid nodule
Select the correct answer using the code given below. (d) thyroglossal cyst with only functioning thyroid
(a) 1, 2 and 3 tissue
(b) 1, 2 and 4
(d)

Sol
thyroglossal cyst with only functioning thyroid tissue

A classical thyroglossal cyst occurs in the midline and moves upward on protrusion of the tongue or swallowing. Sistrunk’s procedure removes the cyst, the tract, and the mid-portion of the hyoid bone to reduce recurrence. If the ectopic thyroid tissue within the cyst represents the patient’s only functioning thyroid tissue, removing it causes hypothyroidism, necessitating thyroxine replacement. A straightforward thyroglossal cyst (with a normal thyroid gland in its usual location) typically does not lead to permanent hypothyroidism postoperatively.

(c) 1, 3 and 4
(d) 2, 3 and 4 6. A 40-year-old smoker presents with soreness of

(a)

Sol
1, 2 and 3 (Leukaemia, lung cancer, and breast cancer)

Ionizing radiation is a well-established carcinogen. Leukaemia is notably linked to radiation exposure (as observed in atomic bomb survivors). Lung cancer risk increases particularly with exposures such as radon (a radioactive gas). Breast cancer has also been linked to medical or occupational radiation. While lymphoma can be multifactorial, its direct association with ionizing radiation is less classically emphasized than the other three. Hence, the recognized malignancies strongly tied to ionizing radiation here are 1, 2, and 3.
tongue since last 2 months. On examination, it is
found that the oral hygiene is poor and there is a white
3. Which of the following are correct regarding Li- plaque over the lateral border of the tongue. What is
Fraumeni syndrome? the next step in the management of this patient?
1. It has autosomal dominant inheritance and is (a) Oral vitamin C supplementation
associated with P53 gene (b) Oral antifungal treatment
2. It has autosomal recessive inheritance and is (c) Edge biopsy of the lesion
associated with P53 gene (d) Local topical cauterization
3. It is associated with an increased risk of
(c)

Sol
Edge biopsy of the lesion

A white plaque on the lateral border of the tongue in a chronic smoker raises concern for leukoplakia or possible malignant transformation (e.g., squamous cell carcinoma). While oral candidiasis (thrush) can present as white patches, the patient’s risk factors (tobacco use, poor oral hygiene) and lesion location necessitate ruling out malignancy. The best immediate step is to perform a biopsy of the lesion margin. This ensures an accurate diagnosis and helps guide definitive treatment.

sarcomas and leukaemia

4. It is associated with an increased risk of brain 7. Consider the following causes of visual loss :
tumours and osteo-sarcomas 1. Obstruction of the central retinal artery
Select the answer using the code given below. 2. Vitreous and retinal haemorrhage
(a) 2, 3 and 4 3. Cataract
(b) 1, 3 and 4 4. Retinal detachment
(c) 1 and 4 only Which of the above causes are associated with acute
(d) 1 and 3 only visual loss in a patient?

(b)

Sol
1, 3 and 4

Li-Fraumeni syndrome is classically caused by a germline mutation in the TP53 tumor suppressor gene and is inherited in an autosomal dominant pattern (making statement 1 correct, while statement 2 is incorrect). It confers a markedly elevated lifetime risk of multiple cancers, particularly soft tissue sarcomas, bone sarcomas (like osteosarcoma), leukaemia, brain tumors, and breast cancer. Therefore, statements 3 and 4 are also true. This combination accurately describes the hereditary cancer predisposition observed in Li-Fraumeni syndrome.
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4

(c)

Sol
1, 2 and 4 (Obstruction of the central retinal artery, vitreous and retinal haemorrhage, retinal detachment)

Acute visual loss commonly occurs with occlusion of the central retinal artery, which abruptly cuts off blood supply to the retina. Sudden haemorrhage into the vitreous or retinal layers can also block or distort vision immediately. Retinal detachment, where the sensory retina peels away from its underlying layer, typically presents with a rapid, painless loss of vision. By contrast, cataract formation progresses gradually over time, causing slow impairment rather than an acute event.
CMS Paper-II Question Paper 2024 MEDINK

8. A 60-year-old lady presents with a recent onset 12. Which among the following are complications of
increase in a long standing swelling on the front of liver trauma?
the neck. The swelling, which was small, had been 1. Liver abscess
present since last 30 years, but has now increased 2. Biliary fistula
to more than twice the size in the last 2 months. 3. Portal thrombosis
On examination, the swelling is firm to hard in 4. Liver failure
consistency and moves with deglutition. What is the Select the correct answer using the code given below.
most likely cause of this clinical presentation? (a) 1, 2 and 3
(a) Cystic degeneration (b) 1, 2 and 4
(b) Haemorrhage (c) 1, 3 and 4
(c) Malignant transformation (d) 2, 3 and 4
(d) Myxomatous transformation
(a)

Sol
1, 2 and 3 (Liver abscess, biliary fistula, portal thrombosis)

Traumatic injury to the liver can lead to several localized complications. Liver abscess may develop from devitalized tissue and bacterial contamination. Biliary fistula arises if a major bile duct is lacerated, allowing bile leakage. Portal vein thrombosis can occur from direct vascular injury or compression. While severe hepatic damage might theoretically precipitate liver failure, immediate “liver failure” from acute trauma is less typically listed as a direct complication compared to the other three. Thus, 1, 2, and 3 are classic recognized complications.

(c)

Sol
Malignant transformation

13.
A long-standing thyroid swelling (commonly a multinodular goiter) that suddenly enlarges rapidly and becomes firm or hard raises strong suspicion of malignant change. Though degenerative changes or haemorrhage can cause sudden expansion, these often present differently (e.g., painful swelling, fluctuant areas). The described consistency and relatively short period of growth are classic indicators of possible thyroid malignancy, prompting further evaluation via imaging and biopsy.

Which of the following are local complications of

9. Which of the following chromosomal abnormalities acute pancreatitis?
are associated with brain tumours? 1. Pseudocyst
1. Neurofibromatosis type 1 2. Pleural effusion
2. Neurofibromatosis type 2 3. Ileus
3. Peutz-Jeghers syndrome 4. Acute fluid collection
4. Hereditary nonpolyposis colorectal cancer Select the correct answer using the code given below.
Select the correct answer using the code given below. (a) 1, 2 and 3
(a) 1, 2 and 3 (b) 2, 3 and 4
(b) 1, 2 and 4 (c) 1, 2 and 4
(c) 1, 3 and 4 (d) 1, 3 and 4
(d) 2, 3 and 4
(d)

Sol
1, 3 and 4 (Pseudocyst, Ileus, Acute fluid collection)

Acute pancreatitis commonly leads to local problems around the pancreas. A pseudocyst is a collection of pancreatic enzymes and fluid contained by a wall of fibrous or granulation tissue. Acute fluid collections (not yet walled off) can also accumulate in or around the pancreas. Ileus (localized or generalized) may develop as an immediate “paralytic” response in nearby bowel loops. Pleural effusion, although possible, is typically considered a more systemic or extrapancreatic complication and not purely local.

(b)

Sol
1, 2 and 4 (Neurofibromatosis type 1, Neurofibromatosis type 2, and Hereditary nonpolyposis colorectal cancer)

14.
Neurofibromatosis type 1 (NF1) is known for optic pathway gliomas and other CNS tumors. NF2 is strongly linked with bilateral vestibular schwannomas and various intracranial tumors. Hereditary nonpolyposis colorectal cancer (Lynch syndrome) can, in certain variants (Turcot syndrome with mismatch repair genes), be associated with glioblastoma. Peutz-Jeghers syndrome typically predisposes to gastrointestinal polyps and certain extragastrointestinal malignancies (pancreatic, for instance), rather than brain tumors. Therefore, 1, 2, and 4 are the relevant associations.

Which of the following are risk factors for the

10. Which one of the following is correct regarding development of pancreatic cancer?
‘witch’s milk’? 1. Cigarette smoking
(a) It is seen in full-term infants. 2. Diabetes mellitus
(b) It is seen only in preterm infants. 3. Caucasian ethnicity
(c) It is caused by stimulation of foetal breast by 4. Male gender
progesterone. Select the correct answer using the code given below.
(d) It is caused by stimulation of foetal breast by (a) 1, 2 and 3
calcitonin. (b) 2, 3 and 4

(a)

Sol
It is seen in full-term infants.

“Witch’s milk” refers to breast milk–like fluid secreted from the nipples of some newborns, more commonly in full-term infants. It results from the transplacental passage of maternal hormones (especially estrogens and prolactin) that stimulate the neonate’s breast tissue. It typically appears a few days after birth and then resolves spontaneously. Neither progesterone nor calcitonin are the principal causes of this phenomenon. The correct statement is that it is commonly observed in full-term babies.
(c) 1, 2 and 4
(d) 1, 3 and 4
11. Which of the following statements are correct
(c)

Sol
1, 2 and 4 (Cigarette smoking, diabetes mellitus, and male gender)

Major risk factors for pancreatic cancer include chronic smoking (one of the most important modifiable factors) and long-standing diabetes mellitus. There is a slight male predominance in pancreatic cancer incidence as well. Regarding ethnicity, African Americans generally have higher incidence rates compared to Caucasians, so “Caucasian ethnicity” is not a confirmed risk factor. Thus, the combination of 1, 2, and 4 aligns with well-established risk factors.

regarding Barrett’s oesophagus?

1. It is a metaplastic change. 15. Which of the following are metabolic causes of
2. It is a risk factor for development of splenic enlargement?
adenocarcinoma. (a) Rickets and Still’s disease
3. Ingestion of NSAIDs is the aetiological factor (b) Amyloid and Gaucher’s disease
for its development. (c) Porphyria and Felty’s syndrome
4. Endoscopic mucosal resection is an effective (d) Myelofibrosis and Weil’s disease
treatment.
(b)

Sol
Amyloid and Gaucher’s disease

Gaucher’s disease is a sphingolipid storage disorder (glucocerebrosidase deficiency) that causes pathological deposition of glucocerebroside in multiple organs, notably the spleen, leading to splenomegaly. Amyloidosis can also involve the spleen, with amyloid protein deposition causing organomegaly. Rickets (vitamin D deficiency) and Still’s disease (a form of inflammatory arthritis) are not typically categorized as metabolic causes of large spleen. Porphyria is a heme synthesis disorder but does not typically present with prominent splenomegaly, and Felty’s syndrome is linked to rheumatoid arthritis.

Select the answer using the code given below.

(a) 1, 2 and 3 16. Which one of the following statements is correct
(b) 2, 3 and 4 about mesenteric cysts?
(c) 1, 2 and 4 (a) It occurs most commonly in children less than
(d) 1, 3 and 4 18 years of age.

(c)

Sol
1, 2 and 4

Barrett’s esophagus involves a metaplastic replacement of the normal squamous epithelium by columnar epithelium (statement 1). It arises primarily from chronic gastroesophageal reflux disease (GERD) and is a significant risk factor for esophageal adenocarcinoma (statement 2). NSAIDs are not recognized as a main etiological cause—chronic acid reflux is. Endoscopic mucosal resection is indeed an effective treatment for high-grade dysplasia or early carcinoma in Barrett’s esophagus (statement 4). Thus, 1, 2, and 4 are correct.
(b) It is more common in males as compared to
females.
(c) It presents most commonly as a painless
MEDINK Question Paper 2024 page 7

abdominal swelling. (c) 1, 3 and 4

(d) Percutaneous aspiration with injection of (d) 2, 3 and 4
sclerosant is the preferred treatment option.
(c)

Sol
1, 3 and 4

Renal cell carcinoma (RCC) originates from the proximal tubular epithelium (statement 1). The main histological subtypes include clear cell, papillary, and chromophobe (statement 3). Surgical resection (partial or radical nephrectomy) is the cornerstone of curative treatment for localized (organ-confined) disease (statement 4). RCC shows a slight male predominance rather than female, making statement 2 incorrect. Therefore, the correct set of statements is 1, 3, and 4.

(c)

Sol
It presents most commonly as a painless abdominal swelling.

21.
Mesenteric cysts are rare intra-abdominal lesions that often remain asymptomatic and can be discovered incidentally or present as a painless, slowly enlarging abdominal mass. While children do frequently develop mesenteric cysts, they can appear at any age; and there is no strong male predominance. Definitive treatment is typically surgical excision rather than percutaneous aspiration with sclerosant. Because most patients notice a mass rather than severe pain, the most consistently correct statement is that mesenteric cysts commonly present as a painless swelling.

Which of the following are features of autosomal

17. Which of the following are features of umbilical dominant polycystic kidney disease?
hernia in adults? 1. Cyst may also occur in liver, pancreas and
1. Patients are commonly overweight with a arachnoid membrane.
thinned and attenuated midline raphe. 2. Most commonly manifests between 20–30
2. Most patients complain of pain due to tissue years of age.
tension. 3. Clinical manifestations are renal and extrarenal.
3. Men are affected more commonly than women. 4. Men tend to progress to renal failure more
4. Hernia repair can be done by the technique rapidly than women.
described by Mayo. Select the correct answer using the code given below.
Select the correct answer using the code given below. (a) 1, 2 and 3
(a) 1, 2 and 3 (b) 1, 2 and 4
(b) 1, 2 and 4 (c) 1, 3 and 4
(c) 1, 3 and 4 (d) 2, 3 and 4
(d) 2, 3 and 4
(c)

Sol
1, 3 and 4

Autosomal dominant polycystic kidney disease (ADPKD) involves multiple bilateral renal cysts, often accompanied by cysts in the liver and sometimes the pancreas or arachnoid (statement 1). Manifestations are both renal (hypertension, renal failure) and extrarenal (e.g., berry aneurysms) (statement 3). Men generally experience more rapid progression to renal failure, partly due to genetic and hormonal factors (statement 4). Although presentation can begin in early adulthood, the classic age range typically centers closer to the 30s–40s rather than strictly 20–30.

(b)

Sol
1, 2 and 4

22.
Umbilical hernias in adults are often associated with obesity or weak abdominal musculature (statement 1). They can cause discomfort or pain from increased tension at the hernia site (statement 2). They are actually more common in women, especially multiparous women, so statement 3 is incorrect. Repair of umbilical hernias using Mayo’s technique (overlapping repair of the defect) is a recognized surgical method (statement 4). Hence, the valid features are 1, 2, and 4.

Extracorporeal Shock Wave Lithotripsy (ESWL) is

18. What is the most common cause of perforation of the most commonly used for the treatment of
oesophagus? (a) gallbladder stones
(a) Barotrauma (b) urinary tract stones
(b) Mediastinitis (c) salivary gland stones
(c) Iatrogenic infection (d) abdominal stony-hard tumour
(d) Malignancy
(b)

Sol
urinary tract stones

ESWL uses shock waves focused on stones in the kidney or ureter to fragment them into smaller pieces, allowing their spontaneous passage through the urinary tract. It is a noninvasive, widely preferred approach for most renal and upper ureteric calculi. Gallbladder stones are typically managed by cholecystectomy. Salivary gland stones can sometimes be removed by endoscopic or surgical measures. ESWL is not indicated for “stony-hard” abdominal tumors. Hence, urinary tract stones represent the primary indication.

(c)

Sol
Iatrogenic infection

23.
The single most common reason for esophageal perforation is iatrogenic trauma—often during endoscopic procedures, instrumentation, or surgery—which can introduce infection into surrounding tissues. “Iatrogenic infection” is somewhat loosely worded here, but it reflects that endoscopic or surgical manipulations of the esophagus frequently lead to perforation and subsequent infection (i.e., mediastinitis). While barotrauma (Boerhaave’s syndrome) and malignancy-related perforations do happen, they are less common overall than iatrogenic causes.

Consider the following clinical features :

19. Which of the following are stages of damage control 1. Raised ICP
surgery? 2. Seizures
1. Patient’s selection 3. Focal deficit
2. Control of haemorrhage 4. Headache
3. Resuscitation in ICU Which of the above clinical features are related to
4. Preventive surgery most brain tumours?
Select the correct answer using the code given below. (a) 1, 2, 3 and 4
(a) 1, 2 and 3 (b) 1 and 2 only
(b) 1, 2 and 4 (c) 1, 2 and 3 only
(c) 1, 3 and 4 (d) 2, 3 and 4 only
(d) 2, 3 and 4
(a)

Sol
1, 2, 3 and 4

Most brain tumors, whether primary or metastatic, can elevate intracranial pressure (ICP), causing headaches and possibly papilledema (1,4). Seizures are a frequent presenting symptom, especially in supratentorial lesions (2). Focal neurological deficits (3) such as weakness, aphasia, or visual changes occur when the tumor affects specific brain regions. Thus, all four (raised ICP, seizures, focal deficit, and headache) are classical clinical features that collectively point toward an intracranial space-occupying lesion.

(a)

Sol
1, 2 and 3

24.
Damage control surgery is classically divided into phases. First, the trauma team selects appropriate patients (those with exsanguinating hemorrhage or unstable physiology) for a rapid, abbreviated surgical intervention to control hemorrhage and contamination. Second, patients receive ongoing resuscitation in the ICU to correct coagulopathy, hypothermia, and acidosis. Finally, definitive surgery is performed once the patient is stabilized. “Preventive surgery” is not among the recognized phases of damage control. Thus, 1, 2, and 3 correctly outline the standard stages.

The most common type of brain tumours associated

20. Which of the following statements are correct with neurofibromatosis type 1 brain tumour syndrome
regarding renal cell carcinoma? is
1. It arises from the epithelium of the proximal (a) astrocytoma
convoluted tubule. (b) acoustic neuroma
2. It has a female preponderance. (c) meningioma
3. Major subtypes are clear cell, papillary and (d) medulloblastoma
chromophobe.
(a)

Sol
astrocytoma

Neurofibromatosis type 1 (NF1) is known for multiple neurocutaneous manifestations, including neurofibromas and optic pathway gliomas. These gliomas are essentially pilocytic astrocytomas affecting the optic nerve or chiasm. By contrast, bilateral acoustic neuromas (vestibular schwannomas) characterize neurofibromatosis type 2 (NF2). Meningiomas and medulloblastomas are not the hallmark brain tumors of NF1. Thus, astrocytoma (particularly optic pathway glioma) is the most common intracranial tumor in NF1.

4. Surgery is the mainstay of treatment for organ-

confined disease. 25. Which of the following are correct for herniation via
Select the answer using the code given below. foramen of Morgagni?
(a) 1, 2 and 3 1. It occurs posteriorly in chest.
(b) 1, 2 and 4 2. Transverse colon is the commonest content.
CMS Paper-II Question Paper 2024 MEDINK

3. Defect is between sternal and costal attachments. (a) 1, 2 and 3

4. It is a type of congenital hernia. (b) 1, 2 and 4
Select the answer using the code given below. (c) 1, 3 and 4
(a) 1, 2 and 3 (d) 2, 3 and 4
(b) 1, 2 and 4
(b)

Sol
1, 2 and 4

Upper motor neuron (UMN) lesions produce spasticity (increased tone) and hyperreflexia due to loss of inhibitory pathways (statements 1 and 2). Patients also exhibit weakness in affected muscles (statement 4). The plantar response typically becomes extensor (Babinski sign) rather than absent. Therefore, statement 3 is incorrect. This pattern of increased tone, brisk reflexes, and Babinski sign differentiates UMN involvement from lower motor neuron lesions (which show decreased tone and hyporeflexia).

(c) 1, 3 and 4
(d) 2, 3 and 4 30. A 56-year-old female has been diagnosed with

(d)

Sol
2, 3 and 4

A Morgagni hernia is an anterior diaphragmatic defect, not a posterior one (so statement 1 is incorrect). It occurs through an opening between the sternal and costal portions of the diaphragm (statement 3) and is a congenital defect (statement 4). The most common herniated organ through this defect is often the transverse colon (statement 2). Hernias in the posterolateral aspect (Bochdalek hernia) are different and occur more commonly.
gallstones and is undergoing a preanesthesia
checkup. She has been a diabetic since last 15 years,
26. A 40-year-old lady complains of progressive but sugar levels are within the limits. Which category
deformities of her hands and fingers associated of physical status does she fit into?
with stiffness which is present in both the hands and (a) ASA 4
improves as the day progresses. On examination, (b) ASA 3
there is symmetrical involvement of hands and (c) ASA 2
fingers of both the upper limbs with flexion and ulnar (d) ASA 1
deviation at the metacarpophalangeal joints. What is
(c)

Sol
ASA 2

The American Society of Anesthesiologists (ASA) physical status classification rates overall surgical risk. An ASA 2 patient has a mild systemic disease with no significant functional limitations—such as well-controlled diabetes or hypertension. ASA 3 entails severe systemic disease that limits activity; ASA 4 includes severe, life-threatening disease. ASA 1 is a completely healthy person. Since this patient’s diabetes is longstanding but well-controlled (no mention of end-organ damage or functional impairment), she is classified as ASA 2.

the most likely diagnosis in this lady?

(a) Osteoarthritis 31. A 30-year-old road traffic accident victim is
(b) Ankylosing spondylitis being taken up for emergency laparotomy for
(c) Rheumatoid arthritis haemoperitoneum and suspected multiorgan trauma.
(d) Tenosynovitis Which one of the following will be an indication for

(c)

Sol
Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically presents with symmetrical joint involvement, most often in the small joints of the hands and feet. Morning stiffness improving later in the day, along with characteristic deformities such as ulnar deviation at the metacarpophalangeal joints, strongly suggests RA. Osteoarthritis more often affects distal interphalangeal joints (Heberden’s nodes). Ankylosing spondylitis primarily involves the spine and sacroiliac joints. Tenosynovitis alone would not explain the classic ulnar deviation deformity.
performing damage control surgery?
(a) Blood pressure < 100 mm Hg
27. A 52-year-old female complains of increasing pain in (b) Acidosis with pH < 7·32
the right shoulder. She is also finding it increasingly (c) Hypothermia < 36 °C
difficult to do overhead abduction of the affected (d) Coagulopathy
joint. She had been diagnosed as a diabetic 20 years
(d)

Sol
Coagulopathy

Damage control surgery is indicated when ongoing hemorrhage and shock begin driving the “lethal triad” of trauma: acidosis, hypothermia, and coagulopathy. Among the choices, frank coagulopathy (poor clotting function) is a key pivot-point indicating the need to abbreviate surgery, stabilize the patient in the ICU, and correct their physiology before attempting definitive repair. Mild hypotension, mild acidosis (pH 7.3), or temperature 36 °C alone may not suffice. The presence of coagulopathy signals a tipping point at which damage control principles are applied.

back and is on treatment since then. What is the most

likely cause of her clinical condition? 32. Consider the following:
(a) Rotator cuff tear 1. Pain relief
(b) Frozen shoulder 2. Prevention of infection
(c) Bacterial arthritis 3. Anaesthesia
(d) Osteoarthritis 4. Restoration of anatomy

(b)

Sol
Frozen shoulder

Frozen shoulder (adhesive capsulitis) is commonly associated with diabetes mellitus. It presents with progressive pain and a significant restriction of both active and passive range of motion—especially in abduction and external rotation. A full-thickness rotator cuff tear often has other clinical signs (weakness, positive drop-arm test). Bacterial arthritis (septic arthritis) is typically acute, severely painful, and accompanied by systemic infection signs. Osteoarthritis is more common in weight-bearing or degenerative joints and less typical in a single shoulder in this manner.
Which of the features given above are benefits of
fracture treatment?
28. A 20-year-old girl presents to the OPD with complaints (a) 1, 3 and 4
of a progressively increasing swelling on the dorsum (b) 1, 2 and 3
of the left wrist. The swelling is cystic and nontender (c) 1, 2 and 4
on examination and becomes more prominent on (d) 2, 3 and 4
plantar flexion of the wrist. The swelling is 2 cm × 1
(c)

Sol
1, 2 and 4 (Pain relief, prevention of infection, restoration of anatomy)

The principal aims (and benefits) of proper fracture management include relieving the patient’s pain (e.g., via immobilization), preventing infection (especially in open fractures), and restoring normal anatomy (through reduction and stabilization) to allow healing and preserve function. While anaesthesia is crucial during fracture reduction or surgical fixation, it is a means rather than a benefit of treatment. Hence, items 1 (pain relief), 2 (infection prevention), and 4 (anatomical restoration) best characterize the benefits of fracture treatment.

cm in size. What is the likely diagnosis in this case?

(a) Ganglion cyst 33. A 30-year-old motorbike rider is brought to the
(b) Sebaceous cyst emergency with history of a road traffic accident
(c) Dermoid cyst and altered consciousness. On secondary survey,
(d) Epidermoid cyst the doctor notices presence of a bruise over the left

(a)

Sol
Ganglion cyst

A ganglion cyst is a fluid-filled sac that typically arises near joint capsules or tendon sheaths. On the wrist’s dorsal aspect, it often becomes more visible with flexion. These cysts are usually smooth, non-tender, and can fluctuate in size. Sebaceous cysts and epidermoid cysts usually occur in the skin or subcutaneous tissue (often over hair-bearing areas), while dermoid cysts are developmental lesions containing skin adnexa. The classic location and features here match a dorsal wrist ganglion cyst.
mastoid process. The finding indicates
(a) fracture of mastoid process
29. Upper motor neuron lesions are characterized by (b) injury to the external auditory meatus
which of the following? (c) fracture of the skull base
1. Increased tone spasticity (d) soft tissue injury to the neck
2. Hyperreflexia
(c)

Sol
fracture of the skull base

A bruise over the mastoid area (Battle’s sign) is a classic indicator of a basilar skull fracture, specifically affecting the posterior cranial fossa. This ecchymosis typically appears some hours after the injury when blood tracks along tissue planes behind the ear. While fractures of the mastoid process itself or injury to the ear canal are possible in trauma, the classical teaching is that Battle’s sign strongly suggests a fracture through the base of the skull rather than isolated mastoid damage.

3. Absent plantar response

4. Motor weakness
Select the correct answer using the code given below.
MEDINK Question Paper 2024 page 9

34. Hangman’s fracture is 2. Calcium 1 mM/day

(a) traumatic spondylolisthesis of atlas vertebra 3. Potassium 50 mM/day
(C₁) 4. Magnesium 1 mM/day
(b) traumatic spondylolisthesis of axis vertebra Select the correct answer using the code given below.
(C₂) (a) 1, 2 and 3
(c) traumatic spondylolisthesis of thoracic vertebra (b) 1, 2 and 4
(T₁) (c) 1, 3 and 4
(d) traumatic spondylolisthesis of lumbar vertebra (d) 2, 3 and 4
(L₁)
(c)

Sol
1, 3, and 4.

In most reference tables, an adult’s typical sodium requirement approximates 50–90 mmol/day, and potassium around 40–60 mmol/day (making 50 mmol/day a reasonable figure). Although actual daily calcium intake targets (800–1000 mg) correspond to roughly 20–25 mmol, many exam-oriented sources simplify it to “1 mmol/day” of net absorbable calcium or near-minimal requirement. Magnesium needs are higher in reality (closer to 10–15 mmol/day), so option (4) is less commonly cited as “1 mM/day.” Accordingly, the official key usually pairs 1, 2, and 3 as “approximate.”

(b)

Sol
traumatic spondylolisthesis of axis vertebra (C₂)

39.
A “Hangman’s fracture” classically refers to a fracture through the pars interarticularis of the C2 (axis) vertebra, leading to a forward slip (spondylolisthesis) of the C2 body on C3. Historically named because of its association with judicial hangings, it more commonly results today from high-impact motor vehicle accidents. This fracture is distinct from those involving the atlas (C1) or lower cervical/thoracic vertebrae. Prompt stabilization is important to avoid spinal cord compromise in this region.

Distributive shock is described by which of the

35. Which of the following are correct in respect of following patterns of cardiovascular responses?
Systemic Inflammatory Response Syndrome (SIRS)? 1. Vasodilation
1. It is caused by the release of lipopolysaccharide 2. Reduced peripheral vascular resistance
endotoxin from dying E. coli bacteria. 3. Inadequate ‘afterload’
2. It is same as bacteraemia. 4. Low cardiac output
3. It results in Multiple Organ Dysfunction Select the correct answer using the code given below.
Syndrome (MODS). (a) 1, 2 and 4
4. White cell counts of more than 12 × 10⁹ / litre (b) 1, 3 and 4
are present. (c) 2, 3 and 4
Select the answer using the code given below. (d) 1, 2 and 3
(a) 1, 2 and 3
(d)

Sol
1, 2 and 3 (Vasodilation, reduced peripheral vascular resistance, inadequate afterload)

Distributive shock (e.g., septic shock, anaphylactic shock) features profound vasodilation and reduced peripheral vascular resistance. The systemic vascular resistance drops, so the effective afterload also diminishes—“inadequate afterload.” Despite low resistance, cardiac output in early distributive shock is often normal or even high because the heart pumps into a low-resistance circuit. Thus, “low cardiac output” (option 4) is not a hallmark of early/mid distributive shock. Ultimately, if uncorrected, cardiac output may fall, but the classic early pattern is 1, 2, and 3.

(b) 1, 2 and 4
(c) 1, 3 and 4 40. The best measure of organ perfusion and the best
(d) 2, 3 and 4 monitor of adequacy of shock therapy is

(c)

Sol
1, 3 and 4

SIRS can certainly be triggered by endotoxin (e.g., lipopolysaccharide from gram-negative bacteria), though it can also arise from other severe insults (pancreatitis, burns, etc.). It is not synonymous with bacteremia (statement 2 is false) because SIRS may occur with or without infection. If severe and uncontrolled, SIRS can progress to sepsis, then multiple organ dysfunction syndrome (MODS). Among the diagnostic criteria of SIRS is an elevated WBC count (>12,000/μL), making statements 1, 3, and 4 correct.
(a) central venous pressure
(b) pulmonary wedge pressure
36. A surgeon is about to start a laparoscopic procedure (c) urine output
on a patient. The floor nurse asks the surgeon about (d) restoring blood pressure/pulse vital parameters
the identity of the patient, site of the procedure to be
(c)

Sol
urine output

Urine output is a reliable, practical indicator of end-organ perfusion (specifically renal perfusion) in shock states. While blood pressure or central venous pressure can be misleading (due to compensatory vasoconstriction or fluid shifts), adequate urine output (≥0.5 mL/kg/hour in adults) demonstrates that the kidneys are being perfused sufficiently to filter and excrete. Pulmonary wedge pressure is invasive and reflects left atrial pressure more than global perfusion. Thus, urine output remains a key, real-time guide to resuscitation effectiveness.

performed and any anticipated critical events during

the surgery. These questions are a part of the 41. Which one of the following statements is correct
(a) universal precautions checklist regarding foetal physiology?
(b) nurses safety checklist (a) Haematopoiesis is demonstrated first in the
(c) MCI patient safety checklist yolk sac by 14th day.
(d) WHO surgical safety checklist (b) Meconium appears at 16 weeks.

(d)

Sol
WHO surgical safety checklist

The WHO Surgical Safety Checklist is a standardized protocol designed to improve communication and prevent avoidable errors before, during, and after surgical procedures. It includes confirming the patient’s identity, surgical site and procedure, the presence of necessary equipment, anticipated critical events, and other safety considerations (e.g., allergies, antibiotic prophylaxis). Universal precautions involve infection control measures, whereas local or institutional checklists may exist but the recognized global standard referencing patient identity and critical event anticipation is the WHO checklist.
(c) Breathing movements are identified at 26
weeks.
37. Which of the following are correct for managing (d) Foetal pancreas secretes insulin as early as 20
hypertrophic scars? weeks.
1. Silicone gel sheeting
(d)

Sol
Foetal pancreas secretes insulin as early as 20 weeks.

Human fetal insulin production typically begins by around 10–12 weeks’ gestation, but significant levels are noted closer to 20 weeks. Meconium formation can begin around the latter half of pregnancy, though it’s typically stored in the fetal intestines and only appears after about 20 weeks, not exactly at 16. Detectable fetal breathing movements begin around 20–24 weeks. Hematopoiesis starts in the yolk sac very early (around the 3rd week) but not precisely limited to “14th day.”

2. Intralesional steroid injections

3. Vitamin A gel applications 42. Which of the following are advantages of state of
4. Laser treatment haemodilution during pregnancy?
Select the answer using the code given below. 1. Optimum gaseous exchange between maternal
(a) 1, 2 and 3 and foetal circulation due to decreased blood
(b) 1, 2 and 4 viscosity
(c) 1, 3 and 4 2. Protection against adverse effect of supine and
(d) 2, 3 and 4 erect posture

(b)

Sol
1, 2 and 4 (Silicone gel sheeting, intralesional steroid injections, laser treatment)

Hypertrophic scar management often combines multiple modalities: silicone gel sheeting to reduce scar thickness, intralesional corticosteroid injections to help flatten the scar, and various laser treatments (pulsed-dye or fractional lasers) to refine scar appearance and vascularity. While topical retinoids (vitamin A derivatives) can sometimes be employed for abnormal scars, the most standard and well-evidenced trio is silicone sheeting, steroid injections, and laser therapy. Together, they help modulate collagen remodeling and improve scar texture over time.
3. Protection against adverse effect of blood loss
during delivery
38. Which of the following are approximate daily Select the correct answer using the code given below.
requirements of the common electrolytes in an adult? (a) 1 and 2 only
1. Sodium 50–90 mM/day (b) 2 and 3 only
CMS Paper-II Question Paper 2024 MEDINK

(c) 1 and 3 only 47. The diameter of engagement of foetal skull in marked
(d) 1, 2 and 3 deflexion is

(d)

Sol
1, 2 and 3

During normal pregnancy, plasma volume expansion exceeds red cell mass increase, leading to physiological haemodilution (“physiological anemia”). This reduced viscosity aids better perfusion and gas exchange. It also provides a reserve against postural hypotension (supine or erect) and helps mitigate the effects of blood loss at delivery. Hence, statements 1, 2, and 3 collectively describe recognized advantages of this natural adaptation in pregnancy.
(a) occipitofrontal diameter
(b) suboccipitofrontal diameter
43. Consider the following statements regarding (c) mentovertical diameter
oligohydramnios : (d) suboccipitobregmatic diameter
1. It is defined on USG when maximum vertical
(c)

Sol
mentovertical diameter

“Marked deflexion” of the fetal head refers to partial extension, such as in a brow presentation. The presenting diameter in this scenario is the mentovertical diameter (approximately 13.5 cm), one of the largest diameters of the fetal skull and thus a more difficult fit through the maternal pelvis. In a well-flexed vertex presentation, the suboccipitobregmatic diameter (around 9.5 cm) typically presents, but with pronounced deflexion/extension, engagement occurs along the longer mentovertical line instead.

pocket of liquor is less than 5 cm.

2. It is defined on USG when AFI is less than 5 48. Onset of labour is initiated by which of the following?
cm. 1. Uterine distension
Which of the statements given above is/are correct? 2. Increased CRH and ACTH from foetal
(a) 1 only hypothalamic-pituitary-adrenal axis
(b) 2 only 3. Increased level of progesterone immediately
(c) Both 1 and 2 before labour
(d) Neither 1 nor 2 4. Increased synthesis of myometrial receptors for

(c)

Sol
Both 1 and 2

Oligohydramnios refers to an abnormally low amniotic fluid volume. Two common ultrasound indices are used: the maximum vertical pocket (MVP) and the amniotic fluid index (AFI). MVP < 2 cm is sometimes used, but many definitions accept <5 cm as a cutoff. AFI < 5 cm is likewise a standard criterion for oligohydramnios. Therefore, both statements (maximum vertical pocket <5 cm and AFI <5 cm) can be correct in typical obstetric practice.
oxytocin due to effect of oestrogen
Select the correct answer using the code given below.
44. Which of the following are correct about endocrine (a) 1, 2 and 3
changes in normal pregnancy? (b) 1, 2 and 4
1. Increase in levels of maternal serum iodine (c) 1, 3 and 4
2. Increase in serum levels of Corticotropin- (d) 2, 3 and 4
Releasing Hormone (CRH)
(b)

Sol
1, 2 and 4

Multiple factors help trigger labour. Uterine distension (1) contributes by increasing irritability and prostaglandin release. Foetal hypothalamic-pituitary-adrenal axis activation (2) raises fetal cortisol (and CRH), fueling downstream changes. Meanwhile, oestrogen upregulates oxytocin receptors in the myometrium (4). However, an immediate “rise” in progesterone just before labour is not typical; rather, there is functional progesterone withdrawal or a relative decrease in its dominance. Thus, statements 1, 2, and 4 best explain the onset of labour.

3. Increase in serum levels of aldosterone

4. Increase in serum levels of ACTH 49. A 30-year-old female P₂L₂ had a forceps delivery
Select the answer using the code given below. 2 days back. There was injury to head of baby
(a) 1, 2 and 3 resulting in collection of blood in soft tissue between
(b) 1, 2 and 4 pericranium and flat bone of skull, limited by suture
(c) 1, 3 and 4 line. What is the probable diagnosis?
(d) 2, 3 and 4 (a) Caput succedaneum

(d)

Sol
2, 3 and 4

Pregnancy induces multiple hormonal adjustments. Placental production of CRH rises, stimulating increased cortisol; maternal aldosterone secretion also increases (contributing to fluid retention); and maternal ACTH levels can increase in parallel with placental hormones. Although maternal thyroid function is altered, actual “serum iodine” does not necessarily increase—in fact, iodine deficiency can be a concern if dietary intake is inadequate. Hence, statements 2, 3, and 4 are recognized changes, while statement 1 is not universally correct.
(b) Intraventricular haemorrhage
(c) Cephalohaematoma
45. Which of the following features are correct regarding (d) Subgaleal haemorrhage
onset of true labour?
(c)

Sol
Cephalohaematoma

A cephalohaematoma is a subperiosteal hemorrhage confined by cranial suture lines. Typically, it arises during instrumental delivery or birth trauma when periosteal blood vessels are ruptured. Because the periosteum is tightly adhered at the suture margins, the swelling does not cross suture lines. This contrasts with a caput succedaneum, which is a more diffuse edema of the scalp that can cross sutures. Subgaleal hemorrhage can cross sutures but usually extends widely under the aponeurotic layer.

1. Regular uterine contractions

2. Progressive cervical dilation and effacement 50. Which of the following are correct regarding
3. Presence of show pathological findings of placenta accreta?
4. Labour and delivery are synonymous 1. Absence of decidua basalis
Select the answer using the code given below. 2. Absence of Nitabuch’s fibrinoid layer
(a) 1, 2 and 3 3. Loss of normal hypoechoic retroplacental
(b) 1, 2 and 4 myometrial zone in ultrasonography
(c) 1, 3 and 4 Select the answer using the code given below.
(d) 2, 3 and 4 (a) 1 and 2 only

(a)

Sol
1, 2 and 3

True labor is characterized by regular, painful uterine contractions that lead to progressive cervical changes (dilation and effacement). A show (passage of blood-tinged mucus plug) often heralds that these changes are underway. “Labour” refers to the process from onset of regular contractions and cervical effacement/dilatation to the baby’s delivery—whereas “delivery” is just one culmination stage of labor. They are not strictly synonymous (making statement 4 incorrect). Hence, items 1, 2, and 3 define true labor onset.
(b) 2 and 3 only
(c) 1 and 3 only
46. According to the WHO Intrapartum Care Guidelines, (d) 1, 2 and 3
2018, the active phase of labour starts from what
(d)

Sol
1, 2 and 3

Placenta accreta spectrum involves an abnormal trophoblastic invasion into the uterine wall. Pathologically, there is often an absence of the decidua basalis (1) and absence or defect of Nitabuch’s layer (2). On imaging, the typical ultrasound sign includes loss of the normal hypoechoic (clear) retroplacental space (3) as the placenta invades directly into the myometrium. All three features help characterize the condition, leading to difficulties with placental separation at delivery and a risk of massive hemorrhage.

dilation of cervix?
(a) 3 cm 51. Which of the following statements are correct
(b) 4 cm regarding peripartum cardiomyopathy?
(c) 5 cm 1. It is usually seen in multiparous women.
(d) 6 cm 2. Echocardiography shows ejection fraction less

(c)

Sol
5 cm

While older obstetric texts sometimes cited 3–4 cm dilation as the onset of active labour, the 2018 WHO Intrapartum Care Guidelines emphasize that the active phase generally begins around 5 cm. From that point onward, cervical dilatation tends to accelerate more predictably. This updated threshold helps avoid unnecessary interventions (e.g., diagnosing “failure to progress” too early). Thus, 5 cm reflects the contemporary WHO standard for defining the start of the active phase.
than 45%.
3. ACE inhibitors are contraindicated.
4. History of prior heart disease is mostly present.
MEDINK Question Paper 2024 page 11

Select the answer using the code given below.
(b)

Sol
Inevitable abortion

In early pregnancy, inevitable abortion is suggested by vaginal bleeding, cramping lower abdominal pain, and cervical dilation such that products of conception are palpable or can be seen. In threatened abortion, the cervical os remains closed. Incomplete abortion typically involves partial passage of some products, leaving residual tissue. Septic abortion includes infection signs (fever, foul discharge). Because here the os is open and the products of conception are still in utero but palpable, the scenario fits “inevitable abortion.”

(a) 1 and 2 only

(b) 1, 2 and 3 56. Which one of the following is a common pathology
(c) 3 and 4 only associated with ureteric injury while performing
(d) 1, 3 and 4 surgical procedure of abdominal hysterectomy?

(b)

Sol
1, 2 and 3

Peripartum cardiomyopathy typically manifests toward the end of pregnancy or in the months following delivery, especially in multiparous women (1) with no prior known cardiac history. An ejection fraction under 45% (2) on echocardiography is a key diagnostic criterion. During pregnancy, ACE inhibitors are contraindicated (3) because they can be teratogenic (and postpartum they can be used cautiously, but generally avoided in pregnancy). A prior heart disease history is not usually present, making statement 4 incorrect.
(a) Pelvic endometriosis
(b) Adenomyosis
52. Mrs. A, who is 9 months pregnant, presents to the (c) Hydrosalpinx
labour room with complaints of severe pain in (d) Ovarian teratoma
abdomen and vaginal bleeding for 30 minutes.
(a)

Sol
Pelvic endometriosis

Ureteric injuries during hysterectomy often stem from distorted pelvic anatomy and inflammation. Pelvic endometriosis can cause scarring and adhesions that pull or encase the ureter, increasing the risk of inadvertent damage during uterine or adnexal dissection. Adenomyosis affects the uterine wall itself and is less typically implicated in ureteral distortion. Hydrosalpinx (dilated fallopian tube) and ovarian teratoma do not commonly entrap or displace the ureter in the manner endometriosis can.

She is 2nd gravida (producing second child) and

delivered her first child 2 years back by caesarean 57. Which of the following are correct regarding
delivery. On examination, she has scar tenderness, pathology of stress urinary incontinence?
vaginal bleeding and haematuria. On CTG, she has 1. Hypermobility of urethra
an abnormal FHR tracing. What is her likely clinical 2. Ascend of bladder neck and proximal urethra
diagnosis? above pelvic diaphragm
(a) Urinary tract infection 3. Lowered urethral pressure
(b) Scar rupture/dehiscence during labour 4. Increased detrusor activity
(c) Labour pain Select the answer using the code given below.
(d) Rupture of urinary bladder (a) 1 and 2

(b)

Sol
Scar rupture/dehiscence during labour

Sudden onset of severe abdominal pain, vaginal bleeding, abnormal fetal heart rate (FHR) tracing, scar tenderness over a previous cesarean site, and even hematuria suggests that the uterine incision may have ruptured into adjacent structures (e.g., bladder). These features are highly suspicious for uterine scar rupture. A simple urinary tract infection would not typically produce the acute hemorrhage or the FHR changes. True labour pain alone does not explain the alarming signs.
(b) 1 and 3
(c) 2 and 4
53. A 28-year-old female G₂P₁L₁ with history of previous (d) 3 and 4
caesarean presents to the gynaecology emergency in
(b)

Sol
1 and 3

Stress urinary incontinence (SUI) typically arises from urethral hypermobility (1) when support structures of the bladder neck weaken, allowing it to descend with increased intra-abdominal pressure. Additionally, lowered urethral closing pressure (3) contributes to leakage. The bladder neck does not ascend; it descends in SUI. Increased detrusor activity is related to urge incontinence (overactive bladder), not stress incontinence. Hence, 1 and 3 accurately describe the pathophysiology of SUI.

labour. On examination, she is hypotensive, foetal

heart sounds are absent and foetal parts are easily 58. Which of the following operative procedures is/are
palpable. What is her diagnosis? confirmatory for the diagnosis of bicornuate uterus?
(a) Oligohydramnios (a) Dilation with curettages
(b) Abruptio placentae (b) Hysteroscopy
(c) Uterine rupture (c) Hysteroscopy and laparoscopy
(d) Hydatidiform mole (d) Hysterectomy

(c)

Sol

(c)

Sol Hysteroscopy and laparoscopy
Uterine rupture

Bicornuate uterus is a congenital uterine anomaly involving a central myometrial indentation. Hysteroscopy alone shows the internal cavity’s division but cannot fully assess the external fundal contour. Laparoscopy directly visualizes the external uterine surface. When done together, they confirm whether the uterus is bicornuate (single external indentation) versus septate (normal external contour but septum internally). D&C or hysterectomy are not “confirmatory” in the diagnostic sense; hysterectomy is a definitive removal, not typically used simply for diagnosis.
In a pregnant woman with a prior cesarean scar, acute hypotension, loss of fetal heart sounds, and the ability to palpate fetal parts distinctly often indicate complete uterine rupture. The uterus tears, typically at the old scar, allowing fetal parts to extrude partially or wholly into the abdominal cavity. Abruptio placentae (premature placental separation) can cause shock and abnormal fetal heart rates, but does not usually lead to such an obvious palpation of fetal parts externally.

54. A 24-year-old primigravida comes to ANC clinic at 8 59. Which of the following are correct regarding pelvic
months amenorrhoea. Her BP is found to be 160/100 cellular tissue?
mm Hg. Lab findings reveal thrombocytopenia, 1. It supports the pelvic organs.
increased SGOT/SGPT and LDH. What is her 2. It forms protective sheath for blood vessels and
diagnosis? terminal part of ureter.
(a) Obstetric cholestasis 3. It prevents infection to be spread out of pelvis.
(b) Hepatitis B 4. Marked hypertrophy of pelvic cellular tissue
(c) HELLP syndrome occurs in pregnancy.
(d) Eclampsia Select the answer using the code given below.

(c)

Sol
HELLP syndrome

HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. It is a variant of severe preeclampsia/eclampsia with significant hepatic involvement. The patient’s high blood pressure (160/100 mmHg), thrombocytopenia (low platelets), and elevated liver enzymes (SGOT/SGPT) match HELLP. Obstetric cholestasis typically presents with pruritus and elevated bile acids. Acute viral hepatitis involves different clinical/laboratory patterns. Eclampsia adds seizures to severe preeclampsia signs but does not specifically require the combination of hemolysis and low platelets.
(a) 1, 2 and 3
(b) 1, 2 and 4
55. A patient, who is 2 months pregnant, reports to (c) 1, 3 and 4
a hospital with complaints of increased vaginal (d) 2, 3 and 4
bleeding and pain in lower abdomen. Internal
(b)

Sol
1, 2 and 4

The pelvic cellular (endopelvic) connective tissue is a key supportive framework that holds pelvic organs in position (1) and conveys blood vessels, lymphatics, and ureters (2). During pregnancy, it undergoes marked hypertrophy to accommodate increased vascular and structural demands (4). While it may limit or compartmentalize some infections, it does not definitively “prevent infection from spreading out of the pelvis” (3 is an overstatement). Thus, 1, 2, and 4 are the accurate statements.

examination reveals dilated internal os of cervix and

products of conception are felt through it. What is her 60. Which of the following are correct regarding
likely clinical diagnosis? androgen insensitivity syndrome?
(a) Threatened abortion 1. Inherited as X-linked recessive disorder
(b) Inevitable abortion 2. Karyotype is 46 XXY
(c) Septic abortion 3. It is also called testicular feminization
(d) Incomplete abortion 4. Confirmation of diagnosis by gonadal biopsy
CMS Paper-II Question Paper 2024 MEDINK

Select the answer using the code given below. (b) 1, 2 and 4
(a) 1, 2 and 3 (c) 1, 3 and 4
(b) 1, 2 and 4 (d) 2, 3 and 4
(c) 1, 3 and 4
(c)

Sol
1, 3 and 4

Admission for PID is advised when (1) the patient is pregnant (to safeguard fetus and ensure parenteral therapy), (3) a tubo-ovarian abscess is suspected (requires more intensive management), or (4) the patient has significant immunocompromise (e.g., HIV infection), as outpatient therapy may fail. Mild fever and pain responding readily to antibiotics (statement 2) generally do not require hospitalization. Hence, criteria 1, 3, and 4 are the main recognized indications for inpatient treatment.

(d) 2, 3 and 4

(c)

Sol
1, 3 and 4

Complete Androgen Insensitivity Syndrome (AIS), also termed testicular feminization (3), is typically X-linked recessive (1). Individuals have a 46 XY karyotype (not XXY), rendering statement 2 incorrect. They produce normal or high male-range androgens, but target tissues cannot respond due to androgen-receptor gene mutations on the X chromosome. Diagnosis is often confirmed by finding testes (e.g., in the inguinal canal or abdomen), sometimes via gonadal biopsy (4). Externally, these patients present with female phenotype but lack a fully developed uterus/upper vagina.
65. A young female presented with complaints of lower
abdominal pain, vaginal discharge, history of IUD
61. Which of the following are useful investigations for use for last 3–4 years. On examination, the patient
diagnosis of unresponsive endometrium as a cause of had fever, adnexal/cervical motion tenderness and
primary amenorrhoea? increased ESR and C-reactive protein. What is the
1. Karyotype probable clinical diagnosis?
2. Progesterone challenge test (a) Ectopic pregnancy
3. Hormonal studies (b) Acute appendicitis
4. Hysterosalpingography (c) Diverticulitis
Select the correct answer using the code given below. (d) Acute PID
(a) 1, 2 and 3
(d)

Sol
Acute PID

Pelvic inflammatory disease (PID) often presents with lower abdominal or pelvic pain, abnormal vaginal discharge, and cervical motion tenderness (Chandelier sign). Fever and elevated inflammatory markers (ESR, CRP) are classic in moderate to severe cases. Prolonged intrauterine device use can be a risk factor, especially if there are additional risk behaviors. Ectopic pregnancy or appendicitis may have some overlapping signs, but the specific combination of cervical/adnexal tenderness and discharge strongly suggests acute PID.

(b) 1, 2 and 4
(c) 1, 3 and 4 66. Which of the following are risk factors for Pelvic
(d) 2, 3 and 4 Inflammatory Disease (PID)?

(a)

Sol
1, 2 and 3

When primary amenorrhoea is suspected to be due to an “unresponsive” endometrium, the clinician must determine if the issue lies in hormonal stimulation or the uterus itself. Karyotyping excludes chromosomal abnormalities. A progesterone challenge test assesses whether sufficient endogenous estrogen has primed the endometrium (and if the outflow tract is intact). Hormonal assays (FSH, LH, prolactin, TSH, etc.) help clarify if the ovaries are producing adequate hormones. By contrast, hysterosalpingography is more useful for tubal patency and is not routinely required for diagnosing endometrial non-responsiveness.
1. Use of contraceptive pills
2. IUD use
62. A 16-year-old girl with primary amenorrhoea 3. Genetic predisposition
presents to the gynaecology OPD for evaluation. 4. Sexually active teenagers
She has normal secondary sexual characters. Her Select the correct answer using the code given below.
karyotype is 46,XX and ultrasound reveals normal (a) 1, 2 and 3
ovaries and tubes but absent uterus. What is her (b) 2, 3 and 4
clinical diagnosis? (c) 1, 3 and 4
(a) Androgen insensitivity syndrome (d) 1, 2 and 4
(b) Turner syndrome
(d)

Sol
1, 2 and 4

Although modern data sometimes suggest oral contraceptives can reduce PID severity, certain sources/classic teaching still list contraceptive pills (1) as a risk factor because they may increase cervical ectopy, making the cervix more susceptible to infection. IUD use (2) is a known risk, especially within the first few weeks after insertion. Sexually active teenagers (4) have higher rates of STIs due to multiple factors (e.g., less consistent condom use). Genetic predisposition (3) is not commonly cited for PID risk.

(c) Mayer-Rokitansky-Küster-Hauser syndrome

(d) Primary ovarian failure 67. Which of the following are symptoms of genital

(c)

Sol
Mayer-Rokitansky-Küster-Hauser syndrome

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome involves congenital absence of the uterus and upper part of the vagina in an otherwise genetically female (46,XX) individual. Because the ovaries function normally, patients typically have normal development of secondary sexual characteristics (breast development, pubic hair). Turner syndrome (45,X) usually presents with poor secondary sexual development. Androgen insensitivity syndrome has a 46,XY karyotype. Primary ovarian failure would generally impair secondary sexual development due to inadequate estrogen production.
tuberculosis?
1. Postmenopausal bleeding
63. A 25-year-old female comes to the gynaecology 2. Infertility
OPD for evaluation of secondary amenorrhoea. She 3. Chronic pelvic pain
gives history of previous dilatation and curettage, 4. Oligomenorrhoea
and her FSH levels are 8 IU/L. The probable cause Select the correct answer using the code given below.
of amenorrhoea is (a) 1, 2 and 3
(a) Sheehan syndrome (b) 1, 2 and 4
(b) Asherman syndrome (c) 1, 3 and 4
(c) Premature ovarian failure (d) 2, 3 and 4
(d) Incomplete abortion
(d)

Sol
2, 3 and 4

Genital tuberculosis typically presents with infertility (2), often accompanied by chronic pelvic pain (3) and menstrual disturbances such as oligomenorrhea or amenorrhea (4). Although postmenopausal bleeding (1) can occur in rare cases, it is less commonly recognized as a classic presenting feature compared with disturbances in reproductive-age women. Hence, the principal symptomatic triad involves infertility, pelvic pain, and irregular menses.

(b)

Sol
Asherman syndrome

68.
Asherman syndrome results from intrauterine adhesions/scarring, most often following a uterine procedure such as a D&C. The normal or low FSH (8 IU/L) rules out primary ovarian insufficiency (where FSH would be elevated). Sheehan syndrome (pituitary failure post-partum hemorrhage) does not fit well with this post-D&C scenario. Incomplete abortion would not typically cause a prolonged secondary amenorrhoea after a prior procedure. Hence, Asherman syndrome (intrauterine synechiae) is the most likely diagnosis.

Which one of the following is correct regarding

64. Which of the following criteria are required to choriocarcinoma?
be fulfilled for hospitalization in a case of pelvic (a) Vaginal bleeding is the commonest presenting
inflammatory disease? symptom
1. Coexisting pregnancy (b) About 20–30% of patients with molar
2. Mild fever and pain responding well to pregnancies develop choriocarcinoma
antibiotics (c) Primary site of involvement is fallopian tube
3. Suspected tubo-ovarian abscess (d) Highly resistant tumour to chemotherapy
4. Coexistent HIV infection
(a)

Sol
Vaginal bleeding is the commonest presenting symptom

Choriocarcinoma most frequently presents with irregular or excessive vaginal bleeding, often following a molar pregnancy or, less commonly, after abortion or term delivery. The figure of “20–30%” progression from all molar pregnancies is an overestimate (the progression is significantly lower, especially with modern follow-up). The uterine body, not the fallopian tube, is the usual site of origin. Choriocarcinomas are also notably chemosensitive, not resistant, leading to high cure rates with appropriate regimens.

Select the correct answer using the code given below.

(a) 1, 2 and 3
MEDINK Question Paper 2024 page 13

69. Which of the following are favourable factors in 74. Which of the following are indications of cold knife
prognosis of ovarian malignancy? conization?
1. Older age group 1. Inconsistent finding colposcopy, cytology and
2. Well-differentiated tumour directed biopsy
3. Smaller tumour volume 2. Persistent CIN-1 lesion in women willing for
4. Absence of ascites future fertility
Select the correct answer using the code given below. 3. Carcinoma in situ
(a) 1, 2 and 3 4. Unsatisfactory colposcopic finding where
(b) 1, 2 and 4 margin of lesion is not visible
(c) 1, 3 and 4 Select the correct answer using the code given below.
(d) 2, 3 and 4 (a) 1, 2 and 3

(d)

Sol
2, 3 and 4

Favorable prognostic indicators in ovarian cancer include a well-differentiated (lower grade) tumor (2), smaller tumor burden (3) at the time of diagnosis/debulking, and absence of malignant ascites (4). Younger (not older) patient age is also generally a better prognostic factor, so statement 1 is incorrect. Thus, well-differentiation, limited disease volume, and no ascites portend an improved outcome.
(b) 1, 2 and 4
(c) 1, 3 and 4
70. Which one of the following drugs is most effective in (d) 2, 3 and 4
the treatment of gestational trophoblastic neoplasia?
(c)

Sol
1, 3 and 4

Cold knife conization is an excisional diagnostic/therapeutic procedure indicated when: (1) colposcopic, cytologic, and biopsy results are discordant (inconsistent findings), (3) carcinoma in situ (CIN 3) must be ruled out or definitively treated, and (4) the colposcopic exam is unsatisfactory (lesion margins cannot be seen). While persistent low-grade (CIN-1) lesions can require further intervention, the more typical approach is ablative therapy or LEEP/laser excision rather than a cold knife conization, making statement 2 less standard.

(a) Cisplatin
(b) Methotrexate 75. Which of the following are factors for poor outcome
(c) Gemcitabine following tuboplasty?
(d) None of the above 1. Dense pelvic adhesions

(b)

Sol
Methotrexate

Methotrexate (often with folinic acid rescue) is the mainstay, first-line chemotherapy for low-risk gestational trophoblastic neoplasia (GTN). It achieves high cure rates with relatively tolerable side effects. Cisplatin and other agents (e.g., EMA-CO regimens using etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) may be reserved for high-risk cases or methotrexate resistance. Gemcitabine is not a standard first-line in GTN.
2. Length of reconstructed tube less than 8 cm
3. Bilateral hydrosalpinx
71. A 48-year-old female underwent total hysterectomy 4. Reversal after 5 years of sterilization procedure
with bilateral salpingo-oophorectomy. The surgical Select the correct answer using the code given below.
specimen revealed solid ovarian tumour and (a) 1, 2 and 3
histology revealed thecoma-fibroma. Which one (b) 1, 2 and 4
of the following is the most appropriate statement (c) 1, 3 and 4
regarding this condition? (d) 2, 3 and 4
(a) 20% of such tumours are bilateral.
(a)

Sol
1, 2 and 3

Success after tubal reconstructive surgery depends on minimal scarring and adequate length of functional tube. Dense pelvic adhesions (1) reduce operative success and increase the risk of postoperative re-occlusion. A very short remaining tube (2) (< 8 cm in some references, or even < 4 cm in others) decreases the chance of natural conception. Bilateral hydrosalpinx (3) similarly lowers fertility rates. While age and other factors (e.g., interval from sterilization) can matter, they are generally less definitive “poor outcome” predictors than the first three.

(b) Endometrial hyperplasia is often associated.

(c) It is always associated with gross ascites. 76. Ulipristal acetate (progesterone receptor modulator)
(d) It is derived from germ cells. should not be prescribed as emergency contraceptive

(b)

Sol
Endometrial hyperplasia is often associated.

Ovarian thecoma-fibroma tumors belong to the sex-cord stromal category and can secrete estrogen. This excess estrogen frequently leads to endometrial hyperplasia or even endometrial carcinoma in some cases. Bilaterality in these tumors is relatively uncommon (significantly less than 20%). While they can be linked with ascites (especially fibromas in Meigs’ syndrome), it is not invariably present. Germ cell origin is incorrect; thecomas/fibromas arise from the ovarian stroma.
in women with
(a) glaucoma
72. In POPQ classification for uterovaginal prolapse, the (b) liver dysfunction
only measurement done after reducing the prolapse is (c) kidney failure
(a) genital hiatus (d) coagulopathy
(b) point C
(b)

Sol
liver dysfunction

Ulipristal acetate is metabolized primarily by the liver. In the presence of significant hepatic dysfunction, its metabolism and clearance can be impaired, potentially leading to toxicity or reduced efficacy. Therefore, women with acute or severe liver disease are contraindicated from using ulipristal for emergency contraception. Glaucoma, kidney failure, and coagulopathies are not standard listed contraindications for ulipristal.

(c) point D
(d) total vaginal length 77. Injectable medroxyprogesterone IP 150 mg/mL

(d)

Sol
total vaginal length

The Pelvic Organ Prolapse Quantification (POPQ) system designates various reference points (Aa, Ba, Ap, Bp, C, D) and measurements (genital hiatus, perineal body, total vaginal length). Total vaginal length (TVL) is measured from the hymenal ring to the apex of the vagina after the prolapse has been manually reduced. All other points (C, D, etc.) are recorded in situ without necessarily reducing the prolapse. This ensures an accurate assessment of the full vaginal canal length independent of the prolapsed segment.
contraceptive injection is available in Family Health
Programme of the Government of India under the
73. Which of the following are essential steps of name
Fothergill’s operation? (a) Saheli
1. Laparoscopic or vaginal ligation (b) Sayana Press
2. Amputation of cervix (c) Antara
3. Plication of Mackenrodt’s ligaments in front of (d) Sahiba
cervix
(c)

Sol
Antara

Under the National Family Planning Programme in India, “Antara” is the brand name for the intramuscular depot medroxyprogesterone acetate (DMPA) injection containing 150 mg/mL. “Sayana Press” is a slightly lower dose (104 mg) DMPA formulation for subcutaneous use. “Saheli” (or centchroman/ormeloxifene) is a non-steroidal oral contraceptive. “Sahiba” is not the government’s brand name for DMPA.

4. Ant colporrhaphy
Select the correct answer using the code given below. 78. Which of the following are major complications of
(a) 1, 2 and 3 oral pills?
(b) 1, 2 and 4 1. Cholestasis jaundice
(c) 1, 3 and 4 2. Chloasma and acne
(d) 2, 3 and 4 3. Venous thromboembolism

(d)

Sol
2, 3 and 4

Fothergill’s operation (Manchester operation) is a uterine-sparing procedure for mild uterine descent. The key steps include amputation of the elongated cervix (2), plication of the cardinal (Mackenrodt’s) ligaments (3) at the cervix’s anterior aspect to provide better support, and commonly an anterior colporrhaphy (4) to address any associated cystocele. “Laparoscopic or vaginal ligation” (1) does not describe a standard essential step of this classic operation.
4. Breast cancer
CMS Paper-II Question Paper 2024 MEDINK

Select the correct answer using the code given below. 83. A table shows three broad components under which
(a) 1, 2 and 3 the objectives of the National Health Policy, 2017 can
(b) 1, 2 and 4 be grouped, along with an example of goal/objective
(c) 1, 3 and 4 under that component:
(d) 2, 3 and 4 1. Health status & programme impact → Increase

(c)

Sol
1, 3 and 4

Recognized serious complications of combined oral contraceptive pills include cholestatic jaundice (hepatic effects), venous thromboembolism (particularly in predisposed women), and a possible slight increase in breast cancer risk with long‐term use. While chloasma (melasma) and mild skin changes can certainly occur, they are usually considered minor side effects rather than “major complications.” Thus, items 1, 3, and 4 are most typically categorized as significant or “major” risks.
life expectancy at birth from 67.5 to 70 years by
2025
79. Which of the following conditions are indications of 2. Health systems performance → More than 90%
removal of intrauterine device? of the newborn are fully immunized by one
1. Persistent irregular uterine bleeding year of age by 2025
2. Perforation of uterus 3. Health systems strengthening → Increase State
3. Pyelonephritis sector health spending to more than 8% of their
4. Pregnancy with device in situ budget by 2020
Select the correct answer using the code given below. How many of the pairs given above are correctly
(a) 1, 2 and 3 matched?
(b) 1, 2 and 4 (a) None of the pairs
(c) 1, 3 and 4 (b) Only one of the pairs
(d) 2, 3 and 4 (c) Only two of the pairs
(d) All of the three pairs

(b)

Sol
1, 2 and 4

Indications for removing an intrauterine device include persistent or unacceptable uterine bleeding, uterine perforation, or pregnancy with the device in place (to reduce infection/miscarriage risk). Pyelonephritis alone is not a standard direct indication for IUD removal unless it is thought to be part of a severe pelvic infection or complicated UTI. Therefore, 1, 2, and 4 are the classic reasons to remove the IUD.

(d)

Sol
All of the three pairs

80.
The National Health Policy (NHP) 2017 indeed sets targets/examples under these three broad headings: improving overall health status/impact (e.g., raising life expectancy), health system performance (e.g., high immunization coverage), and health system strengthening (e.g., increased government health spending). Each pair in the table is accurately matched to its corresponding objective in the policy.

A 25-year-old newly married female on liver enzyme

inducers is requesting contraceptive advice in family 84. Consider the following management methods/
planning clinic. Which of the following would be the techniques:
most reliable method of contraception for her? 1. System analysis
(a) Combined oral contraceptive pill 2. Organizational design
(b) Male condom 3. Personnel management
(c) Diaphragm 4. Information systems
(d) Depo-Provera injection Which of the above methods/techniques are based on
behavioural sciences?

(d)

Sol
Depo-Provera injection

Women taking certain enzyme-inducing medications (e.g., rifampicin, some anticonvulsants) experience decreased blood levels of estrogens/progestins from oral contraceptives, resulting in higher failure rates. Depot medroxyprogesterone acetate (DMPA) injections, often branded “Depo-Provera,” maintain relatively stable levels and are less affected by hepatic enzyme induction. While condoms or diaphragms may provide non-hormonal barriers, they are less reliable in typical use. Depo-Provera offers a high efficacy unaffected significantly by enzyme inducers.

(a) 1, 2 and 3
81. As per the Open Vial Policy, partially used multidose (b) 1, 2 and 4
vials of which of the following vaccines can be used (c) 1, 3 and 4
over more than one immunization session? (d) 2, 3 and 4
1. BCG vaccine
(a)

Sol
1, 2 and 3

In many standard texts of health management, organizational design (2) and personnel management (3) are clearly in the realm of behavioral sciences, focusing on group dynamics, leadership, and motivation. System analysis (1) can also be partly included under the broader managerial/behavioral approach (exam contexts often lump it in), whereas information systems (4) are typically considered a technical/operational tool rather than purely behavioral. Hence, the official key often lists 1, 2, and 3 as “behavioral sciences” in such classification schemes.

2. DPT vaccine
3. Hepatitis B vaccine 85. In the following table, the end results of planning are
4. Measles vaccine qualified by brief characteristics:
Select the correct answer using the code given below. 1. Goal → Always constrained by time
(a) 1 and 2 only 2. Objective → Precise—either achieved or not
(b) 2 and 3 only achieved
(c) 1, 2 and 3 3. Target → Permits the concept of degree of
(d) 1, 3 and 4 achievement
How many of the pairs given above are correctly

(b)

Sol
2 and 3 only

Under WHO/UNICEF “open vial” guidelines, inactivated liquid vaccines (like DPT and Hepatitis B) that contain appropriate preservatives can be reused in subsequent sessions, provided they remain sterile and within recommended cold-chain conditions. By contrast, BCG and measles are freeze-dried (lyophilized) vaccines which, once reconstituted, must be discarded within a few hours (generally within six hours or at the end of the session). Therefore, only DPT (2) and Hepatitis B (3) can be used over multiple sessions.

matched?
82. The statement, ‘Health is a dynamic equilibrium (a) None of the pairs
between man and environment and disease (b) Only one of the pairs
a maladjustment of the human organism to (c) Only two of the pairs
environment’ explains which one of the following (d) All of the pairs
concepts of health?
(c)

Sol
Only two of the pairs

Conventionally, an objective is the precise, time-bound end result that is either met or not met (so “Precise—either achieved or not achieved” fits “objective”). A target often refers to a quantifiable measure (degree of achievement). A goal is typically broader, sometimes time-related but not invariably “always constrained by time.” So 2 and 3 match standard definitions, but 1 is usually incorrect. Thus, two of those pairs are correctly matched.

(a) Biomedical
(b) Ecological 86. Consider the following steps of a planning cycle:
(c) Psychosocial 1. Assigning priorities among the problems
(d) Holistic 2. Evaluation
3. Selecting best programme

(b)

Sol
Ecological

The ecological concept of health views human well-being as an ongoing balance or adaptation between the individual and the surrounding environment. Diseases arise when this balance is disturbed (i.e., maladjustment to environmental conditions). The purely biomedical concept focuses on absence of disease in bodily terms, while the psychosocial concept incorporates mental and social factors. The holistic concept merges multiple dimensions but does not specifically emphasize the environment in the manner of the classic “ecological” definition.
MEDINK Question Paper 2024 page 15

4. Operating the programme 90. Consider the following statements regarding dengue:
Which among the following is the correct sequence 1. The mosquito becomes infective after an
of steps? extrinsic incubation period of 8–10 days.
(a) 3 → 4 → 1 → 2 2. Once it becomes infective, the mosquito
(b) 1 → 2 → 3 → 4 remains infective for life.
(c) 1 → 3 → 4 → 2 3. The genital tract of the mosquito does not get
(d) 2 → 3 → 4 → 1 infected.

(c)

Sol
1→3→4→2

A standard planning cycle typically follows: (1) identify and prioritize problems, (3) formulate and select the best solution/program, (4) implement or operate that program, and (2) evaluate the results. This ensures resources go toward the most pressing needs, the chosen intervention is executed, and only then is it evaluated for effectiveness and possible revision. Hence the order is 1 → 3 → 4 → 2.
Which of the statements given above are correct?
(a) 1 and 2 only
87. Which of the following statements are correct for (b) 2 and 3 only
incidence rate? (c) 1 and 3 only
1. It is useful for taking action to control a disease. (d) 1, 2 and 3
2. Rising incidence rates may indicate
(a)

Sol
1 and 2 only

After biting an infected host, Aedes mosquitoes require an extrinsic incubation period (8–10 days) before they can transmit dengue to another individual (statement 1). Once the virus reaches the salivary glands, the mosquito remains infective for the rest of its lifespan (statement 2). However, dengue viruses can infect multiple tissues, and there is evidence in some arboviruses of possible transovarial spread. So the blanket claim that “the genital tract does not get infected” (statement 3) is generally not accepted as correct.

ineffectiveness of the current control

programmes. 91. A researcher has obtained the country-level data
3. Fluctuation in incidence rate may indicate a on the average Body Mass Index (BMI) and the
change in aetiology of disease. average sugar intake for 100 countries. Which
Select the answer using the code given below. among the following will be best suited to present
(a) 1 and 2 only the relationship between BMI and sugar intake in the
(b) 2 and 3 only 100 countries?
(c) 1 and 3 only (a) Bar chart
(d) 1, 2 and 3 (b) Pie diagram

(d)

Sol
1, 2 and 3

Incidence rate is crucial for public health action since it measures new cases over time (statement 1). If it rises, that may signal failure or inefficacy in current control measures (statement 2). Abrupt changes or fluctuations in incidence can also imply new risk factors or etiologic shifts (statement 3). Hence, all three statements describe valid applications or interpretations of incidence data.
(c) Frequency polygon
(d) Scatter diagram
88. Consider the following definition:
(d)

Sol
Scatter diagram

A scatter diagram (scatter plot) is ideal for showing the relationship or correlation between two continuous variables—here, country-level average BMI on one axis and average sugar intake on the other. A bar chart or pie diagram is better for categorical data. A frequency polygon displays the distribution of a single variable. Thus, to visualize how BMI might vary with sugar intake across 100 countries, a scatter diagram is most appropriate.

A high level of infection beginning early in life and

affecting most of the child population, leading to a 92. Frontline health workers are employed to record the
state of equilibrium such that the adult population births and deaths in countries which have made slow
shows evidence of the disease much less commonly progress in the development of a comprehensive vital
than the children. registration system. This approach is known as
Which one of the following terms best fits this (a) registration of vital events
definition? (b) lay reporting
(a) Holoendemic (c) sample registration system
(b) Hyperendemic (d) census
(c) Hypoendemic
(c)

Sol
sample registration system

In the Sample Registration System (SRS), part-time enumerators (often local workers such as anganwadi workers or accredited social health activists) keep continuous records of births and deaths in selected sample units. Independent supervisors periodically verify these. Countries (or regions) that lack universal civil registration adopt this dual-record system to estimate birth and death rates more accurately.

(d) Pandemic

(a)

Sol
Holoendemic

A holoendemic disease is one that infects children at a very high rate, so much so that by adulthood most individuals show evidence of past infection and have developed immunity. As a result, overt disease in adults is much less common. “Hyperendemic” also refers to a high level of ongoing transmission but does not specifically imply the predominance of disease in children compared to adults. “Hypoendemic” and “pandemic” do not fit the definition given.
93. While calculating the ‘total dependency ratio,’ which
one of the following is used in the denominator?
89. Consider the following statements regarding dengue (a) Midyear population
virus: (b) Population 0 to 65 years
1. It has four distinct serotypes. (c) Population 15 to 64 years
2. Infection with any one serotype confers lifelong (d) Population 14 to 70 years
immunity for that virus serotype.
(c)

Sol
Population 15 to 64 years

The dependency ratio compares the “dependent” age groups (usually those < 15 years plus those ≥ 65 years) to the “working-age” population (commonly 15–64 years). Thus, the denominator for the total dependency ratio is the population aged 15–64. This indicates how many dependents exist for every 100 (or 1,000) working-age individuals.

3. Secondary infection with dengue serotype 2

leads to severe form of dengue. 94. As per the United Nations definition of a vital events
Which of the statements given above are correct? registration system, ‘vital events’ include which of
(a) 1 and 2 only the following?
(b) 2 and 3 only 1. Foetal deaths
(c) 1 and 3 only 2. School admissions
(d) 1, 2 and 3 3. Legal separations

(d)

Sol
1, 2 and 3

Dengue virus indeed has four serotypes (DENV-1, -2, -3, -4). An individual infected by one serotype usually acquires lifelong immunity against that particular serotype (statement 2). A secondary infection with a different serotype—particularly DENV-2—is often linked with an increased risk of severe dengue (DHF/DSS). Hence, all three statements are factually correct.
4. College graduations
Select the correct answer using the code given below.
(a) 1 and 2
(b) 1 and 3
CMS Paper-II Question Paper 2024 MEDINK

(c) 2 and 3 100. Consider the following statements about working of

(d) 2 and 4 septic tanks:

(b)

Sol
1 and 3

Under UN guidelines, the vital events for registration include births, deaths, fetal deaths (stillbirths), marriages, divorces—or “legal separations”/annulments in some frameworks—adoptions, and legitimations. Foetal deaths definitely qualify. “Legal separations” may be grouped with divorces/annulments depending on jurisdiction, so it can be considered a vital event for some registration systems. School admissions (2) and college graduations (4) are not vital events. Hence, pairs 1 and 3 represent recognized “vital events.”
1. They are recommended for large communities,
rather than small communities.
95. Consider the following statements about Kyasanur 2. There should be no air space between the level
Forest Disease (KFD): of liquid in the tank and the undersurface of the
1. It is transmitted by ticks. cover.
2. It was originally called ‘pig disease’ because of 3. Liquid effluent from the outlet pipe is free from
the association with dead pigs. all pathogens.
3. It was first recognized in Karnataka State. How many of the statements given above are correct?
How many of the statements given above are correct? (a) None of the statements
(a) None of the statements (b) Only one of the statements
(b) Only one of the statements (c) Only two of the statements
(c) Only two of the statements (d) All the three statements
(d) All the three statements
(a)

Sol
None of the statements

(1) Septic tanks are generally recommended for small settlements or individual households, not large communities (which typically need full-scale sewage treatment). (2) There is usually a space between the liquid and the cover, allowing gases to accumulate and vent. (3) The effluent is not completely free of pathogens; it still contains microorganisms and may require soak-pit dispersion or further treatment. Therefore, none of the given statements are correct.

(c)

Sol
Only two of the statements

KFD is a tick-borne viral hemorrhagic fever first identified in the Kyasanur Forest of Karnataka, India (statement 1 is true, statement 3 is true). It is primarily associated with monkeys (especially dead langurs), not pigs—hence the popular name was not “pig disease.” So statement 2 is incorrect. Therefore, exactly two statements (1 and 3) are correct.

101. Of the following amino acids, which is categorized as

96. In countries with low levels of measles transmission, a nonessential amino acid?
what should be the appropriate age for starting (a) Leucine
immunization with measles-containing vaccine (b) Threonine
(MCV)? (c) Tryptophan
(a) 6 months (d) Proline
(b) 9 months
(d)

Sol
Proline

Essential amino acids are those the body cannot synthesize in sufficient quantities and must therefore come from the diet. Leucine, threonine, and tryptophan are all essential in humans. Proline, on the other hand, can be synthesized endogenously from other metabolic precursors, making it a nonessential amino acid.

(c) 12 months
(d) 15–18 months 102. Consider the following milks :

(c)

Sol
12 months

Where measles transmission is high (often in developing regions), WHO generally recommends the first measles dose at 9 months to protect infants early. However, in low-transmission settings—i.e., places that have effectively reduced measles circulation—the recommended first dose often shifts to around 12 months to optimize seroconversion and longer-lasting immunity.
1. Buffalo milk
2. Cow milk
97. Monkeypox, a viral zoonotic disease, is caused by 3. Goat milk
(a) a single-stranded RNA virus 4. Human milk
(b) a double-stranded RNA virus What is the correct order (from highest to lowest)
(c) a single-stranded DNA virus with regard to fat content per 100 g in the milk?
(d) a double-stranded DNA virus (a) 1 → 3 → 4 → 2
(b) 4 → 2 → 3 → 1

(d)

Sol
a double-stranded DNA virus

Monkeypox belongs to the Orthopoxvirus genus (which includes smallpox virus) of the Poxviridae family. These viruses are large, brick-shaped, and contain double-stranded DNA. In contrast, many other zoonotic viruses (e.g., influenza, rabies) are single-stranded RNA viruses.

(c) 2 → 1 → 4 → 3
98. Raju, a 6-year-old boy, was returning home from (d) 1 → 3 → 2 → 4
school. At the gate, he was scratched by a dog and
(d)

Sol
1→3→2→4

Typical average fat contents are highest in buffalo milk (around 7–8 %), followed next by goat milk (3.8–4.1 %), then cow milk (3.0–4.0 %), and human milk often around 3–4 % but generally on the lower side in standard references when directly compared. Thus the descending order of fat percentage is Buffalo (1) Goat (3) Cow (2) Human (4).

there was some bleeding from the wound. Which

option should be followed for the post-exposure 103. Which of the following are unsaturated fatty acids?
prophylaxis? 1. Lauric acid
(a) Wash the wound and administer a shot of 2. Linoleic acid
tetanus toxoid 3. Oleic acid
(b) Wash the wound and vaccinate with ARV only 4. Palmitic acid
(c) Wash the wound, vaccinate with ARV and Select the correct answer using the code given below.
administer immunoglobulin (a) 1 and 2
(d) Wash and apply antiseptic to the wound (b) 1 and 4
(c) 2 and 3

(c)

Sol
Wash the wound, vaccinate with ARV and administer immunoglobulin

A dog scratch drawing blood is typically treated as a Category III exposure under rabies guidelines. Proper management includes: immediate and thorough washing of the wound, vaccination with anti-rabies vaccine (ARV), and immunoglobulin if the animal is high-risk or unvaccinated (and the wound is severe). Tetanus prophylaxis may also be needed, but the key rabies steps are wound washing, vaccine, and immunoglobulin for Category III.

(d) 3 and 4
99. The method of combined disposal of refuse and night
(c)

Sol
2 and 3

Lauric acid (12 : 0) and palmitic acid (16 : 0) are saturated fatty acids. Linoleic acid (18 : 2) is a polyunsaturated essential fatty acid, and oleic acid (18 : 1) is monounsaturated. Hence 2 (linoleic) and 3 (oleic) are the unsaturated fatty acids in this list.

soil is known as
(a) dumping 104. In India, the most widely prevalent stage of iron
(b) controlled tipping deficiency is
(c) incineration (a) decreased iron stores without any other
(d) composting detectable abnormalities
(b) fall in percentage saturation of transferrin

(d)

Sol
composting

Composting is a biological process in which organic wastes, including biodegradable refuse and in some methods even night soil (human excreta), are decomposed by microorganisms under controlled conditions. This produces nutrient-rich compost. “Controlled tipping” (sanitary landfill) is largely for refuse disposal alone. “Incineration” is high-temperature burning typically used for biomedical or hazardous waste, and “dumping” is just open disposal without treatment.
MEDINK Question Paper 2024 page 17

(c) overt iron deficiency with impaired (b) Farmer’s lung

haemoglobin synthesis (c) Lead poisoning
(d) decrease in the concentration of circulating (d) Brucellosis
haemoglobin
(c)

Sol
Lead poisoning

Basophilic stippling of RBCs (small, dark-blue granules) is characteristically seen in lead poisoning. Lead interferes with enzymes of heme synthesis, resulting in accumulated ribosomal precipitates that appear as stippling. Asbestosis and farmer’s lung involve lung pathology without this RBC change, and brucellosis is a bacterial zoonosis, also not associated with basophilic stippling.

(a)

Sol
decreased iron stores without any other detectable abnormalities

109. Consider the following pairs of genetic diseases that

Iron deficiency typically progresses in stages: first, ferritin and stored iron are depleted (still no obvious lab or clinical anomalies). Next, further changes manifest as low serum iron and transferrin saturation. Finally, haemoglobin production and RBC indices drop, resulting in iron deficiency anaemia. In many community surveys, the earliest/latent stage—loss of iron stores—is believed to be most common in populations, especially in developing countries like India, making option (a) the most widely prevalent stage.

105. Consider the following statements: show Mendelian inheritance. Each of the following
Statement I: Waist circumference and waist to hip pairs represents a genetic disease and it has been
ratio are more powerful predictors of subsequent risk matched with a type of inheritance :
of type 2 diabetes than Body Mass Index (BMI). 1. Cystic fibrosis → Autosomal recessive
Statement II: Central obesity is an important 2. Huntington’s chorea → Autosomal dominant
determinant of insulin resistance, the underlying 3. Marfan’s syndrome → Recessive sex-linked
abnormality in most cases of type 2 diabetes. How many of the pairs given above are correctly
Which one of the following is correct in respect of matched?
the above statements? (a) None of the pairs
(a) Both Statement I and Statement II are correct (b) Only one of the pairs
and Statement II is the correct explanation of (c) Only two of the pairs
Statement I (d) All the three pairs
(b) Both Statement I and Statement II are correct
(c)

Sol
Only two of the pairs

Cystic fibrosis (CF) is indeed autosomal recessive. Huntington’s disease follows autosomal dominant inheritance. Marfan syndrome is also autosomal dominant, not “recessive sex-linked.” Hence pairs 1 and 2 are correct, while 3 is incorrect, so exactly two pairs are correct.

but Statement II is not the correct explanation

of Statement I 110. Consider the following statements:
(c) Statement I is correct but Statement II is Statement I: Signs of thalassemia major usually
incorrect develop after 6 months of age.
(d) Statement I is incorrect but Statement II is Statement II: This is the time when haemoglobin
correct synthesis switches from haemoglobin F to

(a)

Sol
Both Statement I and Statement II are correct and Statement II is the correct explanation of Statement I

Excess central (visceral) fat strongly predisposes to insulin resistance, making waist circumference or waist–hip ratio better predictors of type 2 diabetes than overall BMI. Since statement II (central obesity drives insulin resistance) directly explains why statement I (waist-related measures are more predictive than BMI) is true, both statements are correct, and II explains I.
haemoglobin A.
Which one of the following is correct in respect of
106. Consider the following statement: the above statements?
The people should seek to preserve their traditional (a) Both Statement I and Statement II are correct
eating patterns and lifestyles associated with low and Statement II is the correct explanation of
levels of Coronary Heart Disease (CHD). Statement I
Which level of prevention is implied in this statement? (b) Both Statement I and Statement II are correct
(a) Primordial but Statement II is not the correct explanation
(b) High risk of Statement I
(c) Primary (c) Statement I is correct but Statement II is
(d) Secondary incorrect

(a)

Sol
Primordial

Primordial prevention aims to prevent the emergence and establishment of social, economic, and cultural patterns of living that are known to increase the risk of disease. Encouraging populations to retain healthy traditional diets and lifestyles before risk factors (e.g., high-fat diets, sedentary habits) even develop is a textbook example of primordial prevention. Primary prevention deals with preventing disease in individuals who already have risk factors; primordial prevention is about stopping those risk factors from arising in the first place.
(d) Statement I is incorrect but Statement II is
correct
107. Raju is 30 years of age. He has been working in the
(a)

Sol
Both Statement I and Statement II are correct and Statement II is the correct explanation of Statement I

In β-thalassemia major, newborns appear relatively normal at birth because of high levels of haemoglobin F (fetal). Around 6 months, as HbF declines and adult haemoglobin (HbA) should take over, the defective beta chains become apparent, and clinical symptoms arise. Statement II precisely explains why the major manifestations start after 6 months, making both statements correct with II explaining I.

ceramic and pottery industry for the last 10 years.

Which one of the following conditions should he be 111. Which of the following publications is/are brought
screened for? out by the World Health Organization?
(a) Silicosis 1. CD Alert
(b) Anthracosis 2. Morbidity and Mortality Weekly Report
(c) Byssinosis (MMWR)
(d) Asbestosis 3. Weekly Epidemiological Record

(a)

Sol
Silicosis

Ceramic and pottery workers are exposed to silica dust, putting them at risk for silicosis, a pneumoconiosis characterized by fibrotic nodules primarily in the upper lobes. Anthracosis is associated with coal dust exposure, byssinosis with cotton dust, and asbestosis with asbestos fibers (shipyard, construction, etc.). Hence, the correct screening for a pottery/ceramics worker is silicosis.
Select the correct answer using the code given below.
(a) 2 only
108. An industrial worker was brought to a medical facility (b) 1 and 2
due to health problems. On his workup including (c) 2 and 3
laboratory tests, a finding of basophilic stippling of (d) 3 only
Red Blood Cells (RBC) was observed. Which among
(d)

Sol
3 only

CD Alert is published by India’s National Centre for Disease Control (NCDC). Morbidity and Mortality Weekly Report (MMWR) is from the U.S. Centers for Disease Control and Prevention (CDC). The Weekly Epidemiological Record (WER) is published by the World Health Organization (WHO). Hence only 3 belongs to WHO.

the following is he/she likely to be having?

(a) Asbestosis
CMS Paper-II Question Paper 2024 MEDINK

112. As per the basic model of a nuclear family life cycle, 116. In the National Malaria Control Programme, Indoor
consider the following phases : Residual Spray (IRS) is the primary method of vector
1. Contraction control in rural setting. Which one of the following is
2. Dissolution the ‘insecticide of choice’?
3. Extension (a) DDT
4. Formation (b) Malathion
Which one of the following best represents the correct (c) Synthetic pyrethroid
sequence of phases in a normal nuclear family? (d) Temephos
(a) 1 → 2 → 3 → 4
(a)

Sol
DDT

In India’s malaria control efforts, DDT (dichlorodiphenyltrichloroethane) has historically been used as the chief insecticide for indoor residual spraying (IRS) in rural areas (provided local mosquitoes remain susceptible). Alternatives like malathion or synthetic pyrethroids are used in regions where DDT resistance is established. Temephos is more commonly employed in larval control.

(b) 4 → 3 → 1 → 2
(c) 1 → 4 → 3 → 2 117. Consider the following statements with regard
(d) 4 → 1 → 2 → 3 to selection of Accredited Social Health Activist

(b)

Sol

2.
3.
4.
4→3→1→2

A commonly cited four-phase cycle for a nuclear family is:

1. Formation (marriage and starting a family) →
Extension (arrival of children and expansion) →
Contraction (grown children begin leaving home) →
Dissolution (retirement, death of a spouse, etc.).
(ASHA) under NRHM:
Hence, in the numbering given, 4 (Formation) → 3 (Extension) → 1 (Contraction) → 2 (Dissolution).

1. ASHA must be a woman preferably in the age

113. Which among the following are characteristics of group of 18 to 25 years.
health education, rather than propaganda? 2. ASHA must have had formal education up to at
1. Knowledge actively acquired, rather than least class ten.
instilled 3. ASHA must be a resident of the village.
2. Appeals to emotion, rather than reason 4. ASHA may be a married, widowed or divorced
3. Behaviour centred, rather than information woman.
centred Which of the statements given above are correct with
4. Arouses and stimulates primitive desires, rather regard to process of selection of ASHA?
than disciplines them (a) 1 and 2 only
Select the correct answer using the code given below. (b) 2 and 3 only
(a) 1 and 2 (c) 3 and 4 only
(b) 1 and 3 (d) 1, 2, 3 and 4
(c) 2 and 3

(c)

Sol
3 and 4 only

ASHA guidelines indicate the worker should be a local resident (3) for familiarity with community, and she may be married, widowed, or divorced (4). The preferred age range is often stated as 25–45 years, not “18–25” (statement 1 is incorrect). Minimum education requirement is typically around class 8 (not necessarily class 10), so statement 2 is also incorrect.

(d) 3 and 4

(b)

Sol
1 and 3
118. Consider the following statements regarding the
Health education relies on helping individuals actively acquire understanding (rather than just drilling in facts) and aims to develop healthy behaviours. By contrast, propaganda often appeals more to raw emotion (2) or base instincts (4). Thus in health education, knowledge is actively sought (1) and is behaviour-oriented (3), not merely emotional persuasion.

Central Drugs Standard Control Organization

114. Consider the following statements regarding LNG- (CDSCO) in India:
20 (Mirena): 1. The CDSCO is headed by the Drugs Controller
1. It is a T-shaped IUD filled with natural hormone General (India) at the Centre.
progesterone. 2. The CDSCO is a part of the Directorate of
2. It is associated with a low pregnancy rate (2 per Director General of Health Services.
1000 women). 3. The CDSCO is under the Ministry of Chemicals
3. It is associated with a large number of ectopic and Fertilizers, Government of India.
pregnancies. 4. The CDSCO has a network of several port
4. It is associated with lower menstrual blood loss offices for monitoring the import and export of
as compared to copper IUDs. drugs.
Which of the statements given above is/are correct? Which of the statements given above are correct?
(a) 2 only (a) 1 and 2 only
(b) 2 and 4 only (b) 1 and 3
(c) 1, 3 and 4 (c) 1, 2 and 4
(d) 2, 3 and 4 (d) 2 and 4 only

(c)

Sol
1, 2 and 4

(b)

Sol
2 and 4 only

The CDSCO is indeed led by the Drugs Controller General of India (DCGI) (1) and functions under the Directorate General of Health Services, Ministry of Health & Family Welfare (2), not under the Ministry of Chemicals and Fertilizers (so 3 is incorrect). It maintains port offices to oversee drug import/export (4).

Mirena contains levonorgestrel (a synthetic progestin), not “natural progesterone,” so statement 1 is incorrect. It indeed has a very low failure rate (about 2 per 1000), making statement 2 correct. Although an IUD pregnancy is more likely to be ectopic if it happens, the overall absolute risk of ectopic is low; it is not associated with a “large number of ectopic pregnancies” (statement 3 is misleading). Mirena does reduce menstrual blood loss more than copper IUDs, so statement 4 is correct.

115. The most common cause of maternal mortality in 119. The National AIDS Control Organization provides
India is prepacked colour-coded STI/RTI kits as a free supply
(a) obstetric haemorrhage to its designated STI/RTI clinics. Consider the
(b) obstructed labour following pairs:
(c) unsafe abortion Pair No. Colour codes STI/RTI conditions
(d) toxaemia of pregnancy

(a)

Sol
obstetric haemorrhage
1 Red Urethral discharge
Despite improvements in obstetric care, postpartum hemorrhage (often combined with other hemorrhagic causes) remains the leading direct cause of maternal death in India, surpassing other causes such as obstructed labor, unsafe abortion, and hypertension (eclampsia/toxemia). Prompt recognition and active management of the third stage of labor are critical to reducing hemorrhagic complications.
MEDINK Question Paper 2024 page 19

2 Green Vaginitis
3 White Inguinal bubo
How many of the pairs given above are correctly
matched?
(a) None of the pairs
(b) Only one pair
(c) Only two pairs
(d) All the three pairs

(b)

Sol
Only one pair

NACO color-coded STI/RTI kits differ from what is listed here. Green kit is indeed used for vaginal discharge (that matches 2). However, Red kit generally relates to lower abdominal pain in women (PID), not “urethral discharge,” and “White kit” is for pelvic inflammatory disease or related conditions—while “inguinal bubo” is usually addressed by the Black kit. Thus, only pair 2 is correct.

120. A table shows results of an ELISA test for HIV

infection:
True Infection Infected Noninfected
Status
Test Positive 4900 950
Test Negative 100 94050
Total 5000 95000
Consider the following statements:
1. The sensitivity is 98%.
2. The specificity is 99%.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2

(c)

Sol
Both 1 and 2

1. Sensitivity = True Positives ÷ (True Positives + False Negatives) = 4900 ÷ 5000 = 98%.
2. Specificity = True Negatives ÷ (True Negatives + False Positives) = 94050 ÷ 95000 ≈ 98.95%, which rounds to 99%.
Hence both statements (1) and (2) are correct.

EN
CMS Paper-II Paper 2024 Answers MEDINK

Paper 2024 Answers

Which of the following are risk factors for wound infection?
1. Malnutrition
2. Poor perfusion
3. Antibodies
4. Foreign body material

the leg muscles. Smoking is a major risk factor for

Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

Sol

arterial disease, which fits this patient’s history. The

1. (b) 1, 2 and 4 brief rest typically restores enough circulation to
Malnutrition impairs overall immunity and allow the person to walk again for a similar distance,
wound healing because of inadequate protein and reinforcing the diagnosis of intermittent claudication.
A midline neck swelling just below the hyoid bone and managed by Sistrunk’s operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is
(a) lateral aberrant thyroid
(b) thyroglossal cyst

micronutrient stores. Poor perfusion lowers oxygen

(c) solitary thyroid nodule
(d) thyroglossal cyst with only functioning thyroid tissue

Sol

and nutrient delivery to tissues, hindering the healing 5. (d) thyroglossal cyst with only functioning thyroid
process and increasing susceptibility to infection. tissue
The presence of foreign body material creates a
A classical thyroglossal cyst occurs in the midline
surface where bacteria can adhere and proliferate,
and moves upward on protrusion of the tongue or
further compromising wound integrity. In contrast,
swallowing. Sistrunk’s procedure removes the cyst,
antibodies actually help in fighting infection and
the tract, and the mid-portion of the hyoid bone to
are not a risk factor. Therefore, items 1, 2, and 4
reduce recurrence. If the ectopic thyroid tissue within
accurately represent risk factors for wound infection.
the cyst represents the patient’s only functioning
Which types of cancer are associated with exposure to ionizing radiation?
1. Leukaemia
2. Lung cancer
3. Breast cancer
4. Lymphoma
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

Sol
thyroid tissue, removing it causes hypothyroidism,
2. (a) 1, 2 and 3 necessitating thyroxine replacement. A
Ionizing radiation is a well-established carcinogen. straightforward thyroglossal cyst (with a normal
Leukaemia is notably linked to radiation exposure (as thyroid gland in its usual location) typically does not
observed in atomic bomb survivors). Lung cancer risk lead to permanent hypothyroidism postoperatively.
A 40-year-old smoker presents with soreness of tongue since last 2 months. On examination, it is found that the oral hygiene is poor and there is a white plaque over the lateral border of the tongue. What is the next step in the management of this patient?
(a)
(b)
Oral vitamin C supplementation
Oral antifungal treatment
(c) Edge biopsy of the lesion
(d) Local topical cauterization

increases particularly with exposures such as radon (a

Sol

radioactive gas). Breast cancer has also been linked to 6. (c) Edge biopsy of the lesion
medical or occupational radiation. While lymphoma A white plaque on the lateral border of the tongue
can be multifactorial, its direct association with in a chronic smoker raises concern for leukoplakia
ionizing radiation is less classically emphasized than or possible malignant transformation (e.g., squamous
the other three. Hence, the recognized malignancies cell carcinoma). While oral candidiasis (thrush)
strongly tied to ionizing radiation here are 1, 2, and 3.
Which of the following are correct regarding Li-Fraumeni syndrome?
1.
2.
3.
It has autosomal dominant inheritance and is associated with P53 gene
It has autosomal recessive inheritance and is associated with P53 gene
It is associated with an increased risk of sarcomas and leukaemia
can present as white patches, the patient’s risk
4. It is associated with an increased risk of brain tumours and osteo-sarcomas

factors (tobacco use, poor oral hygiene) and lesion

Select the answer using the code given below.
(a) 2, 3 and 4
(b) 1, 3 and 4
(c) 1 and 4 only
(d) 1 and 3 only

Sol

location necessitate ruling out malignancy. The best

3. (b) 1, 3 and 4 immediate step is to perform a biopsy of the lesion
Li-Fraumeni syndrome is classically caused by a margin. This ensures an accurate diagnosis and helps
germline mutation in the TP53 tumor suppressor gene Consider the following causes of visual loss :
guide definitive treatment.
1. Obstruction of the central retinal artery
2. Vitreous and retinal haemorrhage

and is inherited in an autosomal dominant pattern

3. Cataract
4. Retinal detachment
Which of the above causes are associated with acute visual loss in a patient?
(a) 1, 2 and 3
(b) 1, 3 and 4
(c) 1, 2 and 4
(d) 2, 3 and 4

(making statement 1 correct, while statement 2 is

Sol

incorrect). It confers a markedly elevated lifetime risk 7. (c) 1, 2 and 4

of multiple cancers, particularly soft tissue sarcomas, Acute visual loss commonly occurs with occlusion
bone sarcomas (like osteosarcoma), leukaemia, brain of the central retinal artery, which abruptly cuts off
tumors, and breast cancer. Therefore, statements 3 and blood supply to the retina. Sudden haemorrhage into
4 are also true. This combination accurately describes the vitreous or retinal layers can also block or distort
the hereditary cancer predisposition observed in Li- vision immediately. Retinal detachment, where the
Fraumeni syndrome.
A 48-year-old smoker presents to the OPD with complaints of cramping pain in both the calves on walking to about 100–150 metres. The pain is relieved on taking rest for about 2–3 minutes and the patient is able to walk for some more distance again before the pain appears. This presentation is suggestive of
(a)
(b)
muscular fatigue
osteoarthritis of the knee
sensory retina peels away from its underlying layer,
(c) intermittent claudication
(d) neurogenic claudication

Sol
typically presents with a rapid, painless loss of vision.
4. (c) intermittent claudication By contrast, cataract formation progresses gradually
Intermittent claudication is characterized by ischemic over time, causing slow impairment rather than an
muscle pain brought on by exertion (walking a fixed acute event.
A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?
(a)
(b)
(c)
Cystic degeneration
Haemorrhage
Malignant transformation
(d) Myxomatous transformation

distance) and relieved by a short rest. This occurs

Sol

due to peripheral arterial disease, often linked to 8. (c) Malignant transformation

atherosclerotic changes that reduce blood flow to
MEDINK Paper 2024 Answers page 21

A long-standing thyroid swelling (commonly a 12. (a) 1, 2 and 3

multinodular goiter) that suddenly enlarges rapidly Traumatic injury to the liver can lead to several
and becomes firm or hard raises strong suspicion of localized complications. Liver abscess may develop
malignant change. Though degenerative changes or from devitalized tissue and bacterial contamination.
haemorrhage can cause sudden expansion, these often Biliary fistula arises if a major bile duct is lacerated,
present differently (e.g., painful swelling, fluctuant allowing bile leakage. Portal vein thrombosis can
areas). The described consistency and relatively short occur from direct vascular injury or compression.
period of growth are classic indicators of possible While severe hepatic damage might theoretically
thyroid malignancy, prompting further evaluation via precipitate liver failure, immediate “liver failure”
1.
2.
imaging and biopsy.
Which of the following chromosomal abnormalities are associated with brain tumours?
Neurofibromatosis type 1
Neurofibromatosis type 2
from acute trauma is less typically listed as a direct
3. Peutz-Jeghers syndrome
4. Hereditary nonpolyposis colorectal cancer
Select the correct answer using the code given below.

complication compared to the other three. Thus, 1, 2,

(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

and 3 are classic recognized complications.

Sol

9. (b) 1, 2 and 4
Which of the following are local complications of acute pancreatitis?
1. Pseudocyst
2. Pleural effusion
3. Ileus
4. Acute fluid collection
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 2, 3 and 4
(c) 1, 2 and 4
(d) 1, 3 and 4

Neurofibromatosis type 1 (NF1) is known for

Sol

optic pathway gliomas and other CNS tumors. 13. (d) 1, 3 and 4
NF2 is strongly linked with bilateral vestibular Acute pancreatitis commonly leads to local problems
schwannomas and various intracranial tumors. around the pancreas. A pseudocyst is a collection of
Hereditary nonpolyposis colorectal cancer (Lynch pancreatic enzymes and fluid contained by a wall of
syndrome) can, in certain variants (Turcot syndrome fibrous or granulation tissue. Acute fluid collections
with mismatch repair genes), be associated with (not yet walled off) can also accumulate in or around
glioblastoma. Peutz-Jeghers syndrome typically the pancreas. Ileus (localized or generalized) may
predisposes to gastrointestinal polyps and certain develop as an immediate “paralytic” response in
extragastrointestinal malignancies (pancreatic, for nearby bowel loops. Pleural effusion, although
instance), rather than brain tumors. Therefore, 1, 2, possible, is typically considered a more systemic or
and 4 are the relevant associations.
Which one of the following is correct regarding ‘witch’s milk’?
(a)
(b)
It is seen in full-term infants.
It is seen only in preterm infants.
extrapancreatic complication and not purely local.
Which of the following are risk factors for the development of pancreatic cancer?
1. Cigarette smoking
(c) It is caused by stimulation of foetal breast by progesterone.
(d) It is caused by stimulation of foetal breast by calcitonin. 2. Diabetes mellitus
3. Caucasian ethnicity
4. Male gender
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 2, 3 and 4
(c) 1, 2 and 4


Sol
(d) 1, 3 and 4

10. (a) It is seen in full-term infants.

Sol

14. (c) 1, 2 and 4

“Witch’s milk” refers to breast milk–like fluid
secreted from the nipples of some newborns, more Major risk factors for pancreatic cancer include
commonly in full-term infants. It results from chronic smoking (one of the most important modifiable
the transplacental passage of maternal hormones factors) and long-standing diabetes mellitus. There
(especially estrogens and prolactin) that stimulate is a slight male predominance in pancreatic cancer
the neonate’s breast tissue. It typically appears a few incidence as well. Regarding ethnicity, African
days after birth and then resolves spontaneously. Americans generally have higher incidence rates
Neither progesterone nor calcitonin are the principal compared to Caucasians, so “Caucasian ethnicity” is
causes of this phenomenon. The correct statement is not a confirmed risk factor. Thus, the combination of
that it is commonly observed in full-term babies. 1, 2, and 4 aligns with well-established risk factors.
Which of the following are metabolic causes of splenic enlargement?
(a)
(b)
Rickets and Still’s disease
Amyloid and Gaucher’s disease
Which of the following statements are correct regarding Barrett’s oesophagus? (c) Porphyria and Felty’s syndrome
1. It is a metaplastic change. (d) Myelofibrosis and Weil’s disease
2. It is a risk factor for development of adenocarcinoma.
3. Ingestion of NSAIDs is the aetiological factor for its development.
4. Endoscopic mucosal resection is an effective treatment.
Select the answer using the code given below.
(a) 1, 2 and 3
(b) 2, 3 and 4
(c) 1, 2 and 4

Sol

(d) 1, 3 and 4

Sol

15. (b) Amyloid and Gaucher’s disease

11. (c) 1, 2 and 4 Gaucher’s disease is a sphingolipid storage
Barrett’s esophagus involves a metaplastic disorder (glucocerebrosidase deficiency) that
replacement of the normal squamous epithelium by causes pathological deposition of glucocerebroside
columnar epithelium (statement 1). It arises primarily in multiple organs, notably the spleen, leading to
from chronic gastroesophageal reflux disease splenomegaly. Amyloidosis can also involve the
(GERD) and is a significant risk factor for esophageal spleen, with amyloid protein deposition causing
adenocarcinoma (statement 2). NSAIDs are not organomegaly. Rickets (vitamin D deficiency) and
recognized as a main etiological cause—chronic acid Still’s disease (a form of inflammatory arthritis)
reflux is. Endoscopic mucosal resection is indeed are not typically categorized as metabolic causes of
an effective treatment for high-grade dysplasia or large spleen. Porphyria is a heme synthesis disorder
early carcinoma in Barrett’s esophagus (statement 4). but does not typically present with prominent
Thus, 1, 2, and 4 are correct.
Which among the following are complications of liver trauma?
1.
2.
Liver abscess
Biliary fistula
splenomegaly, and Felty’s syndrome is linked to
3. Portal thrombosis
4. Liver failure
Select the correct answer using the code given below.

rheumatoid arthritis.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

Which one of the following statements is correct about mesenteric cysts?

(a) It occurs most commonly in children less than 18 years of age.
(b) It is more common in males as compared to females.
(c) It presents most commonly as a painless abdominal swelling.


Sol
(d) Percutaneous aspiration with injection of sclerosant is the preferred treatment option.

Sol
CMS Paper-II Paper 2024 Answers MEDINK

16. (c) It presents most commonly as a painless “Preventive surgery” is not among the recognized
abdominal swelling. phases of damage control. Thus, 1, 2, and 3 correctly
Mesenteric cysts are rare intra-abdominal lesions that outline the standard stages.
Which of the following statements are correct regarding renal cell carcinoma?
1.
2.
It arises from the epithelium of the proximal convoluted tubule.
It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease.
Select the answer using the code given below.

often remain asymptomatic and can be discovered

(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

incidentally or present as a painless, slowly enlarging

Sol

20. (c) 1, 3 and 4

abdominal mass. While children do frequently
develop mesenteric cysts, they can appear at any age; Renal cell carcinoma (RCC) originates from the
and there is no strong male predominance. Definitive proximal tubular epithelium (statement 1). The main
treatment is typically surgical excision rather than histological subtypes include clear cell, papillary,
percutaneous aspiration with sclerosant. Because and chromophobe (statement 3). Surgical resection
most patients notice a mass rather than severe (partial or radical nephrectomy) is the cornerstone
pain, the most consistently correct statement is that of curative treatment for localized (organ-confined)
mesenteric cysts commonly present as a painless disease (statement 4). RCC shows a slight male
swelling.
Which of the following are features of umbilical hernia in adults?
predominance rather than female, making statement
1. Patients are commonly overweight with a thinned and attenuated midline raphe.
2.
3.
4.
Select the correct answer using the code given below.
(a)
(b)
(c)
(d)
Most patients complain of pain due to tissue tension.
Men are affected more commonly than women.
Hernia repair can be done by the technique described by Mayo.

1, 2 and 3
1, 2 and 4
1, 3 and 4
2, 3 and 4
2 incorrect. Therefore, the correct set of statements


Sol is 1, 3, and 4.
Which of the following are features of autosomal dominant polycystic kidney disease?
1. Cyst may also occur in liver, pancreas and arachnoid membrane.

17.
2. Most commonly manifests between 20–30 years of age.
3. Clinical manifestations are renal and extrarenal.
4. Men tend to progress to renal failure more rapidly than women.

(b) 1, 2 and 4 Select the correct answer using the code given below.
(a)
(b)
(c)
(d)
1, 2 and 3
1, 2 and 4
1, 3 and 4
2, 3 and 4

Umbilical hernias in adults are often associated with

Sol

21. (c) 1, 3 and 4

obesity or weak abdominal musculature (statement
1). They can cause discomfort or pain from increased Autosomal dominant polycystic kidney disease
tension at the hernia site (statement 2). They are (ADPKD) involves multiple bilateral renal cysts,
actually more common in women, especially often accompanied by cysts in the liver and
multiparous women, so statement 3 is incorrect. sometimes the pancreas or arachnoid (statement
Repair of umbilical hernias using Mayo’s technique 1). Manifestations are both renal (hypertension,
(overlapping repair of the defect) is a recognized renal failure) and extrarenal (e.g., berry aneurysms)
surgical method (statement 4). Hence, the valid (statement 3). Men generally experience more rapid
features are 1, 2, and 4. progression to renal failure, partly due to genetic
What is the most common cause of perforation of the oesophagus?
(a) Barotrauma
(b)
(c)
(d)
Mediastinitis
Iatrogenic infection
Malignancy

and hormonal factors (statement 4). Although

presentation can begin in early adulthood, the classic


Sol

18. (c) Iatrogenic infection

age range typically centers closer to the 30s–40s
The single most common reason for esophageal rather than strictly 20–30.
Extracorporeal Shock Wave Lithotripsy (ESWL) is most commonly used for the treatment of

perforation is iatrogenic trauma—often during

(a) gallbladder stones
(b) urinary tract stones
(c) salivary gland stones
(d) abdominal stony-hard tumour

endoscopic procedures, instrumentation, or surgery—

Sol

22. (b) urinary tract stones

which can introduce infection into surrounding
tissues. “Iatrogenic infection” is somewhat loosely ESWL uses shock waves focused on stones in
worded here, but it reflects that endoscopic or the kidney or ureter to fragment them into smaller
surgical manipulations of the esophagus frequently pieces, allowing their spontaneous passage through
lead to perforation and subsequent infection (i.e., the urinary tract. It is a noninvasive, widely
mediastinitis). While barotrauma (Boerhaave’s preferred approach for most renal and upper ureteric
syndrome) and malignancy-related perforations do calculi. Gallbladder stones are typically managed
happen, they are less common overall than iatrogenic by cholecystectomy. Salivary gland stones can
causes. sometimes be removed by endoscopic or surgical
Which of the following are stages of damage control surgery?
1. Patient’s selection

measures. ESWL is not indicated for “stony-hard”

2. Control of haemorrhage
3. Resuscitation in ICU
4. Preventive surgery
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

Sol abdominal tumors. Hence, urinary tract stones

19. (a) 1, 2 and 3 Consider the following clinical features :
represent the primary indication.
1.
2.
Raised ICP
Seizures
3. Focal deficit
4. Headache
Which of the above clinical features are related to most brain tumours?

Damage control surgery is classically divided into

(a) 1, 2, 3 and 4
(b) 1 and 2 only
(c) 1, 2 and 3 only
(d) 2, 3 and 4 only

phases. First, the trauma team selects appropriate

Sol

23. (a) 1, 2, 3 and 4

patients (those with exsanguinating hemorrhage
or unstable physiology) for a rapid, abbreviated Most brain tumors, whether primary or metastatic,
surgical intervention to control hemorrhage and can elevate intracranial pressure (ICP), causing
contamination. Second, patients receive ongoing headaches and possibly papilledema (1,4). Seizures
resuscitation in the ICU to correct coagulopathy, are a frequent presenting symptom, especially in
hypothermia, and acidosis. Finally, definitive supratentorial lesions (2). Focal neurological deficits
surgery is performed once the patient is stabilized. (3) such as weakness, aphasia, or visual changes
MEDINK Paper 2024 Answers page 23

occur when the tumor affects specific brain regions. (weakness, positive drop-arm test). Bacterial arthritis
Thus, all four (raised ICP, seizures, focal deficit, (septic arthritis) is typically acute, severely painful,
and headache) are classical clinical features that and accompanied by systemic infection signs.
collectively point toward an intracranial space- Osteoarthritis is more common in weight-bearing
(a)
(b)
occupying lesion.
The most common type of brain tumours associated with neurofibromatosis type 1 brain tumour syndrome is
astrocytoma
acoustic neuroma
or degenerative joints and less typical in a single
(c) meningioma
(d) medulloblastoma

Sol
shoulder in this manner.
A 20-year-old girl presents to the OPD with complaints of a progressively increasing swelling on the dorsum of the left wrist. The swelling is cystic and nontender on examination and becomes more prominent on plantar flexion of the wrist. The swelling is 2 cm × 1 cm in size. What is the likely diagnosis in this case?
(a)
(b)
Ganglion cyst
Sebaceous cyst
(c) Dermoid cyst

24.
(d) Epidermoid cyst

(a) astrocytoma

Sol

Neurofibromatosis type 1 (NF1) is known 28. (a) Ganglion cyst

for multiple neurocutaneous manifestations, A ganglion cyst is a fluid-filled sac that typically
including neurofibromas and optic pathway arises near joint capsules or tendon sheaths. On the
gliomas. These gliomas are essentially pilocytic wrist’s dorsal aspect, it often becomes more visible
astrocytomas affecting the optic nerve or chiasm. with flexion. These cysts are usually smooth, non-
By contrast, bilateral acoustic neuromas (vestibular tender, and can fluctuate in size. Sebaceous cysts
schwannomas) characterize neurofibromatosis type 2 and epidermoid cysts usually occur in the skin or
(NF2). Meningiomas and medulloblastomas are not subcutaneous tissue (often over hair-bearing areas),
the hallmark brain tumors of NF1. Thus, astrocytoma while dermoid cysts are developmental lesions
(particularly optic pathway glioma) is the most containing skin adnexa. The classic location and
common intracranial tumor in NF1.
Which of the following are correct for herniation via foramen of Morgagni?
1.
2.
3.
It occurs posteriorly in chest.
Transverse colon is the commonest content.
1.
2.
features here match a dorsal wrist ganglion cyst.
Upper motor neuron lesions are characterized by which of the following?
Increased tone spasticity
Hyperreflexia
Defect is between sternal and costal attachments. 3. Absent plantar response
4. It is a type of congenital hernia. 4. Motor weakness
Select the answer using the code given below. Select the correct answer using the code given below.
(a) 1, 2 and 3 (a) 1, 2 and 3
(b) 1, 2 and 4 (b) 1, 2 and 4
(c) 1, 3 and 4 (c) 1, 3 and 4
(d) 2, 3 and 4 (d) 2, 3 and 4

Sol

Sol

25. (d) 2, 3 and 4 29. (b) 1, 2 and 4

A Morgagni hernia is an anterior diaphragmatic Upper motor neuron (UMN) lesions produce
defect, not a posterior one (so statement 1 is incorrect). spasticity (increased tone) and hyperreflexia due to
It occurs through an opening between the sternal loss of inhibitory pathways (statements 1 and 2).
and costal portions of the diaphragm (statement 3) Patients also exhibit weakness in affected muscles
and is a congenital defect (statement 4). The most (statement 4). The plantar response typically
common herniated organ through this defect is often becomes extensor (Babinski sign) rather than absent.
the transverse colon (statement 2). Hernias in the Therefore, statement 3 is incorrect. This pattern of
posterolateral aspect (Bochdalek hernia) are different increased tone, brisk reflexes, and Babinski sign
and occur more commonly.
A 40-year-old lady complains of progressive deformities of her hands and fingers associated with stiffness which is present in both the hands and improves as the day progresses. On examination, there is symmetrical involvement of hands and fingers of both the upper limbs with flexion and ulnar deviation at the metacarpophalangeal joints. What is the most likely diagnosis in this lady?
(a)
(b)
Osteoarthritis
Ankylosing spondylitis
differentiates UMN involvement from lower motor
(c) Rheumatoid arthritis
(d) Tenosynovitis

Sol
neuron lesions (which show decreased tone and
26. (c) Rheumatoid arthritis hyporeflexia).
A 56-year-old female has been diagnosed with gallstones and is undergoing a preanesthesia checkup. She has been a diabetic since last 15 years, but sugar levels are within the limits. Which category of physical status does she fit into?
(a)
(b)
(c)
(d)
ASA 4
ASA 3
ASA 2
ASA 1

Rheumatoid arthritis (RA) is a chronic inflammatory

Sol

disorder that typically presents with symmetrical 30. (c) ASA 2

joint involvement, most often in the small joints The American Society of Anesthesiologists (ASA)
of the hands and feet. Morning stiffness improving physical status classification rates overall surgical
later in the day, along with characteristic deformities risk. An ASA 2 patient has a mild systemic disease
such as ulnar deviation at the metacarpophalangeal with no significant functional limitations—such
joints, strongly suggests RA. Osteoarthritis more as well-controlled diabetes or hypertension. ASA 3
often affects distal interphalangeal joints (Heberden’s entails severe systemic disease that limits activity;
nodes). Ankylosing spondylitis primarily involves ASA 4 includes severe, life-threatening disease.
the spine and sacroiliac joints. Tenosynovitis ASA 1 is a completely healthy person. Since this
alone would not explain the classic ulnar deviation patient’s diabetes is longstanding but well-controlled
deformity.
A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?
(a)
(b)
Rotator cuff tear
Frozen shoulder
(no mention of end-organ damage or functional
(c) Bacterial arthritis
(d) Osteoarthritis

Sol
impairment), she is classified as ASA 2.
A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?
(a)
(b)
Blood pressure < 100 mm Hg
Acidosis with pH < 7·32
(c) Hypothermia < 36 °C

27.
(d) Coagulopathy

(b) Frozen shoulder

Sol

Frozen shoulder (adhesive capsulitis) is commonly 31. (d) Coagulopathy

associated with diabetes mellitus. It presents with Damage control surgery is indicated when ongoing
progressive pain and a significant restriction of both hemorrhage and shock begin driving the “lethal triad”
active and passive range of motion—especially in of trauma: acidosis, hypothermia, and coagulopathy.
abduction and external rotation. A full-thickness Among the choices, frank coagulopathy (poor
rotator cuff tear often has other clinical signs clotting function) is a key pivot-point indicating the
CMS Paper-II Paper 2024 Answers MEDINK

need to abbreviate surgery, stabilize the patient in the uncontrolled, SIRS can progress to sepsis, then
ICU, and correct their physiology before attempting multiple organ dysfunction syndrome (MODS).
definitive repair. Mild hypotension, mild acidosis Among the diagnostic criteria of SIRS is an elevated
(pH 7.3), or temperature 36 °C alone may not suffice. WBC count (>12,000/μL), making statements 1, 3,
The presence of coagulopathy signals a tipping point and 4 correct.
A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the
(a)
(b)
universal precautions checklist
nurses safety checklist
(c) MCI patient safety checklist
(d) WHO surgical safety checklist

Consider the following:

at which damage control principles are applied.
1.
2.
Pain relief
Prevention of infection


Sol

3. Anaesthesia

36.
4. Restoration of anatomy
Which of the features given above are benefits of fracture treatment?
(a) 1, 3 and 4
(b)
(c)
(d)
1, 2 and 3
1, 2 and 4
2, 3 and 4

(d) WHO surgical safety checklist

Sol

32. (c) 1, 2 and 4 The WHO Surgical Safety Checklist is a standardized

protocol designed to improve communication and
The principal aims (and benefits) of proper fracture
prevent avoidable errors before, during, and after
management include relieving the patient’s pain (e.g.,
surgical procedures. It includes confirming the
via immobilization), preventing infection (especially
patient’s identity, surgical site and procedure, the
in open fractures), and restoring normal anatomy
presence of necessary equipment, anticipated critical
(through reduction and stabilization) to allow healing
events, and other safety considerations (e.g., allergies,
and preserve function. While anaesthesia is crucial
antibiotic prophylaxis). Universal precautions
during fracture reduction or surgical fixation, it is
involve infection control measures, whereas local or
a means rather than a benefit of treatment. Hence,
institutional checklists may exist but the recognized
items 1 (pain relief), 2 (infection prevention), and 4
global standard referencing patient identity and
(anatomical restoration) best characterize the benefits
critical event anticipation is the WHO checklist.
of fracture treatment.
Which of the following are correct for managing hypertrophic scars?
1. Silicone gel sheeting
2. Intralesional steroid injections
3. Vitamin A gel applications
4. Laser treatment
A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates Select the answer using the code given below.
(a) fracture of mastoid process (a) 1, 2 and 3
(b) injury to the external auditory meatus (b) 1, 2 and 4
(c) fracture of the skull base (c) 1, 3 and 4
(d) soft tissue injury to the neck (d) 2, 3 and 4

Sol

Sol

33. (c) fracture of the skull base 37. (b) 1, 2 and 4

A bruise over the mastoid area (Battle’s sign) Hypertrophic scar management often combines
is a classic indicator of a basilar skull fracture, multiple modalities: silicone gel sheeting to reduce
specifically affecting the posterior cranial fossa. This scar thickness, intralesional corticosteroid injections
ecchymosis typically appears some hours after the to help flatten the scar, and various laser treatments
injury when blood tracks along tissue planes behind (pulsed-dye or fractional lasers) to refine scar
the ear. While fractures of the mastoid process itself appearance and vascularity. While topical retinoids
or injury to the ear canal are possible in trauma, (vitamin A derivatives) can sometimes be employed
the classical teaching is that Battle’s sign strongly for abnormal scars, the most standard and well-
suggests a fracture through the base of the skull evidenced trio is silicone sheeting, steroid injections,
Hangman’s fracture is
rather than isolated mastoid damage.
(a)
(b)
traumatic spondylolisthesis of atlas vertebra (C₁)
traumatic spondylolisthesis of axis vertebra (C₂)
and laser therapy. Together, they help modulate
(c) traumatic spondylolisthesis of thoracic vertebra (T₁)
(d) traumatic spondylolisthesis of lumbar vertebra (L₁)

Sol
collagen remodeling and improve scar texture over
34. (b) traumatic spondylolisthesis of axis vertebra (C₂) 2.
3.
4.
time.
Which of the following are approximate daily requirements of the common electrolytes in an adult?
1. Sodium 50–90 mM/day
Calcium 1 mM/day
Potassium 50 mM/day
Magnesium 1 mM/day
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4

A “Hangman’s fracture” classically refers to a fracture

(c) 1, 3 and 4
(d) 2, 3 and 4

Sol

through the pars interarticularis of the C2 (axis) 38. (c) 1, 3, and 4.

vertebra, leading to a forward slip (spondylolisthesis)
In most reference tables, an adult’s typical sodium
of the C2 body on C3. Historically named because
requirement approximates 50–90 mmol/day, and
of its association with judicial hangings, it more
potassium around 40–60 mmol/day (making 50
commonly results today from high-impact motor
mmol/day a reasonable figure). Although actual daily
vehicle accidents. This fracture is distinct from those
calcium intake targets (800–1000 mg) correspond to
involving the atlas (C1) or lower cervical/thoracic
roughly 20–25 mmol, many exam-oriented sources
vertebrae. Prompt stabilization is important to avoid
simplify it to “1 mmol/day” of net absorbable
spinal cord compromise in this region.
calcium or near-minimal requirement. Magnesium
Which of the following are correct in respect of Systemic Inflammatory Response Syndrome (SIRS)?
1. It is caused by the release of lipopolysaccharide endotoxin from dying E. coli bacteria.
2. It is same as bacteraemia.
3. It results in Multiple Organ Dysfunction Syndrome (MODS).
4. White cell counts of more than 12 × 10⁹ / litre are present.
Select the answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

Sol
needs are higher in reality (closer to 10–15 mmol/
35. (c) 1, 3 and 4 day), so option (4) is less commonly cited as “1 mM/
SIRS can certainly be triggered by endotoxin (e.g., day.” Accordingly, the official key usually pairs 1, 2,
lipopolysaccharide from gram-negative bacteria), and 3 as “approximate.”
Distributive shock is described by which of the following patterns of cardiovascular responses?
1.
2.
Vasodilation
Reduced peripheral vascular resistance
3. Inadequate ‘afterload’
4. Low cardiac output
Select the correct answer using the code given below.
(a) 1, 2 and 4
(b) 1, 3 and 4

though it can also arise from other severe insults

(c) 2, 3 and 4
(d) 1, 2 and 3

Sol

(pancreatitis, burns, etc.). It is not synonymous 39. (d) 1, 2 and 3

with bacteremia (statement 2 is false) because SIRS
may occur with or without infection. If severe and
MEDINK Paper 2024 Answers page 25

Distributive shock (e.g., septic shock, anaphylactic 43. (c) Both 1 and 2
shock) features profound vasodilation and reduced Oligohydramnios refers to an abnormally low
peripheral vascular resistance. The systemic vascular amniotic fluid volume. Two common ultrasound
resistance drops, so the effective afterload also indices are used: the maximum vertical pocket
diminishes—“inadequate afterload.” Despite low (MVP) and the amniotic fluid index (AFI). MVP <
resistance, cardiac output in early distributive shock 2 cm is sometimes used, but many definitions accept
is often normal or even high because the heart pumps <5 cm as a cutoff. AFI < 5 cm is likewise a standard
into a low-resistance circuit. Thus, “low cardiac criterion for oligohydramnios. Therefore, both
output” (option 4) is not a hallmark of early/mid statements (maximum vertical pocket <5 cm and AFI
distributive shock. Ultimately, if uncorrected, cardiac <5 cm) can be correct in typical obstetric practice.
Which of the following are correct about endocrine changes in normal pregnancy?
1. Increase in levels of maternal serum iodine
2. Increase in serum levels of Corticotropin-Releasing Hormone (CRH)

output may fall, but the classic early pattern is 1, 2,

3. Increase in serum levels of aldosterone
4. Increase in serum levels of ACTH
Select the answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

and 3.
The best measure of organ perfusion and the best monitor of adequacy of shock therapy is


Sol

44.
(a) central venous pressure
(b) pulmonary wedge pressure

(d) 2, 3 and 4
(c) urine output
(d) restoring blood pressure/pulse vital parameters

Sol

40. (c) urine output Pregnancy induces multiple hormonal adjustments.

Urine output is a reliable, practical indicator of end- Placental production of CRH rises, stimulating
organ perfusion (specifically renal perfusion) in increased cortisol; maternal aldosterone secretion
shock states. While blood pressure or central venous also increases (contributing to fluid retention); and
pressure can be misleading (due to compensatory maternal ACTH levels can increase in parallel with
vasoconstriction or fluid shifts), adequate urine placental hormones. Although maternal thyroid
output (≥0.5 mL/kg/hour in adults) demonstrates that function is altered, actual “serum iodine” does not
the kidneys are being perfused sufficiently to filter necessarily increase—in fact, iodine deficiency can
and excrete. Pulmonary wedge pressure is invasive be a concern if dietary intake is inadequate. Hence,
and reflects left atrial pressure more than global statements 2, 3, and 4 are recognized changes, while
perfusion. Thus, urine output remains a key, real-time statement 1 is not universally correct.
Which of the following features are correct regarding onset of true labour?
1.
2.
Regular uterine contractions
Progressive cervical dilation and effacement
3. Presence of show
4. Labour and delivery are synonymous
Select the answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4

guide to resuscitation effectiveness.

(c) 1, 3 and 4
(d) 2, 3 and 4

Which one of the following statements is correct regarding foetal physiology?

(a) Haematopoiesis is demonstrated first in the yolk sac by 14th day.
(b) Meconium appears at 16 weeks.
(c) Breathing movements are identified at 26 weeks.

Sol

(d) Foetal pancreas secretes insulin as early as 20 weeks.

Sol

45. (a) 1, 2 and 3

41. (d) Foetal pancreas secretes insulin as early as 20 True labor is characterized by regular, painful uterine
weeks. contractions that lead to progressive cervical changes
Human fetal insulin production typically begins by (dilation and effacement). A show (passage of blood-
around 10–12 weeks’ gestation, but significant levels tinged mucus plug) often heralds that these changes
are noted closer to 20 weeks. Meconium formation are underway. “Labour” refers to the process from
can begin around the latter half of pregnancy, though onset of regular contractions and cervical effacement/
it’s typically stored in the fetal intestines and only dilatation to the baby’s delivery—whereas “delivery”
appears after about 20 weeks, not exactly at 16. is just one culmination stage of labor. They are not
Detectable fetal breathing movements begin around strictly synonymous (making statement 4 incorrect).
20–24 weeks. Hematopoiesis starts in the yolk sac Hence, items 1, 2, and 3 define true labor onset.
According to the WHO Intrapartum Care Guidelines, 2018, the active phase of labour starts from what dilation of cervix?
(a) 3 cm
(b) 4 cm

very early (around the 3rd week) but not precisely

(c) 5 cm
(d) 6 cm

Sol

limited to “14th day.”

Which of the following are advantages of state of haemodilution during pregnancy?
1.
2.
Optimum gaseous exchange between maternal and foetal circulation due to decreased blood viscosity
Protection against adverse effect of supine and erect posture
46. (c) 5 cm
3. Protection against adverse effect of blood loss during delivery
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

Sol
While older obstetric texts sometimes cited 3–4 cm
42. (d) 1, 2 and 3 dilation as the onset of active labour, the 2018 WHO
During normal pregnancy, plasma volume Intrapartum Care Guidelines emphasize that the
expansion exceeds red cell mass increase, leading active phase generally begins around 5 cm. From that
to physiological haemodilution (“physiological point onward, cervical dilatation tends to accelerate
anemia”). This reduced viscosity aids better more predictably. This updated threshold helps avoid
perfusion and gas exchange. It also provides a reserve unnecessary interventions (e.g., diagnosing “failure
against postural hypotension (supine or erect) and to progress” too early). Thus, 5 cm reflects the
helps mitigate the effects of blood loss at delivery. contemporary WHO standard for defining the start of
Hence, statements 1, 2, and 3 collectively describe the active phase.
The diameter of engagement of foetal skull in marked deflexion is
(a)
(b)
occipitofrontal diameter
suboccipitofrontal diameter
(c) mentovertical diameter
(d) suboccipitobregmatic diameter

recognized advantages of this natural adaptation in

Sol

pregnancy.
Consider the following statements regarding oligohydramnios :
1.
2.
It is defined on USG when maximum vertical pocket of liquor is less than 5 cm.
It is defined on USG when AFI is less than 5 cm.
47. (c) mentovertical diameter
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2

Sol
CMS Paper-II Paper 2024 Answers MEDINK

“Marked deflexion” of the fetal head refers to Peripartum cardiomyopathy typically manifests
partial extension, such as in a brow presentation. toward the end of pregnancy or in the months
The presenting diameter in this scenario is the following delivery, especially in multiparous women
mentovertical diameter (approximately 13.5 cm), one (1) with no prior known cardiac history. An ejection
of the largest diameters of the fetal skull and thus a fraction under 45% (2) on echocardiography is a
more difficult fit through the maternal pelvis. In a well- key diagnostic criterion. During pregnancy, ACE
flexed vertex presentation, the suboccipitobregmatic inhibitors are contraindicated (3) because they can
diameter (around 9.5 cm) typically presents, but with be teratogenic (and postpartum they can be used
pronounced deflexion/extension, engagement occurs cautiously, but generally avoided in pregnancy).
Onset of labour is initiated by which of the following?
along the longer mentovertical line instead.
1.
2.
Uterine distension
Increased CRH and ACTH from foetal hypothalamic-pituitary-adrenal axis
A prior heart disease history is not usually present,
3. Increased level of progesterone immediately before labour
4. Increased synthesis of myometrial receptors for oxytocin due to effect of oestrogen

making statement 4 incorrect.

Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4
Mrs. A, who is 9 months pregnant, presents to the labour room with complaints of severe pain in abdomen and vaginal bleeding for 30 minutes. She is 2nd gravida (producing second child) and delivered her first child 2 years back by caesarean delivery. On examination, she has scar tenderness, vaginal bleeding and haematuria. On CTG, she has an abnormal FHR tracing. What is her likely clinical diagnosis?
(a) Urinary tract infection
(b) Scar rupture/dehiscence during labour
(c) Labour pain
(d) Rupture of urinary bladder

Sol

48. (b) 1, 2 and 4

Sol

52. (b) Scar rupture/dehiscence during labour

Multiple factors help trigger labour. Uterine
Sudden onset of severe abdominal pain, vaginal
distension (1) contributes by increasing irritability and
bleeding, abnormal fetal heart rate (FHR) tracing,
prostaglandin release. Foetal hypothalamic-pituitary-
scar tenderness over a previous cesarean site, and
adrenal axis activation (2) raises fetal cortisol (and
even hematuria suggests that the uterine incision may
CRH), fueling downstream changes. Meanwhile,
have ruptured into adjacent structures (e.g., bladder).
oestrogen upregulates oxytocin receptors in the
These features are highly suspicious for uterine scar
myometrium (4). However, an immediate “rise” in
rupture. A simple urinary tract infection would not
progesterone just before labour is not typical; rather,
typically produce the acute hemorrhage or the FHR
there is functional progesterone withdrawal or a
changes. True labour pain alone does not explain the
relative decrease in its dominance. Thus, statements
alarming signs.
1, 2, and 4 best explain the onset of labour.
A 28-year-old female G₂P₁L₁ with history of previous caesarean presents to the gynaecology emergency in labour. On examination, she is hypotensive, foetal heart sounds are absent and foetal parts are easily palpable. What is her diagnosis?
(a) Oligohydramnios
(b) Abruptio placentae
(c) Uterine rupture
(d) Hydatidiform mole
A 30-year-old female P₂L₂ had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?
(a) Caput succedaneum
(b) Intraventricular haemorrhage
(c) Cephalohaematoma
(d) Subgaleal haemorrhage

Sol

53. (c) Uterine rupture

Sol

49. (c) Cephalohaematoma

In a pregnant woman with a prior cesarean scar,
A cephalohaematoma is a subperiosteal hemorrhage
acute hypotension, loss of fetal heart sounds, and the
confined by cranial suture lines. Typically, it arises
ability to palpate fetal parts distinctly often indicate
during instrumental delivery or birth trauma when
complete uterine rupture. The uterus tears, typically at
periosteal blood vessels are ruptured. Because the
the old scar, allowing fetal parts to extrude partially or
periosteum is tightly adhered at the suture margins,
wholly into the abdominal cavity. Abruptio placentae
the swelling does not cross suture lines. This contrasts
(premature placental separation) can cause shock and
with a caput succedaneum, which is a more diffuse
abnormal fetal heart rates, but does not usually lead
edema of the scalp that can cross sutures. Subgaleal
to such an obvious palpation of fetal parts externally.
hemorrhage can cross sutures but usually extends A 24-year-old primigravida comes to ANC clinic at 8 months amenorrhoea. Her BP is found to be 160/100 mm Hg. Lab findings reveal thrombocytopenia, increased SGOT/SGPT and LDH. What is her diagnosis?
(a) Obstetric cholestasis
(b) Hepatitis B
(c) HELLP syndrome
(d) Eclampsia

widely under the aponeurotic layer.

Sol

54.
Which of the following are correct regarding pathological findings of placenta accreta?
1. Absence of decidua basalis
2.
3.
Select the answer using the code given below.
(a)
(b)
(c)
(d)
Absence of Nitabuch’s fibrinoid layer
Loss of normal hypoechoic retroplacental myometrial zone in ultrasonography

1 and 2 only
2 and 3 only
1 and 3 only
1, 2 and 3
(c) HELLP syndrome


Sol

HELLP syndrome stands for Hemolysis, Elevated

50. (d) 1, 2 and 3 Liver enzymes, and Low Platelet count. It is a
Placenta accreta spectrum involves an abnormal variant of severe preeclampsia/eclampsia with
trophoblastic invasion into the uterine wall. significant hepatic involvement. The patient’s high
Pathologically, there is often an absence of the decidua blood pressure (160/100 mmHg), thrombocytopenia
basalis (1) and absence or defect of Nitabuch’s layer (low platelets), and elevated liver enzymes (SGOT/
(2). On imaging, the typical ultrasound sign includes SGPT) match HELLP. Obstetric cholestasis typically
loss of the normal hypoechoic (clear) retroplacental presents with pruritus and elevated bile acids. Acute
space (3) as the placenta invades directly into the viral hepatitis involves different clinical/laboratory
myometrium. All three features help characterize patterns. Eclampsia adds seizures to severe
the condition, leading to difficulties with placental preeclampsia signs but does not specifically require
separation at delivery and a risk of massive the combination of hemolysis and low platelets.
A patient, who is 2 months pregnant, reports to a hospital with complaints of increased vaginal bleeding and pain in lower abdomen. Internal examination reveals dilated internal os of cervix and products of conception are felt through it. What is her likely clinical diagnosis?
(a) Threatened abortion
(b) Inevitable abortion
(c) Septic abortion

1.
2.
hemorrhage.
Which of the following statements are correct regarding peripartum cardiomyopathy?
It is usually seen in multiparous women.
Echocardiography shows ejection fraction less than 45%.
(d)

Sol
Incomplete abortion

3. ACE inhibitors are contraindicated.

4. History of prior heart disease is mostly present.

55.
Select the answer using the code given below.
(a) 1 and 2 only
(b) 1, 2 and 3
(c)
(d)
3 and 4 only
1, 3 and 4

(b) Inevitable abortion

Sol

51. (b) 1, 2 and 3 In early pregnancy, inevitable abortion is suggested

by vaginal bleeding, cramping lower abdominal pain,
MEDINK Paper 2024 Answers page 27

and cervical dilation such that products of conception position (1) and conveys blood vessels, lymphatics,
are palpable or can be seen. In threatened abortion, and ureters (2). During pregnancy, it undergoes
the cervical os remains closed. Incomplete abortion marked hypertrophy to accommodate increased
typically involves partial passage of some products, vascular and structural demands (4). While it may
leaving residual tissue. Septic abortion includes limit or compartmentalize some infections, it does
infection signs (fever, foul discharge). Because here not definitively “prevent infection from spreading
the os is open and the products of conception are still out of the pelvis” (3 is an overstatement). Thus, 1, 2,
in utero but palpable, the scenario fits “inevitable and 4 are the accurate statements.
Which of the following are correct regarding androgen insensitivity syndrome?
1.
2.
Inherited as X-linked recessive disorder
Karyotype is 46 XXY
3. It is also called testicular feminization
4. Confirmation of diagnosis by gonadal biopsy

abortion.”
Which one of the following is a common pathology associated with ureteric injury while performing surgical procedure of abdominal hysterectomy?
(a)
(b)
Pelvic endometriosis
Adenomyosis
Select the answer using the code given below.
(a)
(b)
(c)
(d)
1, 2 and 3
1, 2 and 4
1, 3 and 4
2, 3 and 4

(c) Hydrosalpinx
(d) Ovarian teratoma

Sol

60. (c) 1, 3 and 4

Sol

56. (a) Pelvic endometriosis

Complete Androgen Insensitivity Syndrome (AIS),
Ureteric injuries during hysterectomy often stem
also termed testicular feminization (3), is typically
from distorted pelvic anatomy and inflammation.
X-linked recessive (1). Individuals have a 46 XY
Pelvic endometriosis can cause scarring and
karyotype (not XXY), rendering statement 2 incorrect.
adhesions that pull or encase the ureter, increasing
They produce normal or high male-range androgens,
the risk of inadvertent damage during uterine or
but target tissues cannot respond due to androgen-
adnexal dissection. Adenomyosis affects the uterine
receptor gene mutations on the X chromosome.
wall itself and is less typically implicated in ureteral
Diagnosis is often confirmed by finding testes (e.g.,
distortion. Hydrosalpinx (dilated fallopian tube) and
in the inguinal canal or abdomen), sometimes via
ovarian teratoma do not commonly entrap or displace
gonadal biopsy (4). Externally, these patients present
the ureter in the manner endometriosis can.
with female phenotype but lack a fully developed
Which of the following are correct regarding pathology of stress urinary incontinence?
1. Hypermobility of urethra
2. Ascend of bladder neck and proximal urethra above pelvic diaphragm
3. Lowered urethral pressure
4. Increased detrusor activity
Select the answer using the code given below.
(a) 1 and 2
(b) 1 and 3
(c) 2 and 4
(d) 3 and 4

Sol
uterus/upper vagina.
Which of the following are useful investigations for diagnosis of unresponsive endometrium as a cause of primary amenorrhoea?
1.
2.
Karyotype
Progesterone challenge test
3. Hormonal studies

57.
4. Hysterosalpingography
Select the correct answer using the code given below.
(a) 1, 2 and 3

(b) 1 and 3 (b)

(c)
(d)
1, 2 and 4
1, 3 and 4
2, 3 and 4

Sol

Stress urinary incontinence (SUI) typically arises 61. (a) 1, 2 and 3

from urethral hypermobility (1) when support
When primary amenorrhoea is suspected to be due to
structures of the bladder neck weaken, allowing it
an “unresponsive” endometrium, the clinician must
to descend with increased intra-abdominal pressure.
determine if the issue lies in hormonal stimulation or
Additionally, lowered urethral closing pressure (3)
the uterus itself. Karyotyping excludes chromosomal
contributes to leakage. The bladder neck does not
abnormalities. A progesterone challenge test assesses
ascend; it descends in SUI. Increased detrusor activity
whether sufficient endogenous estrogen has primed
is related to urge incontinence (overactive bladder),
the endometrium (and if the outflow tract is intact).
not stress incontinence. Hence, 1 and 3 accurately
Hormonal assays (FSH, LH, prolactin, TSH, etc.)
describe the pathophysiology of SUI.
help clarify if the ovaries are producing adequate
Which of the following operative procedures is/are confirmatory for the diagnosis of bicornuate uterus?
(a) Dilation with curettages
(b) Hysteroscopy
(c) Hysteroscopy and laparoscopy
(d) Hysterectomy

Sol

hormones. By contrast, hysterosalpingography

58. (c) Hysteroscopy and laparoscopy is more useful for tubal patency and is not
Bicornuate uterus is a congenital uterine anomaly routinely required for diagnosing endometrial non-
involving a central myometrial indentation. responsiveness.
A 16-year-old girl with primary amenorrhoea presents to the gynaecology OPD for evaluation. She has normal secondary sexual characters. Her karyotype is 46,XX and ultrasound reveals normal ovaries and tubes but absent uterus. What is her clinical diagnosis?
(a) Androgen insensitivity syndrome
(b) Turner syndrome

Hysteroscopy alone shows the internal cavity’s

(c) Mayer-Rokitansky-Küster-Hauser syndrome
(d) Primary ovarian failure

Sol

division but cannot fully assess the external fundal 62. (c) Mayer-Rokitansky-Küster-Hauser syndrome
contour. Laparoscopy directly visualizes the external
Mayer-Rokitansky-Küster-Hauser (MRKH)
uterine surface. When done together, they confirm
syndrome involves congenital absence of the uterus
whether the uterus is bicornuate (single external
and upper part of the vagina in an otherwise genetically
indentation) versus septate (normal external contour
female (46,XX) individual. Because the ovaries
but septum internally). D&C or hysterectomy are not
function normally, patients typically have normal
“confirmatory” in the diagnostic sense; hysterectomy
development of secondary sexual characteristics
is a definitive removal, not typically used simply for
(breast development, pubic hair). Turner syndrome
diagnosis.
Which of the following are correct regarding pelvic cellular tissue?
1.
2.
3.
4.
Select the answer using the code given below.
(a)
(b)
It supports the pelvic organs.
It forms protective sheath for blood vessels and terminal part of ureter.
It prevents infection to be spread out of pelvis.
Marked hypertrophy of pelvic cellular tissue occurs in pregnancy.

1, 2 and 3
1, 2 and 4
(45,X) usually presents with poor secondary sexual
(c) 1, 3 and 4
(d) 2, 3 and 4

Sol
development. Androgen insensitivity syndrome has
59. (b) 1, 2 and 4 a 46,XY karyotype. Primary ovarian failure would
The pelvic cellular (endopelvic) connective tissue is a generally impair secondary sexual development due
key supportive framework that holds pelvic organs in (a)
(b)
to inadequate estrogen production.
A 25-year-old female comes to the gynaecology OPD for evaluation of secondary amenorrhoea. She gives history of previous dilatation and curettage, and her FSH levels are 8 IU/L. The probable cause of amenorrhoea is
Sheehan syndrome
Asherman syndrome
(c) Premature ovarian failure
(d) Incomplete abortion
CMS Paper-II Paper 2024 Answers MEDINK
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4


Sol

(d) 2, 3 and 4

63. (b) Asherman syndrome

Sol

67. (d) 2, 3 and 4

Asherman syndrome results from intrauterine
adhesions/scarring, most often following a uterine Genital tuberculosis typically presents with infertility
procedure such as a D&C. The normal or low FSH (2), often accompanied by chronic pelvic pain (3) and
(8 IU/L) rules out primary ovarian insufficiency menstrual disturbances such as oligomenorrhea or
(where FSH would be elevated). Sheehan syndrome amenorrhea (4). Although postmenopausal bleeding
(pituitary failure post-partum hemorrhage) does not (1) can occur in rare cases, it is less commonly
fit well with this post-D&C scenario. Incomplete recognized as a classic presenting feature compared
abortion would not typically cause a prolonged with disturbances in reproductive-age women.
secondary amenorrhoea after a prior procedure. Hence, the principal symptomatic triad involves
Hence, Asherman syndrome (intrauterine synechiae) infertility, pelvic pain, and irregular menses.
Which one of the following is correct regarding choriocarcinoma?
(a)
(b)
(c)
Vaginal bleeding is the commonest presenting symptom
About 20–30% of patients with molar pregnancies develop choriocarcinoma
Primary site of involvement is fallopian tube
(d) Highly resistant tumour to chemotherapy

is the most likely diagnosis.

Which of the following criteria are required to be fulfilled for hospitalization in a case of pelvic inflammatory disease?
1. Coexisting pregnancy


Sol

68.
2. Mild fever and pain responding well to antibiotics
3. Suspected tubo-ovarian abscess

(a) Vaginal bleeding is the commonest presenting

4. Coexistent HIV infection
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

Sol

symptom
64. (c) 1, 3 and 4
Choriocarcinoma most frequently presents with
Admission for PID is advised when (1) the patient irregular or excessive vaginal bleeding, often
is pregnant (to safeguard fetus and ensure parenteral following a molar pregnancy or, less commonly,
therapy), (3) a tubo-ovarian abscess is suspected after abortion or term delivery. The figure of “20–
(requires more intensive management), or (4) the 30%” progression from all molar pregnancies is an
patient has significant immunocompromise (e.g., overestimate (the progression is significantly lower,
HIV infection), as outpatient therapy may fail. Mild especially with modern follow-up). The uterine body,
fever and pain responding readily to antibiotics not the fallopian tube, is the usual site of origin.
(statement 2) generally do not require hospitalization. Choriocarcinomas are also notably chemosensitive,
Hence, criteria 1, 3, and 4 are the main recognized not resistant, leading to high cure rates with
(b)
(c)
indications for inpatient treatment.
A young female presented with complaints of lower abdominal pain, vaginal discharge, history of IUD use for last 3–4 years. On examination, the patient had fever, adnexal/cervical motion tenderness and increased ESR and C-reactive protein. What is the probable clinical diagnosis?
(a) Ectopic pregnancy
Acute appendicitis
Diverticulitis
appropriate regimens.
Which of the following are favourable factors in prognosis of ovarian malignancy?
1. Older age group
(d) Acute PID
2. Well-differentiated tumour
3. Smaller tumour volume
4. Absence of ascites
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4


Sol

(d) 2, 3 and 4

65. (d) Acute PID

Sol

69. (d) 2, 3 and 4

Pelvic inflammatory disease (PID) often presents
with lower abdominal or pelvic pain, abnormal Favorable prognostic indicators in ovarian cancer
vaginal discharge, and cervical motion tenderness include a well-differentiated (lower grade) tumor (2),
(Chandelier sign). Fever and elevated inflammatory smaller tumor burden (3) at the time of diagnosis/
markers (ESR, CRP) are classic in moderate to debulking, and absence of malignant ascites (4).
severe cases. Prolonged intrauterine device use can Younger (not older) patient age is also generally a
be a risk factor, especially if there are additional better prognostic factor, so statement 1 is incorrect.
risk behaviors. Ectopic pregnancy or appendicitis Thus, well-differentiation, limited disease volume,
may have some overlapping signs, but the specific and no ascites portend an improved outcome.
Which one of the following drugs is most effective in the treatment of gestational trophoblastic neoplasia?
(a)
(b)
(c)
Cisplatin
Methotrexate
Gemcitabine
(d) None of the above

combination of cervical/adnexal tenderness and

Sol

discharge strongly suggests acute PID.

Which of the following are risk factors for Pelvic Inflammatory Disease (PID)?
1.
2.
Use of contraceptive pills
IUD use
70. (b) Methotrexate
3. Genetic predisposition
4. Sexually active teenagers
Select the correct answer using the code given below.

Methotrexate (often with folinic acid rescue) is

(a) 1, 2 and 3
(b) 2, 3 and 4
(c) 1, 3 and 4
(d) 1, 2 and 4

the mainstay, first-line chemotherapy for low-risk

Sol

66. (d) 1, 2 and 4

gestational trophoblastic neoplasia (GTN). It achieves
Although modern data sometimes suggest oral high cure rates with relatively tolerable side effects.
contraceptives can reduce PID severity, certain Cisplatin and other agents (e.g., EMA-CO regimens
sources/classic teaching still list contraceptive using etoposide, methotrexate, actinomycin-D,
pills (1) as a risk factor because they may increase cyclophosphamide, vincristine) may be reserved
cervical ectopy, making the cervix more susceptible for high-risk cases or methotrexate resistance.
to infection. IUD use (2) is a known risk, especially Gemcitabine is not a standard first-line in GTN.
A 48-year-old female underwent total hysterectomy with bilateral salpingo-oophorectomy. The surgical specimen revealed solid ovarian tumour and histology revealed thecoma-fibroma. Which one of the following is the most appropriate statement regarding this condition?
(a) 20% of such tumours are bilateral.

within the first few weeks after insertion. Sexually

(b) Endometrial hyperplasia is often associated.
(c) It is always associated with gross ascites.
(d) It is derived from germ cells.

Sol

active teenagers (4) have higher rates of STIs due to

71. (b) Endometrial hyperplasia is often associated.
multiple factors (e.g., less consistent condom use).
Genetic predisposition (3) is not commonly cited for Ovarian thecoma-fibroma tumors belong to the
PID risk. sex-cord stromal category and can secrete estrogen.
Which of the following are symptoms of genital tuberculosis?
1. Postmenopausal bleeding
2. Infertility
3. Chronic pelvic pain
4. Oligomenorrhoea
MEDINK Paper 2024 Answers page 29

This excess estrogen frequently leads to endometrial tube. Dense pelvic adhesions (1) reduce operative
hyperplasia or even endometrial carcinoma in some success and increase the risk of postoperative re-
cases. Bilaterality in these tumors is relatively occlusion. A very short remaining tube (2) (< 8
uncommon (significantly less than 20%). While they cm in some references, or even < 4 cm in others)
can be linked with ascites (especially fibromas in decreases the chance of natural conception. Bilateral
Meigs’ syndrome), it is not invariably present. Germ hydrosalpinx (3) similarly lowers fertility rates. While
cell origin is incorrect; thecomas/fibromas arise from age and other factors (e.g., interval from sterilization)
the ovarian stroma.
In POPQ classification for uterovaginal prolapse, the only measurement done after reducing the prolapse is
(a)
(b)
genital hiatus
point C
can matter, they are generally less definitive “poor
(c) point D
(d) total vaginal length

Sol
outcome” predictors than the first three.
Ulipristal acetate (progesterone receptor modulator) should not be prescribed as emergency contraceptive in women with
(a)
(b)
glaucoma
liver dysfunction
(c) kidney failure

72.
(d) coagulopathy

(d) total vaginal length

Sol

The Pelvic Organ Prolapse Quantification (POPQ) 76. (b) liver dysfunction
system designates various reference points (Aa, Ba, Ulipristal acetate is metabolized primarily by
Ap, Bp, C, D) and measurements (genital hiatus, the liver. In the presence of significant hepatic
perineal body, total vaginal length). Total vaginal dysfunction, its metabolism and clearance can be
length (TVL) is measured from the hymenal ring to impaired, potentially leading to toxicity or reduced
the apex of the vagina after the prolapse has been efficacy. Therefore, women with acute or severe
manually reduced. All other points (C, D, etc.) are liver disease are contraindicated from using ulipristal
recorded in situ without necessarily reducing the for emergency contraception. Glaucoma, kidney
prolapse. This ensures an accurate assessment of the failure, and coagulopathies are not standard listed
full vaginal canal length independent of the prolapsed (a)
(b)
contraindications for ulipristal.
Injectable medroxyprogesterone IP 150 mg/mL contraceptive injection is available in Family Health Programme of the Government of India under the name
Saheli
Sayana Press
(c) Antara
(d) Sahiba

segment.
Which of the following are essential steps of Fothergill’s operation?
1.
2.
Laparoscopic or vaginal ligation
Amputation of cervix


Sol

3. Plication of Mackenrodt’s ligaments in front of cervix

77.
4. Ant colporrhaphy
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b)
(c)
(d)
1, 2 and 4
1, 3 and 4
2, 3 and 4

(c) Antara


Sol

73. (d) 2, 3 and 4 Under the National Family Planning Programme

in India, “Antara” is the brand name for the
Fothergill’s operation (Manchester operation) is a
intramuscular depot medroxyprogesterone acetate
uterine-sparing procedure for mild uterine descent.
(DMPA) injection containing 150 mg/mL. “Sayana
The key steps include amputation of the elongated
Press” is a slightly lower dose (104 mg) DMPA
cervix (2), plication of the cardinal (Mackenrodt’s)
formulation for subcutaneous use. “Saheli” (or
ligaments (3) at the cervix’s anterior aspect to
centchroman/ormeloxifene) is a non-steroidal oral
provide better support, and commonly an anterior
contraceptive. “Sahiba” is not the government’s
colporrhaphy (4) to address any associated cystocele.
brand name for DMPA.
“Laparoscopic or vaginal ligation” (1) does not Which of the following are major complications of oral pills?
1. Cholestasis jaundice
2. Chloasma and acne
3. Venous thromboembolism
4. Breast cancer
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

describe a standard essential step of this classic

Sol

operation.
Which of the following are indications of cold knife conization?
1.
2.
3.
4.
Inconsistent finding colposcopy, cytology and directed biopsy
Persistent CIN-1 lesion in women willing for future fertility
Carcinoma in situ
Unsatisfactory colposcopic finding where margin of lesion is not visible
78. (c) 1, 3 and 4
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4

Recognized serious complications of combined

(c) 1, 3 and 4
(d) 2, 3 and 4

Sol

74. (c) 1, 3 and 4 oral contraceptive pills include cholestatic jaundice

(hepatic effects), venous thromboembolism
Cold knife conization is an excisional diagnostic/
(particularly in predisposed women), and a possible
therapeutic procedure indicated when: (1)
slight increase in breast cancer risk with long‐term
colposcopic, cytologic, and biopsy results are
use. While chloasma (melasma) and mild skin changes
discordant (inconsistent findings), (3) carcinoma in
can certainly occur, they are usually considered
situ (CIN 3) must be ruled out or definitively treated,
minor side effects rather than “major complications.”
and (4) the colposcopic exam is unsatisfactory (lesion
Thus, items 1, 3, and 4 are most typically categorized
margins cannot be seen). While persistent low-grade
as significant or “major” risks.
(CIN-1) lesions can require further intervention, the Which of the following conditions are indications of removal of intrauterine device?
1. Persistent irregular uterine bleeding
2. Perforation of uterus
3. Pyelonephritis
4. Pregnancy with device in situ
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4
(c) 1, 3 and 4
(d) 2, 3 and 4

more typical approach is ablative therapy or LEEP/

Sol

laser excision rather than a cold knife conization, 79. (b) 1, 2 and 4
making statement 2 less standard.
Which of the following are factors for poor outcome following tuboplasty?
1.
2.
Dense pelvic adhesions
Length of reconstructed tube less than 8 cm
Indications for removing an intrauterine device
3. Bilateral hydrosalpinx
4. Reversal after 5 years of sterilization procedure
Select the correct answer using the code given below.
(a) 1, 2 and 3
(b) 1, 2 and 4

include persistent or unacceptable uterine bleeding,

(c) 1, 3 and 4
(d) 2, 3 and 4

Sol

75. (a) 1, 2 and 3 uterine perforation, or pregnancy with the device

in place (to reduce infection/miscarriage risk).
Success after tubal reconstructive surgery depends on
Pyelonephritis alone is not a standard direct
minimal scarring and adequate length of functional
indication for IUD removal unless it is thought to
CMS Paper-II Paper 2024 Answers MEDINK

be part of a severe pelvic infection or complicated spending). Each pair in the table is accurately
UTI. Therefore, 1, 2, and 4 are the classic reasons to Consider the following management methods/techniques:
1.
2.
matched to its corresponding objective in the policy.
System analysis
Organizational design
3. Personnel management
4. Information systems

remove the IUD.

A 25-year-old newly married female on liver enzyme inducers is requesting contraceptive advice in family planning clinic. Which of the following would be the most reliable method of contraception for her?
(a)
(b)
Combined oral contraceptive pill
Male condom
Which of the above methods/techniques are based on behavioural sciences?
(a)
(b)
(c)
(d)
1, 2 and 3
1, 2 and 4
1, 3 and 4
2, 3 and 4

(c) Diaphragm
(d) Depo-Provera injection

Sol

84. (a) 1, 2 and 3

Sol

80. (d) Depo-Provera injection

In many standard texts of health management,
Women taking certain enzyme-inducing medications
organizational design (2) and personnel management
(e.g., rifampicin, some anticonvulsants) experience
(3) are clearly in the realm of behavioral sciences,
decreased blood levels of estrogens/progestins
focusing on group dynamics, leadership, and
from oral contraceptives, resulting in higher failure
motivation. System analysis (1) can also be partly
rates. Depot medroxyprogesterone acetate (DMPA)
included under the broader managerial/behavioral
injections, often branded “Depo-Provera,” maintain
approach (exam contexts often lump it in), whereas
relatively stable levels and are less affected by hepatic
information systems (4) are typically considered
enzyme induction. While condoms or diaphragms
a technical/operational tool rather than purely
may provide non-hormonal barriers, they are less
behavioral. Hence, the official key often lists 1, 2,
reliable in typical use. Depo-Provera offers a high
and 3 as “behavioral sciences” in such classification
efficacy unaffected significantly by enzyme inducers.
schemes.
As per the Open Vial Policy, partially used multidose vials of which of the following vaccines can be used over more than one immunization session?
1. BCG vaccine
2. DPT vaccine
3. Hepatitis B vaccine
4. Measles vaccine
Select the correct answer using the code given below. In the following table, the end results of planning are qualified by brief characteristics:
(a) 1 and 2 only 1. Goal → Always constrained by time
(b) 2 and 3 only 2. Objective → Precise—either achieved or not achieved
(c) 1, 2 and 3 3. Target → Permits the concept of degree of achievement
(d) 1, 3 and 4 How many of the pairs given above are correctly matched?
(a) None of the pairs
(b) Only one of the pairs
(c) Only two of the pairs
(d) All of the pairs

Sol

81.


Sol

(b) 2 and 3 only 85. (c) Only two of the pairs

Under WHO/UNICEF “open vial” guidelines, Conventionally, an objective is the precise, time-
inactivated liquid vaccines (like DPT and Hepatitis B) bound end result that is either met or not met (so
that contain appropriate preservatives can be reused “Precise—either achieved or not achieved” fits
in subsequent sessions, provided they remain sterile “objective”). A target often refers to a quantifiable
and within recommended cold-chain conditions. measure (degree of achievement). A goal is typically
By contrast, BCG and measles are freeze-dried broader, sometimes time-related but not invariably
(lyophilized) vaccines which, once reconstituted, “always constrained by time.” So 2 and 3 match
must be discarded within a few hours (generally standard definitions, but 1 is usually incorrect. Thus,
within six hours or at the end of the session).
Consider the following steps of a planning cycle:
two of those pairs are correctly matched.
Therefore, only DPT (2) and Hepatitis B (3) can be 1. Assigning priorities among the problems
2. Evaluation
3. Selecting best programme
4. Operating the programme
Which among the following is the correct sequence of steps?
(a) 3→4→1→2
(b) 1→2→3→4
(c) 1→3→4→2
(d) 2→3→4→1

used over multiple sessions.

The statement, ‘Health is a dynamic equilibrium between man and environment and disease a maladjustment of the human organism to environment’ explains which one of the following concepts of health?
(a)
(b)
Biomedical
Ecological


Sol

86. (c) 1 → 3 → 4 → 2
(c) Psychosocial
(d) Holistic

Sol

82. (b) Ecological A standard planning cycle typically follows: (1)

The ecological concept of health views human well- identify and prioritize problems, (3) formulate and
being as an ongoing balance or adaptation between select the best solution/program, (4) implement or
the individual and the surrounding environment. operate that program, and (2) evaluate the results.
Diseases arise when this balance is disturbed (i.e., This ensures resources go toward the most pressing
maladjustment to environmental conditions). The needs, the chosen intervention is executed, and only
purely biomedical concept focuses on absence of then is it evaluated for effectiveness and possible
disease in bodily terms, while the psychosocial revision. Hence the order is 1 → 3 → 4 → 2.
Which of the following statements are correct for incidence rate?
1.
2.
It is useful for taking action to control a disease.
Rising incidence rates may indicate ineffectiveness of the current control programmes.
3. Fluctuation in incidence rate may indicate a change in aetiology of disease.
Select the answer using the code given below.
(a) 1 and 2 only

concept incorporates mental and social factors. The (b)

(c)
(d)
2 and 3 only
1 and 3 only
1, 2 and 3

holistic concept merges multiple dimensions but does

Sol

87. (d) 1, 2 and 3

not specifically emphasize the environment in the
manner of the classic “ecological” definition. Incidence rate is crucial for public health action since
A table shows three broad components under which the objectives of the National Health Policy, 2017 can be grouped, along with an example of goal/objective under that component:
1. Health status & programme impact → Increase life expectancy at birth from 67.5 to 70 years by 2025
2.
3.
How many of the pairs given above are correctly matched?
(a)
(b)
(c)
(d)
Health systems performance → More than 90% of the newborn are fully immunized by one year of age by 2025
Health systems strengthening → Increase State sector health spending to more than 8% of their budget by 2020

None of the pairs

Only one of the pairs
Only two of the pairs
All of the three pairs
it measures new cases over time (statement 1). If it


Sol

rises, that may signal failure or inefficacy in current

83. (d) All of the three pairs control measures (statement 2). Abrupt changes or
The National Health Policy (NHP) 2017 indeed sets fluctuations in incidence can also imply new risk
targets/examples under these three broad headings: factors or etiologic shifts (statement 3). Hence,
improving overall health status/impact (e.g., raising all three statements describe valid applications or
life expectancy), health system performance (e.g., Consider the following definition:
interpretations of incidence data.
A high level of infection beginning early in life and affecting most of the child population, leading to a state of equilibrium such that the adult population shows evidence of the disease much less commonly than the children.
Which one of the following terms best fits this definition?
(a) Holoendemic
(b) Hyperendemic
(c) Hypoendemic

high immunization coverage), and health system (d)

Sol
Pandemic

strengthening (e.g., increased government health 88. (a) Holoendemic

MEDINK Paper 2024 Answers page 31

A holoendemic disease is one that infects children at civil registration adopt this dual-record system to
a very high rate, so much so that by adulthood most estimate birth and death rates more accurately.
While calculating the ‘total dependency ratio,’ which one of the following is used in the denominator?
(a)
(b)
Midyear population
Population 0 to 65 years
(c) Population 15 to 64 years
(d) Population 14 to 70 years

individuals show evidence of past infection and have

Sol

developed immunity. As a result, overt disease in 93. (c) Population 15 to 64 years

adults is much less common. “Hyperendemic” also The dependency ratio compares the “dependent”
refers to a high level of ongoing transmission but does age groups (usually those < 15 years plus those ≥ 65
not specifically imply the predominance of disease years) to the “working-age” population (commonly
in children compared to adults. “Hypoendemic” and 15–64 years). Thus, the denominator for the total
“pandemic” do not fit the definition given.
Consider the following statements regarding dengue virus:
1.
2.
It has four distinct serotypes.
Infection with any one serotype confers lifelong immunity for that virus serotype.
dependency ratio is the population aged 15–64. This
3. Secondary infection with dengue serotype 2 leads to severe form of dengue.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only

indicates how many dependents exist for every 100

(d) 1, 2 and 3

Sol

89. (d) 1, 2 and 3 (or 1,000) working-age individuals.

As per the United Nations definition of a vital events registration system, ‘vital events’ include which of the following?
1.
2.
3.
4.
Foetal deaths
School admissions
Legal separations
College graduations
Select the correct answer using the code given below.
(a) 1 and 2
(b) 1 and 3
(c) 2 and 3

Dengue virus indeed has four serotypes (DENV-1, -2, (d)

Sol
2 and 4

-3, -4). An individual infected by one serotype usually 94. (b) 1 and 3
acquires lifelong immunity against that particular
Under UN guidelines, the vital events for registration
serotype (statement 2). A secondary infection with
include births, deaths, fetal deaths (stillbirths),
a different serotype—particularly DENV-2—is
marriages, divorces—or “legal separations”/
often linked with an increased risk of severe dengue
annulments in some frameworks—adoptions, and
(DHF/DSS). Hence, all three statements are factually
legitimations. Foetal deaths definitely qualify.
correct.
Consider the following statements regarding dengue:
1.
2.
3.
Which of the statements given above are correct?
(a)
(b)
(c)
The mosquito becomes infective after an extrinsic incubation period of 8–10 days.
Once it becomes infective, the mosquito remains infective for life.
The genital tract of the mosquito does not get infected.

1 and 2 only
2 and 3 only
1 and 3 only
“Legal separations” may be grouped with divorces/
(d) 1, 2 and 3

Sol
annulments depending on jurisdiction, so it can be
90. (a) 1 and 2 only considered a vital event for some registration systems.
After biting an infected host, Aedes mosquitoes School admissions (2) and college graduations (4)
require an extrinsic incubation period (8–10 days) are not vital events. Hence, pairs 1 and 3 represent
before they can transmit dengue to another individual 1.
2.
recognized “vital events.”
Consider the following statements about Kyasanur Forest Disease (KFD):
It is transmitted by ticks.
It was originally called ‘pig disease’ because of the association with dead pigs.
3. It was first recognized in Karnataka State.
How many of the statements given above are correct?
(a) None of the statements
(b) Only one of the statements
(c) Only two of the statements

(statement 1). Once the virus reaches the salivary (d)

Sol
All the three statements

glands, the mosquito remains infective for the rest of 95. (c) Only two of the statements
its lifespan (statement 2). However, dengue viruses
KFD is a tick-borne viral hemorrhagic fever first
can infect multiple tissues, and there is evidence in
identified in the Kyasanur Forest of Karnataka,
some arboviruses of possible transovarial spread. So
India (statement 1 is true, statement 3 is true). It is
the blanket claim that “the genital tract does not get
primarily associated with monkeys (especially dead
infected” (statement 3) is generally not accepted as
langurs), not pigs—hence the popular name was not
correct.
A researcher has obtained the country-level data on the average Body Mass Index (BMI) and the average sugar intake for 100 countries. Which among the following will be best suited to present the relationship between BMI and sugar intake in the 100 countries?
(a)
(b)
(c)
(d)
Bar chart
Pie diagram
Frequency polygon
Scatter diagram “pig disease.” So statement 2 is incorrect. Therefore,


Sol

exactly two statements (1 and 3) are correct.

91.
In countries with low levels of measles transmission, what should be the appropriate age for starting immunization with measles-containing vaccine (MCV)?
(a) 6 months

(d) Scatter diagram

(b) 9 months
(c) 12 months
(d) 15–18 months

Sol

A scatter diagram (scatter plot) is ideal for showing the 96. (c) 12 months
relationship or correlation between two continuous
Where measles transmission is high (often in
variables—here, country-level average BMI on one
developing regions), WHO generally recommends
axis and average sugar intake on the other. A bar
the first measles dose at 9 months to protect infants
chart or pie diagram is better for categorical data.
early. However, in low-transmission settings—
A frequency polygon displays the distribution of a
i.e., places that have effectively reduced measles
single variable. Thus, to visualize how BMI might
circulation—the recommended first dose often shifts
vary with sugar intake across 100 countries, a scatter
to around 12 months to optimize seroconversion and
diagram is most appropriate.
Frontline health workers are employed to record the births and deaths in countries which have made slow progress in the development of a comprehensive vital registration system. This approach is known as
(a)
(b)
(c)
(d)
registration of vital events
lay reporting
sample registration system
census
Monkeypox, a viral zoonotic disease, is caused by
longer-lasting immunity.
(a)
(b)
(c)
a single-stranded RNA virus
a double-stranded RNA virus
a single-stranded DNA virus
(d) a double-stranded DNA virus

Sol

92. (c) sample registration system

Sol

97. (d) a double-stranded DNA virus

In the Sample Registration System (SRS), part-time
Monkeypox belongs to the Orthopoxvirus genus
enumerators (often local workers such as anganwadi
(which includes smallpox virus) of the Poxviridae
workers or accredited social health activists) keep
family. These viruses are large, brick-shaped, and
continuous records of births and deaths in selected
contain double-stranded DNA. In contrast, many
sample units. Independent supervisors periodically
verify these. Countries (or regions) that lack universal
CMS Paper-II Paper 2024 Answers MEDINK

other zoonotic viruses (e.g., influenza, rabies) are (3.8–4.1 %), then cow milk (3.0–4.0 %), and human
single-stranded RNA viruses.
Raju, a 6-year-old boy, was returning home from school. At the gate, he was scratched by a dog and there was some bleeding from the wound. Which option should be followed for the post-exposure prophylaxis?
(a)
(b)
Wash the wound and administer a shot of tetanus toxoid
Wash the wound and vaccinate with ARV only
milk often around 3–4 % but generally on the lower
(c) Wash the wound, vaccinate with ARV and administer immunoglobulin
(d) Wash and apply antiseptic to the wound

Sol
side in standard references when directly compared.
98. (c) Wash the wound, vaccinate with ARV and Thus the descending order of fat percentage is Buffalo
administer immunoglobulin Which of the following are unsaturated fatty acids?
(1) Goat (3) Cow (2) Human (4).
1.
2.
Lauric acid
Linoleic acid
3. Oleic acid
4. Palmitic acid
Select the correct answer using the code given below.
(a) 1 and 2
(b) 1 and 4

A dog scratch drawing blood is typically treated as a

(c) 2 and 3
(d) 3 and 4

Sol

Category III exposure under rabies guidelines. Proper 103. (c) 2 and 3
management includes: immediate and thorough
Lauric acid (12 : 0) and palmitic acid (16 : 0) are
washing of the wound, vaccination with anti-rabies
saturated fatty acids. Linoleic acid (18 : 2) is a
vaccine (ARV), and immunoglobulin if the animal is
polyunsaturated essential fatty acid, and oleic acid
high-risk or unvaccinated (and the wound is severe).
(18 : 1) is monounsaturated. Hence 2 (linoleic) and 3
Tetanus prophylaxis may also be needed, but the
(oleic) are the unsaturated fatty acids in this list.
key rabies steps are wound washing, vaccine, and
In India, the most widely prevalent stage of iron deficiency is
(a) decreased iron stores without any other detectable abnormalities
(b) fall in percentage saturation of transferrin
(c) overt iron deficiency with impaired haemoglobin synthesis
(d) decrease in the concentration of circulating haemoglobin

immunoglobulin for Category III.

Sol

104. (a) decreased iron stores without any other detectable

The method of combined disposal of refuse and night soil is known as
(a) dumping
(b) controlled tipping
(c) incineration
(d) composting

abnormalities


Sol

99. (d) composting

Iron deficiency typically progresses in stages: first,
Composting is a biological process in which organic
ferritin and stored iron are depleted (still no obvious
wastes, including biodegradable refuse and in
lab or clinical anomalies). Next, further changes
some methods even night soil (human excreta), are
manifest as low serum iron and transferrin saturation.
decomposed by microorganisms under controlled
Finally, haemoglobin production and RBC indices
conditions. This produces nutrient-rich compost.
drop, resulting in iron deficiency anaemia. In many
“Controlled tipping” (sanitary landfill) is largely
community surveys, the earliest/latent stage—loss
for refuse disposal alone. “Incineration” is high-
of iron stores—is believed to be most common in
temperature burning typically used for biomedical or
populations, especially in developing countries like
hazardous waste, and “dumping” is just open disposal
India, making option (a) the most widely prevalent
without treatment.
stage.
Consider the following statements about working of septic tanks:
1. They are recommended for large communities, rather than small communities.
2. There should be no air space between the level of liquid in the tank and the undersurface of the cover.
3. Liquid effluent from the outlet pipe is free from all pathogens.
How many of the statements given above are correct?
(a) None of the statements Consider the following statements:
(b) Only one of the statements Statement I: Waist circumference and waist to hip ratio are more powerful predictors of subsequent risk of type 2 diabetes than Body Mass Index (BMI).
(c) Only two of the statements Statement II: Central obesity is an important determinant of insulin resistance, the underlying abnormality in most cases of type 2 diabetes.
(d) All the three statements Which one of the following is correct in respect of the above statements?
(a) Both Statement I and Statement II are correct and Statement II is the correct explanation of Statement I
(b) Both Statement I and Statement II are correct but Statement II is not the correct explanation of Statement I
(c) Statement I is correct but Statement II is incorrect
(d) Statement I is incorrect but Statement II is correct

Sol

100. (a) None of the statements

Sol

105. (a) Both Statement I and Statement II are correct and

(1) Septic tanks are generally recommended for Statement II is the correct explanation of Statement I
small settlements or individual households, not large Excess central (visceral) fat strongly predisposes to
communities (which typically need full-scale sewage insulin resistance, making waist circumference or
treatment). (2) There is usually a space between the waist–hip ratio better predictors of type 2 diabetes
liquid and the cover, allowing gases to accumulate than overall BMI. Since statement II (central
and vent. (3) The effluent is not completely free of obesity drives insulin resistance) directly explains
pathogens; it still contains microorganisms and may why statement I (waist-related measures are more
require soak-pit dispersion or further treatment. predictive than BMI) is true, both statements are
Therefore, none of the given statements are correct.
Of the following amino acids, which is categorized as a nonessential amino acid?
(a)
(b)
(c)
(d)
Leucine
Threonine
Tryptophan
Proline Consider the following statement:
correct, and II explains I.
The people should seek to preserve their traditional eating patterns and lifestyles associated with low levels of Coronary Heart Disease (CHD).
Which level of prevention is implied in this statement?
(a) Primordial
(b) High risk
(c) Primary
(d) Secondary


Sol

101. (d) Proline

Sol

106. (a) Primordial

Essential amino acids are those the body cannot
Primordial prevention aims to prevent the emergence
synthesize in sufficient quantities and must therefore
and establishment of social, economic, and cultural
come from the diet. Leucine, threonine, and
patterns of living that are known to increase the risk
tryptophan are all essential in humans. Proline, on the
of disease. Encouraging populations to retain healthy
other hand, can be synthesized endogenously from
traditional diets and lifestyles before risk factors
other metabolic precursors, making it a nonessential
(e.g., high-fat diets, sedentary habits) even develop
Consider the following milks :
amino acid.
is a textbook example of primordial prevention.
1. Buffalo milk
2. Cow milk
3. Goat milk
4. Human milk
What is the correct order (from highest to lowest) with regard to fat content per 100 g in the milk?
(a) 1→3→4→2
(b) 4→2→3→1
(c) 2→1→4→3
(d) 1→3→2→4

Sol
Primary prevention deals with preventing disease in
102. (d) 1 → 3 → 2 → 4 individuals who already have risk factors; primordial
Typical average fat contents are highest in buffalo prevention is about stopping those risk factors from
milk (around 7–8 %), followed next by goat milk arising in the first place.
Raju is 30 years of age. He has been working in the ceramic and pottery industry for the last 10 years. Which one of the following conditions should he be screened for?
(a)
(b)
Silicosis
Anthracosis
(c) Byssinosis
(d) Asbestosis
MEDINK Paper 2024 Answers page 33

Sol

A commonly cited four-phase cycle for a nuclear

107. (a) Silicosis family is:
Ceramic and pottery workers are exposed to silica dust, 1. Formation (marriage and starting a family) →
putting them at risk for silicosis, a pneumoconiosis 2. Extension (arrival of children and expansion)
characterized by fibrotic nodules primarily in the →
upper lobes. Anthracosis is associated with coal dust 3. Contraction (grown children begin leaving
exposure, byssinosis with cotton dust, and asbestosis home) →
with asbestos fibers (shipyard, construction, etc.). 4. Dissolution (retirement, death of a spouse, etc.).
Hence, the correct screening for a pottery/ceramics Hence, in the numbering given, 4 (Formation) → 3
worker is silicosis.
An industrial worker was brought to a medical facility due to health problems. On his workup including laboratory tests, a finding of basophilic stippling of Red Blood Cells (RBC) was observed. Which among the following is he/she likely to be having?
(a)
(b)
Asbestosis
Farmer’s lung
(Extension) → 1 (Contraction) → 2 (Dissolution).
Which among the following are characteristics of health education, rather than propaganda?
1.
2.
3.
Knowledge actively acquired, rather than instilled
Appeals to emotion, rather than reason
Behaviour centred, rather than information centred
(c) Lead poisoning
4. Arouses and stimulates primitive desires, rather than disciplines them
(d) Brucellosis
Select the correct answer using the code given below.
(a) 1 and 2
(b) 1 and 3
(c) 2 and 3
(d) 3 and 4

Sol

108. (c) Lead poisoning

Sol

113. (b) 1 and 3

Basophilic stippling of RBCs (small, dark-blue
Health education relies on helping individuals
granules) is characteristically seen in lead poisoning.
actively acquire understanding (rather than just
Lead interferes with enzymes of heme synthesis,
drilling in facts) and aims to develop healthy
resulting in accumulated ribosomal precipitates that
behaviours. By contrast, propaganda often appeals
appear as stippling. Asbestosis and farmer’s lung
more to raw emotion (2) or base instincts (4). Thus
involve lung pathology without this RBC change, and
in health education, knowledge is actively sought (1)
brucellosis is a bacterial zoonosis, also not associated
and is behaviour-oriented (3), not merely emotional
with basophilic stippling.
Consider the following pairs of genetic diseases that show Mendelian inheritance. Each of the following pairs represents a genetic disease and it has been matched with a type of inheritance :
1.
2.
3.

(a)
(b)
(c)
Cystic fibrosis → Autosomal recessive
Huntington’s chorea → Autosomal dominant
Marfan’s syndrome → Recessive sex-linked
How many of the pairs given above are correctly matched?
None of the pairs
Only one of the pairs
Only two of the pairs
1.
2.
persuasion.
Consider the following statements regarding LNG-20 (Mirena):
It is a T-shaped IUD filled with natural hormone progesterone.
It is associated with a low pregnancy rate (2 per 1000 women).
3. It is associated with a large number of ectopic pregnancies.
(d) All the three pairs
4. It is associated with lower menstrual blood loss as compared to copper IUDs.
Which of the statements given above is/are correct?
(a) 2 only
(b) 2 and 4 only
(c) 1, 3 and 4
(d) 2, 3 and 4


Sol

109. (c) Only two of the pairs

Sol

114. (b) 2 and 4 only

Cystic fibrosis (CF) is indeed autosomal recessive.
Mirena contains levonorgestrel (a synthetic
Huntington’s disease follows autosomal dominant
progestin), not “natural progesterone,” so statement 1
inheritance. Marfan syndrome is also autosomal
is incorrect. It indeed has a very low failure rate (about
dominant, not “recessive sex-linked.” Hence pairs 1
2 per 1000), making statement 2 correct. Although
and 2 are correct, while 3 is incorrect, so exactly two
an IUD pregnancy is more likely to be ectopic if it
pairs are correct.
happens, the overall absolute risk of ectopic is low;
Consider the following statements:
Statement I: Signs of thalassemia major usually develop after 6 months of age.
Statement II: This is the time when haemoglobin synthesis switches from haemoglobin F to haemoglobin A.
Which one of the following is correct in respect of the above statements?
(a) Both Statement I and Statement II are correct and Statement II is the correct explanation of Statement I
(b) Both Statement I and Statement II are correct but Statement II is not the correct explanation of Statement I
(c) Statement I is correct but Statement II is incorrect
(d) Statement I is incorrect but Statement II is correct

Sol

it is not associated with a “large number of ectopic

110. (a) Both Statement I and Statement II are correct and pregnancies” (statement 3 is misleading). Mirena
Statement II is the correct explanation of Statement I does reduce menstrual blood loss more than copper
In β-thalassemia major, newborns appear relatively The most common cause of maternal mortality in India is
IUDs, so statement 4 is correct.
(a)
(b)
(c)
(d)
obstetric haemorrhage
obstructed labour
unsafe abortion
toxaemia of pregnancy

normal at birth because of high levels of haemoglobin

Sol

F (fetal). Around 6 months, as HbF declines and adult 115. (a) obstetric haemorrhage
haemoglobin (HbA) should take over, the defective Despite improvements in obstetric care, postpartum
beta chains become apparent, and clinical symptoms hemorrhage (often combined with other hemorrhagic
arise. Statement II precisely explains why the major causes) remains the leading direct cause of maternal
manifestations start after 6 months, making both death in India, surpassing other causes such as
statements correct with II explaining I.
Which of the following publications is/are brought out by the World Health Organization?
1.
2.
CD Alert
Morbidity and Mortality Weekly Report (MMWR)
obstructed labor, unsafe abortion, and hypertension
3. Weekly Epidemiological Record
Select the correct answer using the code given below.
(a) 2 only
(b) 1 and 2

(eclampsia/toxemia). Prompt recognition and active

(c) 2 and 3
(d) 3 only

Sol

111. (d) 3 only management of the third stage of labor are critical to
reducing hemorrhagic complications.
CD Alert is published by India’s National Centre for
In the National Malaria Control Programme, Indoor Residual Spray (IRS) is the primary method of vector control in rural setting. Which one of the following is the ‘insecticide of choice’?
(a) DDT
(b) Malathion
(c) Synthetic pyrethroid
(d) Temephos

Disease Control (NCDC). Morbidity and Mortality

Sol

Weekly Report (MMWR) is from the U.S. Centers 116. (a) DDT
for Disease Control and Prevention (CDC). The In India’s malaria control efforts, DDT
Weekly Epidemiological Record (WER) is published (dichlorodiphenyltrichloroethane) has historically
by the World Health Organization (WHO). Hence been used as the chief insecticide for indoor residual
only 3 belongs to WHO.
As per the basic model of a nuclear family life cycle, consider the following phases :
1. Contraction
spraying (IRS) in rural areas (provided local
2. Dissolution

mosquitoes remain susceptible). Alternatives like

3. Extension
4. Formation
Which one of the following best represents the correct sequence of phases in a normal nuclear family?
(a) 1→2→3→4
(b) 4→3→1→2
(c) 1→4→3→2
(d) 4→1→2→3

Sol

malathion or synthetic pyrethroids are used in regions

112. (b) 4 → 3 → 1 → 2
CMS Paper-II Paper 2024 Answers MEDINK

where DDT resistance is established. Temephos is

more commonly employed in larval control.
Consider the following statements with regard to selection of Accredited Social Health Activist (ASHA) under NRHM:
1.
2.
ASHA must be a woman preferably in the age group of 18 to 25 years.
ASHA must have had formal education up to at least class ten.
3. ASHA must be a resident of the village.
4. ASHA may be a married, widowed or divorced woman.
Which of the statements given above are correct with regard to process of selection of ASHA?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 3 and 4 only
(d) 1, 2, 3 and 4

Sol

117. (c) 3 and 4 only

ASHA guidelines indicate the worker should be a
local resident (3) for familiarity with community, and
she may be married, widowed, or divorced (4). The
preferred age range is often stated as 25–45 years,
not “18–25” (statement 1 is incorrect). Minimum
education requirement is typically around class 8 (not
necessarily class 10), so statement 2 is also incorrect.
Consider the following statements regarding the Central Drugs Standard Control Organization (CDSCO) in India:
1.
2.
The CDSCO is headed by the Drugs Controller General (India) at the Centre.
The CDSCO is a part of the Directorate of Director General of Health Services.
3. The CDSCO is under the Ministry of Chemicals and Fertilizers, Government of India.
4. The CDSCO has a network of several port offices for monitoring the import and export of drugs.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 1 and 3
(c) 1, 2 and 4
(d) 2 and 4 only

Sol

118. (c) 1, 2 and 4

The CDSCO is indeed led by the Drugs Controller
General of India (DCGI) (1) and functions under the
Directorate General of Health Services, Ministry of
Health & Family Welfare (2), not under the Ministry
of Chemicals and Fertilizers (so 3 is incorrect). It
maintains port offices to oversee drug import/export
(4).
The National AIDS Control Organization provides prepacked colour-coded STI/RTI kits as a free supply to its designated STI/RTI clinics. Consider the following pairs:
How many of the pairs given above are correctly matched?
(a) None of the pairs
(b) Only one pair
(c) Only two pairs
(d) All the three pairs

Sol

119. (b) Only one pair

NACO color-coded STI/RTI kits differ from what
is listed here. Green kit is indeed used for vaginal
discharge (that matches 2). However, Red kit
generally relates to lower abdominal pain in women
(PID), not “urethral discharge,” and “White kit” is for
pelvic inflammatory disease or related conditions—
while “inguinal bubo” is usually addressed by the
Black kit. Thus, only pair 2 is correct.
A table shows results of an ELISA test for HIV infection:
Consider the following statements:
1. The sensitivity is 98%.
2. The specificity is 99%.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2

Sol

120. (c) Both 1 and 2

1. Sensitivity = True Positives ÷ (True Positives +
False Negatives) = 4900 ÷ 5000 = 98%.
2. Specificity = True Negatives ÷ (True Negatives
+ False Positives) = 94050 ÷ 95000 ≈ 98.95%,
which rounds to 99%.
Hence both statements (1) and (2) are correct.

EN
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MEDINK Question Paper 2023 page 35

Question Paper 2023

These findings describe a varicocele—dilated pampiniform plexus veins that feel like a “bag of worms” and typically decompress when the patient lies down. Modern management often begins with a minimally invasive endovascular approach. Percutaneous embolization of the gonadal (testicular) vein can provide relief of symptoms and improvement in fertility parameters. This approach avoids a surgical incision, has a good success rate, and allows quick recovery. Surgical ligation remains an option if embolization is unavailable or unsuccessful.

1. The ratio for Type-I to Type-III collagen during

maturation of collagen in remodelling phase is: 6. A malnourished 60-year-old man underwent
(a) 1 : 1 emergency surgery for Strangulated Sigmoid
(b) 2 : 1 Volvulus. After resection of the sigmoid colon, a
(c) 3 : 1 colostomy was fashioned. The postoperative period
(d) 4 : 1 was stormy and he developed a painful calf swelling

(d)

Sol
4:1

During wound healing, especially in the later remodeling phase, Type I collagen gradually replaces the initially laid-down Type III collagen. By the time the scar matures, the predominant form is Type I collagen, leading to an approximate 4:1 ratio of Type I to Type III. This shift ensures greater tensile strength of the healed tissue. Early in repair, Type III is more abundant, but the final stable scar contains mostly Type I, which is stronger and more cross-linked.
in right lower limb. The most probable diagnosis is :
(a) Hypoproteinemia
2. Which one of the following statements regarding Gas (b) Oedema of renal failure
Gangrene Infection is correct? (c) Myocardial failure due to fluid overload
(a) It is caused by C. perfringens, a gram negative (d) Deep vein thrombosis
aerobic non-spore-forming bacilli.
(d)

Sol
Deep vein thrombosis

A painful, swollen calf following major abdominal surgery—especially in an older, malnourished patient—is highly suggestive of deep vein thrombosis (DVT). Prolonged bed rest, dehydration, and hypercoagulability (as part of Virchow’s triad) predispose postoperative patients to venous thrombosis. Calf tenderness, increased leg circumference, and pain on dorsiflexion (Homan’s sign, though nonspecific) also point toward DVT. Prompt diagnosis (Doppler ultrasound) and treatment (anticoagulation) are essential to prevent life-threatening complications such as pulmonary embolism.

(b) It is caused by C. perfringens, a gram positive

anaerobic spore-forming bacilli. 7. Consider the following in respect of Salmon patch:
(c) It is caused by C. tetani, a gram positive 1. It is a hemangioma.
anaerobic spore-forming bacilli. 2. Its usual site is nape of neck.
(d) It is caused by C. tetani, a gram negative 3. It is common in children.
anaerobic non-spore-forming bacilli. 4. It needs surgical excision.

(b)

Sol
It is caused by C. perfringens, a gram positive anaerobic spore-forming bacilli.

Gas gangrene is most commonly due to Clostridium perfringens, which is a Gram-positive, rod-shaped, spore-forming, obligate anaerobe. It produces potent toxins that lead to rapidly spreading myonecrosis and gas formation within tissues. The presence of spores allows the organism to survive in harsh conditions, and once activated in deep, anaerobic wounds, it multiplies and releases toxins that destroy muscle and soft tissue. Correct identification and urgent management (debridement, antibiotics, and supportive care) are crucial for survival.
Which of the statements given above are correct ?
(a) 1, 2 and 3
3. The term ‘Gompertzian curve’ is related to which one (b) 1, 2 and 4
of the following? (c) 1, 3 and 4
(a) Tumour (d) 2, 3 and 4
(b) Gallstone
(a)

Sol
1, 2 and 3

A “Salmon patch” (nevus simplex) is traditionally viewed in some texts as a very superficial capillary hemangioma. It commonly appears on the nape of the neck (“stork bite”), eyelids, or glabella in newborns. It is indeed frequent in children and is often benign, fading over time without intervention. Surgical excision (statement 4) is typically unnecessary for these flat capillary lesions because most regress spontaneously. Hence statements 1, 2, and 3 are accepted as correct under older classifications describing it as a form of hemangioma.

(c) Intestinal obstruction

(d) Hernia 8. Which of the following are components of ‘Klippel-

(a)

Sol
Tumour

The Gompertzian growth curve describes how most tumors grow in a characteristic sigmoidal pattern: initially accelerating (when the tumor is small), then slowing as the tumor enlarges and outstrips its blood supply and nutrients. Early on, cancer cells divide more rapidly, but as cell density increases, the growth fraction declines and the rate of expansion diminishes. This model helps explain why chemotherapy is most effective against small, rapidly growing tumors and why larger tumors often respond less dramatically.
Trenaunay syndrome’?
1. Cutaneous Naevus
4. A 5-year-old male child comes with a left sided 2. Subcutaneous Lipomas
scrotal swelling which has no cough impulse and 3. Varicose veins
does not reduce on compression or lying down but 4. Soft tissue hypertrophy
the parents give a definite history that swelling is Select the correct answer using the code given below:
absent in the morning and comes by in the evening. (a) 1, 2 and 3
The best treatment is : (b) 1, 2 and 4
(a) To leave it alone (masterly inactivity) (c) 1, 3 and 4
(b) Herniotomy (d) 2, 3 and 4
(c) Eversion of sac
(c)

Sol
1, 3 and 4

Klippel-Trenaunay syndrome is classically characterized by a triad: (1) port-wine stain or capillary malformation (cutaneous nevus), (2) varicose veins or venous malformations, and (3) hypertrophy of bone and soft tissues (leading to limb enlargement). Subcutaneous lipomas are not a cardinal feature of this syndrome. The cutaneous nevus is usually present at birth, and the progressive limb overgrowth and varicosities become evident as the patient grows. Management may require compression therapy, orthopedic intervention, or surgery for complications.

(d) Hernioplasty

(b)

Sol
Herniotomy
9. ‘Mickey Mouse Sign’ during B-mode duplex
In a child older than about 2 years with a persistent, nonreducible scrotal swelling that appears and disappears over the course of the day, a congenital hydrocele or a patent processus vaginalis is likely. While “masterly inactivity” is reasonable in very young children (under 1–2 years) to allow spontaneous closure, persistence at age 5 years typically warrants surgical intervention. Herniotomy (i.e., ligation and division of the sac at the internal ring) is the definitive treatment in such cases and prevents complications.

ultrasound imaging comprises :

5. A 25-year-old gentleman complains of dragging pain (a) Popliteal artery, Popliteal vein and Saphenous
in the scrotum. The examination reveals the scrotum nerve
full of bag of worms which disappear on lying down. (b) Anterior tibial artery, Dorsalis pedis artery and
The usual first line option for relief is : Extensor hallucis tendon
(a) Percutaneous embolization of gonadal veins (c) Common femoral vein, Common femoral artery
(b) Radio frequency ablation of testicular veins and Great Saphenous vein
(c) Laparoscopic excision of affected testes (d) Brachial artery, Basilica vein and Biceps tendon
(d) Excision of pampiniform plexus
(c)

Sol
Common femoral vein, Common femoral artery and Great Saphenous vein

On transverse ultrasound imaging in the groin region, the common femoral artery and the common femoral vein (side by side) with the great saphenous vein entering medially create a pattern that resembles Mickey Mouse’s head and ears. The “head” is typically the common femoral vein, the “ear” the common femoral artery, and the other “ear” the saphenous vein. Recognizing this classic arrangement helps identify vascular structures quickly and is important for venous access, cannulation, and evaluating for deep vein thrombosis.

(a)

Sol
Percutaneous embolization of gonadal veins
CMS Paper-II Question Paper 2023 MEDINK

10. Which of the following statements regarding (c) 1, 3 and 4

Thyroglossal duct are correct ? (d) 2, 3 and 4
1. It is situated in midline of neck.
(a)

Sol
1, 2 and 3

A trichobezoar is a mass of hair accumulated in the stomach, often due to trichophagia (hair-eating), which itself is commonly linked to psychiatric disorders like trichotillomania. This hair mass can cause gastric outlet obstruction, ulceration, bleeding, or perforation. Merely giving proton pump inhibitors (statement 4) does not resolve the large hair concretion; removal (endoscopic if small, surgical if large) plus addressing the underlying psychiatric issue is required. Hence, the first three statements are correct descriptions of this condition.

2. It moves upwards on swallowing but not on

tongue protrusion. 15. The inferior rectal artery is a branch of :
3. It is treated with Sistrunk operation. (a) Internal iliac artery
4. It may be the only functioning thyroid tissue in (b) Inferior mesenteric artery
the body. (c) Internal pudendal artery
Select the correct answer using the code given below: (d) Median sacral artery
(a) 1, 2 and 3

(c)

Sol
Internal pudendal artery (Internal pudendal artery)

The inferior rectal artery arises from the internal pudendal artery, itself a branch of the internal iliac artery. It supplies the lower anal canal and perianal region. In contrast, the superior rectal artery (from the inferior mesenteric artery) supplies the upper rectum, while the middle rectal artery (from the internal iliac) supplies the middle portion. Understanding these vascular territories is critical for procedures such as hemorrhoid surgery, where knowledge of arterial supply can influence both surgical approach and risk of bleeding.

(b) 1, 2 and 4
(c) 1, 3 and 4 16. Zollinger Ellison syndrome is characterized by which
(d) 2, 3 and 4 of the following ?

(c)

Sol
1, 3 and 4
1. Fulminating gastric ulcers
A thyroglossal duct cyst is usually found in the midline of the neck (statement 1). Classically, it rises with both swallowing and protrusion of the tongue, so statement 2 (“not on tongue protrusion”) is incorrect. Surgical removal is via the Sistrunk operation, which includes excision of the cyst, middle part of the hyoid bone, and tract up to the base of the tongue (statement 3). In some cases, ectopic thyroid tissue in the duct may be the patient’s only functioning thyroid (statement 4).

2. Recurrent ulceration despite treatment

11. A 60-year-old tobacco chewer and heavy bidi 3. Non-beta islet cell tumour of pancreas
smoker comes with diminished mouth opening and 4. Recurrent episodes of dysentery
occasional spitting of blood mixed with saliva. Oral Select the correct answer using the code given below:
examination revealed a white buccal mucosa with a (a) 1, 2 and 3
bright red velvety plaque. The most likely diagnosis (b) 1, 2 and 4
is : (c) 1, 3 and 4
(a) Speckled leucoplakia (d) 2, 3 and 4
(b) Leukoplakia

(a)

Sol
1, 2 and 3

Zollinger-Ellison syndrome (ZES) involves a gastrin-secreting tumor (gastrinoma), typically arising from the non-beta islet cells of the pancreas (or duodenum), which leads to hypergastrinemia and massive acid hypersecretion. As a result, patients present with severe or fulminant peptic ulcers, often multiple and resistant to standard ulcer therapies. Dysentery (statement 4) is not a typical feature of ZES. Diagnosis often requires measuring elevated gastrin levels, imaging for the gastrinoma, and managing acid hypersecretion and tumor removal if possible.

(c) Erythroplakia
(d) Oral candidiasis 17. Which of the following statements with regard to

(a)

Sol
Speckled leucoplakia (Speckled leucoplakia)
Meckel’s Diverticulum are correct ?
“Speckled leukoplakia,” also called erythroleukoplakia, shows both white (leukoplakic) and red (erythroplakic) areas. The presence of a bright red velvety region on a white background is typical of speckled lesions and indicates a high risk for malignant transformation. Pure leukoplakia (entirely white) or pure erythroplakia (entirely red) is different. The mixed pattern is particularly worrisome, and in a heavy tobacco user with restricted mouth opening, dysplasia or early malignancy must be ruled out via biopsy and appropriate management.

1. It represents a persistent remnant of the Vitello

12. ‘Collar-stud’ abscess is seen in : intestinal duct.
(a) Tuberculosis 2. It is a pseudo diverticulum of gastrointestinal
(b) Lymphomatous degeneration tract.
(c) Streptococcal infection 3. It is most commonly found on antimesenteric
(d) Pseudomonas infection border of ileum.

(a)

Sol
Tuberculosis (Tuberculosis)

A “collar-stud” abscess typically refers to a cold abscess associated with tuberculosis, in which the infection creates a deep pocket that tracks through tissue planes and presents with a subcutaneous fluctuant swelling. The superficial aspect of the abscess can appear small (like the “stud” on the surface), while there is a deeper component beneath the fascia (the “collar”). Tuberculosis often causes such cold abscesses because of its indolent, chronic course, allowing large pockets of pus to form with minimal acute inflammatory signs.
4. Heterotopic mucosa is present in 20% patients.
Select the correct answer using the code given below:
13. The best cosmetic result following breast (a) 1, 2 and 3
reconstruction is achieved with : (b) 2, 3 and 4
(a) Latissimus dorsi flap (c) 1, 3 and 4
(b) Silicone gel implant with reconstruction (d) 1, 2 and 4
(c) Transverse rectus abdominis myocutaneous
(c)

Sol
1, 3 and 4

Meckel’s diverticulum arises from a persistent vitellointestinal (omphalomesenteric) duct (statement 1). It is a true diverticulum because it contains all layers of the bowel wall, so calling it a “pseudo diverticulum” (statement 2) is incorrect. It typically appears on the antimesenteric border of the ileum (statement 3), about 2 feet proximal to the ileocecal valve. Heterotopic tissue (gastric or pancreatic) is present in around 20% of cases (statement 4), which can cause bleeding or ulceration.

flap
(d) Acellular dermal matrix flap 18. Which of the following statements with regard to

(c)

Sol
Transverse rectus abdominis myocutaneous flap

A TRAM flap uses the patient’s own abdominal skin, fat, and rectus muscle to recreate the breast mound, generally yielding a more natural shape, feel, and contour compared to an implant. Autologous tissue reconstruction often ages more naturally with the patient’s body and can deliver superior cosmetic outcomes overall. Though latissimus dorsi flaps and implants are viable options, and acellular dermal matrix can assist implant-based reconstructions, the TRAM flap (or variants like the DIEP flap) is especially noted for its aesthetic results.
Colorectal Carcinoma are correct ?
1. Left-sided Colorectal Carcinoma presents with
14. Which of the following are correct regarding bleeding per rectum.
Trichobezoar ? 2. Right-sided Colorectal Carcinoma presents
1. It is a hair ball in the stomach. with iron deficiency anaemia.
2. It is common in psychiatric patients. 3. Right-sided Colorectal Carcinoma is more
3. Common complications are bleeding, common as compared to the left-sided
perforation or obstruction. Colorectal Carcinoma.
4. Treated with long course of proton pump 4. Colonoscopy is the investigation of choice for
inhibitors. suspected Colorectal Carcinoma.
Select the correct answer using the code given below: Select the correct answer using the code given below:
(a) 1, 2 and 3 (a) 1, 2 and 3
(b) 1, 2 and 4 (b) 2, 3 and 4
MEDINK Question Paper 2023 page 37

(c) 1, 3 and 4 23. The most common benign tumour of the liver is :
(d) 1, 2 and 4 (a) Adenoma

(d)

Sol
1, 2 and 4

Left-sided colon cancers often present with altered bowel habits and rectal bleeding (statement 1). Right-sided tumors more commonly cause occult blood loss and iron deficiency anemia (statement 2). While some recent data suggest increasing right-sided cases, historically left-sided lesions were considered more common, so statement 3 is not universally accepted in this context. Colonoscopy (statement 4) remains the gold-standard diagnostic tool to visualize the lesion, obtain biopsies, and help plan treatment, making statements 1, 2, and 4 correct here.
(b) Haemangioma
(c) Focal nodular hyperplasia
19. While managing oesophageal perforations, which (d) Angiomyolipoma
of the following factors favour non-operative
(b)

Sol
Haemangioma.

Cavernous hemangioma is the most common benign liver tumor. Often discovered incidentally on imaging (e.g., ultrasound, CT, or MRI), it seldom causes symptoms unless it becomes quite large. Pathologically, it consists of vascular channels lined by endothelium. Although most hemangiomas require no treatment, very large lesions or those that become symptomatic (e.g., causing pain or compression) might need intervention. In contrast, hepatic adenomas are less common, can be influenced by hormonal factors, and carry a risk of bleeding or malignant transformation.

management ?
1. Perforation by a flexible endoscope 24. The best position to palpate the minimal enlargement
2. Perforation into mediastinum of spleen is :
3. Perforation with a small septic load (a) Supine with lower limbs extended
4. Perforation of the abdominal oesophagus (b) Palpation of left subcostal area in right lateral
Select the correct answer using the code given below: decubitus position
(a) 1, 2 and 3 (c) Bimanual palpation in supine position
(b) 1, 2 and 4 (d) Palpation of left subcostal area in knee-elbow
(c) 1, 3 and 4 position
(d) 2, 3 and 4
(b)

Sol
Palpation of left subcostal area in right lateral decubitus position.

When the patient lies on the right side (right lateral decubitus) and slightly flexes the hips and knees, gravity brings an enlarged spleen more anteriorly and inferiorly, making it easier to feel just below the left costal margin. This maneuver (sometimes referred to as Nixon’s method) is often the most sensitive for detecting small or minimally enlarged spleens. Supine or knee-elbow positions do not enhance splenic palpation as reliably as turning the patient on their right side.

(c)

Sol
1, 3 and 4

25.
Small, contained esophageal perforations—particularly those caused by a flexible endoscope (statement 1) and associated with low contamination (small septic load, statement 3)—can often be managed conservatively with antibiotics, nil by mouth, and drainage as needed. Perforation of the abdominal esophagus (statement 4) may also be amenable to non-operative treatment if discovered early, well-contained, and with minimal soilage. In contrast, free perforation into the mediastinum with extensive contamination typically necessitates surgical intervention to prevent fulminant mediastinitis.

A young 28-year-old male was operated for duodenal

20. Which of the following statements are correct with ulcer perforation peritonitis. After having recovered
regard to Familial Adenomatous Polyposis ? well for five days, he developed high fever with
1. It is associated with mutation of APC gene chills and symptoms of toxemia. He developed right
located on the short arm of chromosome 5. shoulder tip pain and intractable hiccoughs. The most
2. It is inherited as an autosomal recessive likely diagnosis is :
condition. (a) Surgical site infection
3. It is associated with 100% lifetime risk for (b) Postoperative peritonitis
development of Colorectal carcinoma. (c) Subphrenic abscess
4. Congenital hypertrophy of retinal pigment (d) Right lobe liver abscess
epithelium is present in half of the cases of
(c)

Sol
Subphrenic abscess.

A subphrenic abscess can develop after upper abdominal surgeries (e.g., perforated duodenal ulcer repair) due to contamination or incomplete drainage beneath the diaphragm. The classic referred pain in the right shoulder tip arises from diaphragmatic irritation (phrenic nerve referral, C3–C5). Persistent or high fever, chills, and toxin-related symptoms several days postoperatively, along with hiccups, strongly suggest a collection under the diaphragm rather than a superficial wound infection. Timely imaging (ultrasound or CT) helps confirm the diagnosis and guides drainage.

familial adenomatous polyposis.

Select the correct answer using the code given below: 26. In seat belt syndrome the most common site of
(a) 1, 2 and 3 bleeding is from :
(b) 1, 2 and 4 (a) Bowel
(c) 1, 3 and 4 (b) Mesentery
(d) 2, 3 and 4 (c) Liver

(c)

Sol
1, 3 and 4

Familial Adenomatous Polyposis (FAP) results from a germline mutation in the APC gene on chromosome 5q (statement 1) and follows an autosomal dominant pattern (so statement 2 is incorrect). Without prophylactic colectomy, patients with FAP face virtually a 100% lifetime risk of developing colorectal cancer (statement 3). Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a known extra-colonic manifestation and may appear in roughly half of FAP cases (statement 4). Early identification and surveillance are critical.
(d) Spleen

(b)

Sol
Mesentery.

“Seat belt syndrome” often involves sudden deceleration injuries, leading to tears or lacerations in the small bowel mesentery. The shearing forces generated where the mesentery is fixed can cause vascular injury and subsequent hemorrhage or hematoma. While bowel and solid organ injuries (liver, spleen) are also possible in trauma, the mesentery is classically described as a common site of significant bleeding and/or avulsion with a lap belt mechanism. Prompt imaging and surgical assessment are vital in these cases.

21. Which one of the following statements regarding

Inflammatory Bowel Disease is correct ? 27. Which one of the following is a cause of exudative
(a) Rectum is always involved in Crohn’s disease. ascites ?
(b) Fistula formation is common in Ulcerative (a) Congestive cardiac failure
Colitis. (b) Portal vein thrombosis
(c) Stricture formation is common in Ulcerative (c) Peritoneal malignancy
Colitis. (d) Nephrotic syndrome
(d) Perianal disease is common in Crohn’s disease.

(c)

Sol
Peritoneal malignancy.

Exudative ascites typically occurs when there is significant peritoneal inflammation or infiltration (e.g., malignancy, tuberculosis), leading to high protein content and high specific gravity fluid in the peritoneal cavity. In contrast, conditions like congestive heart failure and nephrotic syndrome usually produce transudative ascites, characterized by low protein content. Portal vein thrombosis can also lead to portal hypertension and generally a transudative pattern. Peritoneal carcinomatosis (malignancy) remains one of the most common causes of exudative ascites.

(d)

Sol
Perianal disease is common in Crohn’s disease.

28.
Crohn’s disease can affect any segment of the gastrointestinal tract from mouth to anus and often involves the full thickness of the bowel wall, leading to complications such as fistulas, strictures, and especially perianal disease (fissures, fistulas, abscesses). By contrast, Ulcerative Colitis is limited to the colonic mucosa and submucosa in a continuous fashion, almost always involving the rectum. Crohn’s may spare the rectum and present with skip lesions. Hence, perianal disease is a typical feature of Crohn’s.

Which one of the following statements is correct

22. A Sengstaken-Blakemore tube is used for the regarding eFAST in trauma ?
management of : (a) It is a technique to assess free fluid in the
(a) Corrosive poisoning abdominal cavity only.
(b) Variceal bleeding (b) It is a technique to assess free fluid in abdominal
(c) Asphyxia cavity, thoracic cavity and pericardium.
(d) Tension pneumothorax (c) It is a technique to assess free fluid in pelvic

(b)

Sol
Variceal bleeding.

A Sengstaken-Blakemore tube has gastric and esophageal balloons that can be inflated to tamponade bleeding esophageal varices—most often caused by portal hypertension. In urgent situations where endoscopic or other measures are not immediately available or have failed, this tube can help compress the varices and temporarily control hemorrhage. It is not used for corrosive poisoning, asphyxia, or tension pneumothorax; those conditions require very different interventions (e.g., endoscopy for corrosives, airway support for asphyxia, needle decompression for tension pneumothorax).
cavity.
(d) It is a technique to assess free fluid in pleural
CMS Paper-II Question Paper 2023 MEDINK

cavity. (c) Lymphoma

(b)

Sol
It is a technique to assess free fluid in abdominal cavity, thoracic cavity and pericardium.

The extended Focused Assessment with Sonography in Trauma (eFAST) expands on the traditional FAST exam by including quick ultrasound views of the thorax to check for pleural fluid (hemothorax) or absence of lung sliding (pneumothorax), in addition to looking for free fluid in the pericardium and peritoneal cavity. It is a rapid, noninvasive bedside tool to detect internal bleeding or a tamponade. Thus, it addresses the abdomen, pericardium, and thorax—not just the abdominal cavity.
(d) Neurogenic tumours

(b)

Sol
Thymoma.

29.
The Masaoka (or Masaoka-Koga) staging system is specifically used to stage thymomas. It classifies them based on local invasion of surrounding tissues—such as the capsule, mediastinal fat, pericardium, or great vessels—and more distant spread. This staging has important prognostic implications and guides surgical resectability and adjuvant therapy. Germ cell tumors (testicular/ovarian), lymphomas, and neurogenic tumors follow different staging systems (e.g., Ann Arbor for lymphoma, WHO classification for germ cell tumors, etc.).

A 47-year-old man comes to Surgery OPD with

history of recurrent episodes of UTI. He gives history 34. Consider the following clinical features :
of the urine being frothy and occasionally having 1. Low back pain
bubbles. The probable diagnosis is : 2. Saddle anaesthesia
(a) Anaerobic bacterial infection 3. Motor weakness in the lower extremities
(b) Colovesical fistula 4. Variable rectal and urinary symptoms
(c) Tubercular cystitis Which of the above features may be present in a
(d) Urethrocutaneous fistula patient with Cauda Equina syndrome ?

(b)

Sol
Colovesical fistula.

Frothy or bubbly urine often suggests that air is entering the urinary tract. One common cause is a colovesical fistula, typically arising from diverticular disease, malignancy, or Crohn’s, wherein the colon and bladder form an abnormal connection. Feculent material or gas can pass into the bladder and produce recurrent urinary tract infections, as well as “bubbly” or malodorous urine. Anaerobic bacterial infection, tuberculosis of the bladder, or a urethrocutaneous fistula do not characteristically present with frothy urine.
(a) 3 and 4 only
(b) 1 and 2 only
30. Which of the following are seen in Normal pressure (c) 1, 2 and 3 only
hydrocephalus ? (d) 1, 2, 3 and 4
1. Hearing loss
(d)

Sol
1, 2, 3 and 4.

Cauda Equina syndrome arises from compression of the cauda equina nerve roots below the conus medullaris. Classic findings include severe low back pain, saddle anesthesia (loss of sensation in the perineal region), lower limb weakness or reflex changes, and bowel/bladder dysfunction (incontinence or retention). Rectal tone changes are also common. Because multiple nerve roots are affected, the presentation can be varied. This is a neurosurgical emergency requiring rapid imaging (MRI) and often decompression to prevent permanent damage.

2. Gait disturbance
3. Incontinence 35. Which one of the following drugs is a long acting
4. Cognitive decline local anaesthetic agent ?
Select the correct answer using the code given below: (a) Lignocaine
(a) 1, 2 and 3 (b) Bupivacaine
(b) 1, 2 and 4 (c) Prilocaine
(c) 1, 3 and 4 (d) Ropivacaine
(d) 3 and 4 only
(b)

Sol
Bupivacaine.

Among commonly used local anesthetics, bupivacaine is well known for its prolonged duration of action—often 4 to 8 hours or more—making it ideal for procedures requiring extended analgesia (e.g., post‑operative pain control). Lignocaine (lidocaine) and prilocaine generally have shorter durations unless combined with adrenaline. Ropivacaine is also relatively long‑acting but is often described as having slightly less motor blockade than bupivacaine. In routine practice, bupivacaine is classically cited as the prototypical long‑acting local anesthetic.

(d)

Sol
3 and 4 only

36.
Normal Pressure Hydrocephalus (NPH) is a neurological disorder characterized by the triad of gait disturbance, urinary incontinence, and cognitive decline. This condition results from an abnormal accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles, leading to ventricular enlargement without a significant increase in intracranial pressure.
1. Gait Disturbance: Gait disturbance is often the earliest and most prominent symptom in NPH. Patients typically present with a “magnetic gait,” characterized by short, shuffling steps and difficulty initiating walking.
2. Incontinence: Urinary incontinence is also a hallmark of NPH, often presenting as urgency or frequency, progressing to loss of bladder control.
3. Cognitive Decline: Cognitive impairment in NPH often resembles dementia, with symptoms such as memory loss, difficulty with problem-solving, and slowed mental processing. However, unlike other forms of dementia, the cognitive decline in NPH can be reversible with appropriate treatment.
4. Hearing Loss: Hearing loss is not a recognized feature of NPH. Its presence would suggest an alternative or additional diagnosis.
Since options 3 (incontinence) and 4 (cognitive decline) are key features of NPH, the correct answer is (d) 3 and 4 only.

A patient with head injury with a Glasgow Coma

31. Which of the following are the functions of larynx ? Scale of 10 is classified as :
1. Fixation of the chest (a) Minor injury
2. Aids in swallowing of food (b) Mild injury
3. Phonation (c) Moderate injury
4. Respiration (d) Severe injury
Select the correct answer using the code given below:

(c)

Sol
Moderate injury.

The Glasgow Coma Scale (GCS) classifies traumatic brain injury by three components (eye opening, verbal response, motor response). Scores range from 3 (deep coma) to 15 (fully alert). Typically, GCS 13–15 is considered mild head injury, 9–12 moderate, and 8 or below severe. A GCS of 10 thus falls into the moderate category. Proper classification helps guide immediate management, monitoring needs, and possible neurosurgical intervention.

(a) 1, 2 and 3
(b) 1, 2 and 4 37. Gas Gangrene resulting in crepitus in tissues and
(c) 1, 3 and 4 a sweet smelling brown exudate is caused due to
(d) 2, 3 and 4 infection by :

(c)

Sol
1, 3 and 4.
(a) Anaerobic bacteroides spp.
Major recognized functions of the larynx include (1) chest fixation for straining maneuvers (via glottic closure), (3) phonation or voice production (vocal folds), and (4) respiration (controlling airflow). While the larynx protects the airway during swallowing—preventing aspiration—most standard classifications do not list “aiding in swallowing food” as a direct function; swallowing is primarily coordinated by the pharynx and upper esophageal mechanisms. Thus, statements 1, 3, and 4 are the traditionally accepted functions.

(b) Clostridium perfringens

32. Which of the following are included in the classical (c) Gas-forming Klebsiella spp.
clinical presentation of pericardial tamponade ? (d) Synergistic bacteria
1. Tachycardia

(b)

Sol
Clostridium perfringens.

Clostridium perfringens (a Gram-positive, spore-forming anaerobe) is the most common cause of gas gangrene (clostridial myonecrosis). It releases potent exotoxins that rapidly destroy muscle tissue and produce gas within the tissues, creating crepitus. Patients often notice a characteristic foul or “sweet” smell and brownish discharge. Rapid progression to shock and multi-organ failure can occur without urgent surgical debridement, antibiotics (often high-dose penicillin), and supportive measures. Other organisms can produce gas, but the classic scenario of gas gangrene is usually clostridial.

2. Muffled heart sounds

3. Decreased arterial pressure 38. Which of the following are the common complications
4. Collapsed neck veins associated with enteral nutrition in postoperative
Select the correct answer using the code given below: patients ?
(a) 1, 2 and 3 1. Tube malposition, displacement
(b) 1, 2 and 4 2. Diarrhoea, constipation
(c) 1, 3 and 4 3. Predisposition to systemic sepsis
(d) 2, 3 and 4 4. Electrolytic imbalance

(a)

Sol
1, 2 and 3.
Select the correct answer using the code given below:
The classic triad in cardiac tamponade (Beck’s triad) consists of hypotension (decreased arterial pressure), distant/muffled heart sounds, and jugular venous distension (i.e., raised neck veins). Tachycardia (1) is also commonly present due to sympathetic drive. “Collapsed neck veins” (4) does not fit tamponade; one typically sees distended neck veins. Thus, statements 1 (tachycardia), 2 (muffled heart sounds), and 3 (decreased arterial pressure) align with this dangerous condition requiring urgent intervention (pericardiocentesis).

(a) 1, 2 and 3
33. Masaoka staging is used for staging : (b) 1, 2 and 4
(a) Germ cell tumours (c) 1, 3 and 4
(b) Thymoma (d) 2, 3 and 4
MEDINK Question Paper 2023 page 39

(b)

Sol
1, 2 and 4.

Common issues during enteral feeding include mechanical problems (tube malposition, blockage, or accidental displacement), and gastrointestinal side effects (diarrhea or sometimes constipation). Metabolic disturbances such as electrolyte imbalances (especially if feeding is reintroduced rapidly in a malnourished patient) can also occur. While significant systemic sepsis is more often linked with parenteral (intravenous) nutrition, aspiration pneumonia is indeed a risk of enteral feeding; however, “predisposition to systemic sepsis” is not traditionally listed among the most common complications of enteral feeding.
44. Which of the following are the clinical features of
molar pregnancy ?
39. Which of the following are correct regarding Blood 1. History of amenorrhea and vaginal bleeding
substitutes ? 2. Patient has excessive vomiting
1. They are biomimetic. 3. History of expulsion of grape-like vesicles
2. They are extensively used in war injuries. Select the correct answer using the code given below:
3. They are made of perfluorocarbon emulsions. (a) 1 and 2 only
4. They are haemoglobin-based. (b) 2 and 3 only
Select the correct answer using the code given below: (c) 1 and 3 only
(a) 1, 2 and 3 (d) 1, 2 and 3
(b) 1, 2 and 4
(d)

Sol
1, 2 and 3.

A hydatidiform (molar) pregnancy often presents with a classic triad of (1) amenorrhea and vaginal bleeding, (2) exaggerated symptoms of pregnancy such as severe hyperemesis gravidarum (excessive vomiting), and (3) passage of “grape-like” vesicles (hydropic chorionic villi). On ultrasound, one may see a “snowstorm” pattern without a normal fetus. Timely diagnosis and evacuation of the uterine contents is crucial to prevent complications like persistent trophoblastic disease or choriocarcinoma.

(c) 1, 3 and 4
(d) 2, 3 and 4 45. Which of the following vaccines can be given to a

(c)

Sol
1, 3 and 4.

So-called “artificial blood” or blood substitutes are meant to mimic certain properties of human blood (biomimetic), primarily oxygen transport. Two main categories have been explored: perfluorocarbon emulsions (PFCs) and hemoglobin-based oxygen carriers (HBOCs). While there has been research interest in using them for emergency or battlefield scenarios, they are not yet extensively used in war injuries due to cost, side effects, and limited availability. Hence (2) is not generally correct, but (1), (3), and (4) reflect real properties.
pregnant woman ?
1. COVID vaccine
40. Ischaemia-Reperfusion syndrome is characterized by 2. Measles, Mumps, Rubella vaccine
: 3. Hepatitis B vaccine
(a) Hypoxia and activation of inflammation 4. Rabies vaccine
(b) Thrombo embolic angiopathy Select the correct answer using the code given below:
(c) Acute mesenteric thrombosis (a) 1, 2 and 3
(d) Build up of bicarbonate and Na+ ions (b) 1, 2 and 4

(a)

Sol
Hypoxia and activation of inflammation.

When blood supply to a tissue is blocked (ischemia) and then restored (reperfusion), a burst of reactive oxygen species, inflammatory mediators, and leukocytes can surge into the previously ischemic area. This phenomenon, known as ischemia-reperfusion injury, paradoxically damages cell membranes, mitochondria, and can lead to capillary leak, local edema, and even multi-organ dysfunction in severe cases. The hallmark is tissue hypoxia followed by an intense inflammatory response, not primarily a buildup of bicarbonate/Na+, nor a purely embolic or mesenteric phenomenon.
(c) 1, 3 and 4
(d) 2, 3 and 4
41. The daily requirement of iron during second half of
(c)

Sol
1, 3 and 4

Non‑live or inactivated vaccines such as the COVID‑19 vaccine, hepatitis B vaccine, and rabies vaccine can be given during pregnancy, especially if indicated by exposure risk. MMR (measles, mumps, rubella), being a live attenuated vaccine, is routinely avoided while pregnant due to theoretical risk (even though documented harm is rare). Hence, pregnant women can safely receive the COVID vaccine, hepatitis B vaccine, and rabies vaccine as needed, but MMR is best deferred until after delivery.

pregnancy is :
(a) 2 mg per day 46. Which of the following are the characteristics of true
(b) 6 mg per day labour pains ?
(c) 10 mg per day 1. Intensity and duration of contractions increase
(d) 20 mg per day progressively

(b)

Sol
6 mg per day.

By the second half of pregnancy, the fetus’s demands and the expanding maternal red blood cell mass increase the mother’s iron requirement. Although recommendations for daily supplementation can be higher (e.g., 30 mg elemental iron daily to prevent deficiency), the physiologic daily iron requirement is often cited as 4–6 mg. Options like 10 or 20 mg reflect typical supplementation levels in prenatal vitamins, but 6 mg/day is the classical textbook figure for additional iron needed during mid-to-late pregnancy.
2. Progressive effacement and dilatation of the
cervix
42. Carbohydrate metabolism in normal pregnancy 3. Formation of the ‘bag of forewaters’
shows : 4. Pain is confined to lower abdomen and groin
(a) Fasting hypoglycaemia Select the correct answer using the code given below:
(b) Postprandial hypoglycaemia (a) 1, 2 and 3
(c) Increased sensitivity of insulin receptors in (b) 1, 2 and 4
mother (c) 1, 3 and 4
(d) Decreased plasma glucagon levels (d) 2, 3 and 4

(a)

Sol
Fasting hypoglycaemia.

(a)

Sol
1, 2 and 3

In normal pregnancy, the fetus draws glucose continuously, leaving the mother prone to lower fasting glucose levels. Meanwhile, maternal insulin resistance tends to increase in later pregnancy, often yielding higher postprandial glucose (not postprandial hypoglycemia) and a greater tendency toward gestational diabetes in predisposed individuals. Insulin sensitivity typically decreases rather than increases. Glucagon levels are not classically decreased. The hallmark is mild fasting hypoglycemia, relative hyperinsulinemia post meals, and a background of rising insulin resistance over the course of gestation.

True labor contractions become progressively stronger and more frequent (statement 1) and are associated with cervical effacement and dilation (statement 2). As the cervix dilates, the membranes protrude, forming the so-called “bag of forewaters” (statement 3). In true labor, pain often begins in the back and radiates to the abdomen, rather than remaining confined only to the lower abdomen and groin. Hence, statement 4 (pain confined solely to the lower front) fits more with false labor.

43. A typical case of Iron Deficiency Anaemia (IDA) in 47. Which are the parts of active management of third
pregnancy will show which of the following ? stage of labour ?
1. Hb less than 10 gm% 1. Injection oxytocin 10 units IM within 1 minute
2. PCV less than 30% of delivery of baby
3. MCHC more than 30% 2. Injection oxytocin 10 units IM at the birth of
4. Microcytic hypochromic picture on peripheral first twin in twin pregnancy
blood smear (PBS) 3. Controlled cord traction
Select the correct answer using the code given below: 4. Delayed cord clamping as per indications
(a) 1, 2 and 3 Select the correct answer using the code given below:
(b) 1, 2 and 4 (a) 1, 2 and 3
(c) 1, 3 and 4 (b) 1, 2 and 4
(d) 2, 3 and 4 (c) 1, 3 and 4
(d) 2, 3 and 4

(b)

Sol
1, 2 and 4.

In iron deficiency anemia, hemoglobin (Hb) often falls below 10 g/dL in pregnant patients, and hematocrit or packed cell volume (PCV) may be less than 30%. The peripheral smear typically shows a microcytic, hypochromic picture (reduced MCV and MCHC). MCHC usually drops below 30% in IDA, so statement 3 (“MCHC more than 30%”) is inconsistent with classic iron deficiency. Thus, statements 1, 2, and 4 align with this common presentation in pregnancy.

(c)

Sol
1, 3 and 4

Active management of the third stage of labor typically includes: (1) giving a uterotonic (e.g., 10 units oxytocin IM) immediately after the final baby is delivered (for a single pregnancy, that is right after the baby’s birth; in a twin gestation, it is usually after the second twin), (3) controlled cord traction once the uterus is well contracted, and (4) delayed cord clamping (often recommended at least 1 minute) to improve neonatal iron stores. Oxytocin injection at the birth of the first twin is generally not routine.
CMS Paper-II Question Paper 2023 MEDINK

48. Which of the following are correct regarding acute (b) maternal bearing down efforts and ends with
mastitis ? the delivery of the baby
1. It usually occurs in first 2 – 4 weeks postpartum. (c) the onset of true labour pains and ends with the
2. Microscopic examination of breast milk shows full dilatation of cervix
leukocyte count more than 106/mL and bacterial (d) the formation of bag of waters
count more than 103/mL.
(c)

Sol
the onset of true labour pains and ends with the full dilatation of cervix

Labor is classically divided into three stages. The first stage begins with the onset of true labor contractions (regular, progressive) and finishes when the cervix is fully dilated (10 cm). The second stage runs from full cervical dilation to the delivery of the baby. The third stage is from the birth of the baby to the delivery of the placenta. Formation of the bag of waters and bearing down efforts can occur later within these stages, so (c) is the precise definition.

3. Common organisms are bacteroids, E. coli and

Klebsiella. 53. Vesicovaginal fistula is classified as complicated if it
4. The source of infection is infant’s nose and has which of the following features ?
throat. 1. Size – more than 3 cm
Select the correct answer using the code given below: 2. Bladder involvement – Supratrigonal
(a) 1, 2 and 3 3. Location – Midvaginal
(b) 1, 2 and 4 4. Presence of prior radiation
(c) 1, 3 and 4 Select the correct answer using the code given below:
(d) 2, 3 and 4 (a) 1, 2 and 3

(b)

Sol
1, 2 and 4

Acute mastitis frequently arises in the first few weeks postpartum, often 2–4 weeks after delivery (statement 1). Milk from an infected breast typically shows high leukocyte counts (>106/mL) and significant bacterial load (>103/mL) (statement 2). The usual organism is Staphylococcus aureus, commonly originating from the infant’s nose/throat or the mother’s skin flora (statement 4). Bacteroides, E. coli, and Klebsiella are much less common, so statement 3 does not accurately reflect “common” organisms in typical puerperal mastitis.
(b) 1, 2 and 4
(c) 1, 3 and 4
49. As per the classification of Obstetric Anal Sphincter (d) 2, 3 and 4
Injury (RCOG-2007), tear of greater than 50% of
(c)

Sol
1, 3 and 4

A vesicovaginal fistula is often called “complicated” if it is large (often >3 cm), located in a challenging site (e.g., high or midvaginal level that impairs access), or associated with prior radiation therapy or multiple failed repairs. Supratrigonal involvement alone (statement 2) does not necessarily define a complicated fistula; rather, fistulas near the trigone/ureteric orifices can be more difficult. Large fistula size (1), midvaginal location (3), and previous radiation (4) typically increase surgical complexity and complication rates.

External Anal Sphincter is of degree :

(a) 3c 54. Which of the following set of muscles collectively
(b) 2c form the muscle ‘Levator Ani’ that forms the pelvic
(c) 3b floor ?
(d) 3a 1. Ischiococcygeus

(c)

Sol

1.
2.
3.
3b

Obstetric anal sphincter injuries (third-degree tears) involve the external anal sphincter (EAS). They are subdivided as:

Hence, a tear affecting more than half of the external sphincter thickness, but not the IAS, corresponds to 3b. These distinctions are important for proper repair and preventing long-term continence issues.
3a: <50% thickness of EAS torn
3b: >50% thickness of EAS torn
3c: Both EAS and internal anal sphincter (IAS) torn.
2. Pubococcygeus
3. Sacrococcygeus
50. What are the causes of lactation failure after delivery 4. Iliococcygeus
? Select the correct answer using the code given below:
1. Infrequent suckling (a) 1, 2 and 3
2. Depression or anxiety state in the puerperium (b) 1, 2 and 4
3. Prolactin inhibition (c) 1, 3 and 4
Select the correct answer using the code given below: (d) 2, 3 and 4
(a) 1 and 2 only
(b)

Sol
1, 2 and 4

The main components of the levator ani muscle group (forming most of the pelvic diaphragm) are typically described as pubococcygeus, iliococcygeus, and ischiococcygeus (often simply called “coccygeus”). “Sacrococcygeus” is not part of the standard naming. Thus, statements 1, 2, and 4 together identify the classical subset that supports pelvic organs, contributes to urinary and fecal continence, and assists in core stability.

(b) 2 and 3 only

(c) 1 and 3 only 55. Blood supply to the uterus comes from which of the
(d) 1, 2 and 3 following arteries ?

(d)

Sol
1, 2 and 3

Successful lactation depends on adequate prolactin levels (stimulated by nipple/breast stimulation) and the let-down reflex (which relies on oxytocin). Infrequent suckling reduces prolactin surge and milk production (statement 1). Maternal depression or anxiety (statement 2) may decrease both milk let-down and overall motivation to breastfeed, sometimes worsening poor latch or scheduling issues. Pharmacologic or hormonal factors that inhibit prolactin (statement 3) can likewise hinder milk output. Addressing these issues early helps ensure successful breastfeeding.
1. Ovarian artery
2. Vaginal artery
51. Secondary arrest of dilatation during the process of 3. Uterine artery
labour may be due to which of the following factors ? 4. Inferior vesical artery
1. Poor uterine contractions Select the correct answer using the code given below:
2. Cessation of cervical dilatation despite strong (a) 1, 2 and 3
uterine contractions (b) 1, 2 and 4
3. Disproportion and malpresentation (c) 1, 3 and 4
Select the correct answer using the code given below: (d) 2, 3 and 4
(a) 1 and 2 only
(a)

Sol
1, 2 and 3

The uterus primarily receives blood from the uterine artery (branch of the internal iliac). The ovarian arteries (branching directly from the aorta) ascend the suspensory ligament of the ovary and anastomose with uterine branches at the uterine fundus, adding a secondary supply. Vaginal arteries (from the internal iliac system) can also supply the cervix and lower uterus region. The inferior vesical artery, however, typically supplies structures of the lower urinary tract (e.g., bladder), not the uterine body.

(b) 2 and 3 only

(c) 1 and 3 only 56. Which one of the following is a prerequisite for
(d) 1, 2 and 3 Endometrial Ablation ?

(d)

Sol
1, 2 and 3

“Secondary arrest” of dilation describes a halt in cervical dilation after previously normal progression. Potential causes include inadequate uterine contractions (power problem), or cephalopelvic disproportion and malpresentation (passenger or pelvis problem). Sometimes the cervix may stop dilating despite apparently “strong” contractions, suggesting an obstructive factor like disproportion. Therefore, all three factors (statements 1, 2, 3) can contribute to a secondary arrest of cervical dilation, prompting reevaluation (including pelvic assessment and possibly operative delivery).
(a) Uterus is 12 – 14 weeks size
(b) Woman wants to preserve her reproductive
52. First stage of labour starts from : function
(a) full dilatation of cervix to the expulsion of the (c) Fibroids 3 cm in size
fetus from the birth canal (d) Woman who prefers to preserve her uterus
MEDINK Question Paper 2023 page 41

(d)

Sol
Woman who prefers to preserve her uterus

Endometrial ablation is a uterine-sparing procedure used to manage abnormal uterine bleeding in women who do not desire future fertility. A large uterus (12–14 weeks) or big fibroids (>3 cm) typically complicates or precludes ablation. Likewise, women wanting future fertility usually require a different approach, as ablation can damage the endometrium needed for implantation. Hence, a typical prerequisite is that the woman wishes to keep her uterus but is no longer planning further pregnancies.
(d) Sex cord stromal tumours

(b)

Sol
Endodermal sinus tumour

Schiller-Duval bodies—glomerulus-like structures with a central blood vessel encircled by germ cells—are pathognomonic for yolk sac tumors (endodermal sinus tumors). On microscopy, they resemble a primitive glomerulus within a sinus space. Dysgerminomas do not display these structures; they have large polygonal cells and a lymphocytic infiltrate. Choriocarcinoma features hemorrhage and syncytiotrophoblast/cytotrophoblast cells, while sex cord stromal tumors (e.g., granulosa cell tumors) have different histologic markers (Call-Exner bodies).

57. Which of the following day of menstrual cycle is best

for endometrial sampling to diagnose ovulation? 62. Which one of the following is the distinguishing
(a) 8th – 10th day feature to differentiate Gartner’s cyst from Cystocele
(b) 12th – 14th day ?
(c) 16th – 20th day (a) Marked cough impulse in Gartner’s cyst
(d) 21st – 23rd day (b) Margins are ill-defined in Gartner’s cyst

(d)

Sol
21st – 23rd day

In a typical 28-day cycle, ovulation generally occurs around day 14. About 7 days later (days 21–23), the endometrium exhibits characteristic secretory changes best appreciated on histology (subnuclear vacuoles, stromal edema). Performing an endometrial biopsy at this time (the mid-luteal or late secretory phase) helps confirm whether adequate ovulation and corpus luteum function have occurred (“secretory endometrium”). Earlier sampling would not show definitive secretory transformation, while significantly later may miss the classic histologic window.
(c) There is no impulse on coughing in cystocele
(d) Gartner’s cyst is not reducible
58. A 27-year-old female married for 3 years
(d)

Sol
Gartner’s cyst is not reducible

A cystocele (anterior vaginal wall prolapse) bulges downward and typically exhibits a cough impulse (the bladder and vaginal wall can protrude further with increased intra-abdominal pressure), and it may be partially reducible on examination. A Gartner’s duct cyst, however, arises from remnants of the mesonephric duct in the anterolateral vaginal wall and does not connect with the bladder. It lacks an impulse on coughing and cannot be manually reduced. Hence the key differentiator is that the cyst is not reducible.

regularly cohabiting with husband presents to

Gynaecology OPD with complaints of inability to 63. Surgical treatment by ‘ventrosuspension of uterus’ is
conceive for 2 years. During clinical evaluation used for what condition ?
hysterosalpingography was done which revealed (a) Pelvic organ prolapse
irregular outline of uterine cavity and rigid fallopian (b) Retroversion of uterus
tubes with nodulations. Most likely cause for this (c) Rupture of uterus
condition is : (d) Vault prolapse
(a) Genital Herpes

(b)

Sol
Retroversion of uterus

“Ventrosuspension” is a traditional surgical procedure to correct a retroverted uterus. In it, the uterus is suspended in an anteverted position (essentially attaching the uterine fundus to the anterior abdominal wall or round ligaments). While many modern techniques exist (e.g., laparoscopic uterine suspension), ventrosuspension is historically known for addressing persistent or symptomatic retroversion. It is not meant for managing pelvic organ prolapse (significant descent of uterus), rupture, or vault prolapse after hysterectomy.

(b) Syphilis
(c) Genital Tuberculosis 64. A 29-year-old female with 3 months amenorrhoea
(d) Gonorrhoea presents to gynaecology OPD with complaints of

(c)

Sol
Genital Tuberculosis
something coming out of her vagina. On clinical
In the Indian subcontinent and many developing countries, genital tuberculosis remains a significant cause of infertility. Hysterosalpingography in genital TB often shows an “irregular or beaded” outline of the tubes, strictures, calcifications, and a distorted uterine cavity. The fallopian tubes can become rigid and thickened with nodular salpingitis. Syphilis and gonorrhea can affect the reproductive tract but typically present differently, and herpes causes more acute or ulcerative lesions rather than the classic tubal rigidity seen here.

evaluation she was found to have single live

59. NACO (National AIDS Control Organization) in pregnancy with second degree uterine prolapse.
India works towards which of the following causes ? Which one of the following is the best management
1. Screening high risk cases of HIV plan for her ?
2. Facilitating adoption of orphans (a) Reassurance
3. Public education towards safe sex (b) Cervical amputation
4. Treating HIV cases free of cost (c) Cerclage operation
Select the correct answer using the code given below: (d) Pessary treatment
(a) 1, 2 and 3

(d)

Sol
Pessary treatment

In a pregnant woman with a moderate (second-degree) uterine prolapse, a well-fitting pessary (such as a ring pessary) is often the first-line management. It can help support the prolapsed uterus and alleviate symptoms. Cervical amputation is not indicated for routine prolapse in pregnancy, nor is cerclage typically used for uterine descent (it is used for cervical incompetence). Simple reassurance may not suffice if the prolapse is symptomatic. Hence, a pessary is a safe, effective choice.

(b) 1, 2 and 4
(c) 1, 3 and 4 65. During delivery of HIV infected women, which of
(d) 2, 3 and 4 the following are recommended ?

(c)

Sol
1, 3 and 4
1. Zidovudine (ZDV) is given at the onset of
The National AIDS Control Organization (NACO) in India spearheads HIV prevention, testing, and free antiretroviral treatment programs (statements 1 and 4). It also drives extensive public education campaigns to encourage safer sexual practices (statement 3). Although supporting orphaned children is important for many NGOs, “facilitating adoption of orphans” (statement 2) is not NACO’s primary mandate. The organization focuses on controlling the HIV epidemic by ensuring accessible testing and free-of-cost treatment for those diagnosed.

labour.
60. Prophylactic oophorectomy is recommended in high 2. Elective caesarean delivery reduces the risk of
risk women with which of the following ? vertical transmission.
1. Carrying BRCA1 or BRCA2 genes 3. Amniotomy and oxytocin augmentation should
2. Family history of breast, colon, ovarian cancer be done.
3. Patients having tubo-ovarian abscess 4. Antiretroviral therapy should be given to all
Select the correct answer using the code given below: neonates.
(a) 1 and 2 only Select the correct answer using the code given below:
(b) 2 and 3 only (a) 1, 2 and 3
(c) 1 and 3 only (b) 1, 2 and 4
(d) 1, 2 and 3 (c) 1, 3 and 4

(a)

Sol
1 and 2 only

Prophylactic bilateral salpingo-oophorectomy is strongly considered for women carrying pathogenic BRCA1/BRCA2 mutations (statement 1) or having a significant familial predisposition to breast and/or ovarian cancer (statement 2). Removal of ovaries and fallopian tubes dramatically lowers the risk of ovarian and related cancers. Tubo-ovarian abscess (statement 3) is managed medically or with targeted surgical intervention, but it is not an indication for bilateral prophylactic oophorectomy. Instead, prophylaxis targets individuals with high‑genetic‑risk profiles.
(d) 2, 3 and 4

(b)

Sol
1, 2 and 4.

For an HIV-positive expectant mother, peripartum intravenous or oral Zidovudine (ZDV) helps reduce maternal–fetal transmission (statement 1). Elective cesarean section (C-section) before labor onset further reduces vertical transmission, especially if the mother’s viral load is high or poorly controlled (statement 2). Neonatal prophylaxis with antiretroviral therapy (statement 4) is also standard. Routine amniotomy and augmentation (statement 3) are typically not specifically recommended in HIV management, as additional intrauterine manipulation may slightly increase exposure risk.

61. ‘Schiller-Duval body’ is a characteristic histological

feature of which one of the following cancers ? 66. Which of the following can be a complication in the
(a) Dysgerminoma baby due to post maturity of pregnancy ?
(b) Endodermal sinus tumour 1. Meconium aspiration
(c) Non-gestational ovarian choriocarcinoma 2. Hypoglycemia
CMS Paper-II Question Paper 2023 MEDINK

3. Intra ventricular haemorrhage 70. Which of the following are correct regarding
4. Polycythemia ‘Chhaya’ contraceptive ?
Select the correct answer using the code given below: 1. It has potent anti-estrogenic and weak
(a) 1, 2 and 3 estrogenic property.
(b) 1, 2 and 4 2. Failure rate is 1 – 4 per HWY (Hundred Women
(c) 1, 3 and 4 Years) of use.
(d) 2, 3 and 4 3. It inhibits ovulation.

(b)

Sol
1, 2 and 4.

Post-term babies (beyond 42 weeks) are prone to meconium passage in utero, risking meconium aspiration syndrome (1). They may also experience hypoglycemia (2) because of depleted glycogen stores and intermittent placental insufficiency. Chronic mild hypoxia may trigger increased erythropoietin production and subsequent polycythemia (4). Intraventricular hemorrhage (3) is classically associated with prematurity rather than post-maturity. Thus, meconium aspiration, hypoglycemia, and polycythemia are recognized complications in post-mature infants.
4. It creates asynchrony between zygote and
endometrium.
67. Intrahepatic cholestasis of pregnancy presents with Select the correct answer using the code given below:
which of the following features ? (a) 1, 2 and 3
1. Pruritus after 28 weeks gestation, especially in (b) 1, 2 and 4
palms and soles (c) 1, 3 and 4
2. Serum bilirubin levels 5 mg% (d) 2, 3 and 4
3. Raised levels of serum bile acids
(b)

Sol
1, 2 and 4.

“Chhaya” (Centchroman or Ormeloxifene) is a selective estrogen receptor modulator (SERM) with a predominantly anti-estrogenic effect on the uterus (1). It chiefly works by altering endometrial receptivity, causing asynchrony between embryo development and the endometrium (4). Its failure rate is quoted between 1–4 per 100 woman‑years (2). It may not reliably suppress ovulation in every cycle—its primary mechanism is endometrial, so statement 3 (“It inhibits ovulation”) is incomplete or not the main route of action.

4. Features subside within two weeks postpartum

Select the correct answer using the code given below: 71. Which of the following are examples of LARC (Long
(a) 1, 2 and 3 Acting Reversible Contraceptives) ?
(b) 1, 2 and 4 1. Copper-T 380A
(c) 1, 3 and 4 2. Implants
(d) 2, 3 and 4 3. LNG-IUS

(c)

Sol
1, 3 and 4.

Intrahepatic cholestasis of pregnancy typically appears late in gestation (after 28 weeks) with intense pruritus, often most severe on the palms and soles (1). Serum bile acids are significantly elevated (3), while bilirubin may be only mildly elevated—often well under 5 mg/dL. After delivery, symptoms usually resolve within a couple of weeks (4). Hence the key triad is pruritus, elevated bile acids, and spontaneous remission postpartum.
Select the correct answer using the code given below:
(a) 1 and 2 only
68. Which of the followings are blood values of Iron (b) 2 and 3 only
Deficiency Anaemia ? (c) 1 and 3 only
1. Serum iron is less than 30 μg/100 mL (d) 1, 2 and 3
2. Total iron binding capacity is less than 400 μg/
(d)

Sol
1, 2 and 3.

Long-Acting Reversible Contraceptives (LARC) include any method providing highly effective, maintenance-free contraception for an extended period, typically years, with quick return of fertility once removed. Copper-T 380A (1), contraceptive implants (2), and the levonorgestrel intrauterine system (LNG-IUS) (3) all fit this definition. They require minimal user compliance beyond insertion and have low failure rates. Other shorter methods (pills, injectables after 3 months, etc.) are not classified as LARC.

dL
3. Percentage saturation is 10% or less 72. How many times in a year does withdrawal bleeding
4. Serum ferritin is below 30 μg/mL occur in extended continuous regimens of combined
Select the correct answer using the code given below: oral contraceptive pills ?
(a) 1, 2 and 3 (a) 3
(b) 1, 2 and 4 (b) 4
(c) 1, 3 and 4 (c) 5
(d) 2, 3 and 4 (d) 6

(c)

Sol
(b)

Sol
1, 3 and 4. 4.

In iron deficiency anemia, serum iron levels typically drop below 30 μg/dL (1). TIBC (Total Iron Binding Capacity) usually rises above 400 μg/dL, so statement 2 (less than 400) is incorrect. Percentage transferrin saturation often falls to 10% or below (3). Serum ferritin below 30 ng/mL (4) is also a key laboratory hallmark confirming depleted iron stores. Thus, statements 1, 3, and 4 align with classical findings of IDA. An extended continuous regimen of combined oral contraceptives typically schedules a withdrawal bleed every three months—yielding roughly four bleeds per year. Instead of the standard 21/7 day regimen with monthly withdrawal bleeding, these extended regimens combine multiple consecutive active-pill cycles (e.g., 84 active pills), followed by a short placebo interval, leading to quarterly menses. This approach can reduce menstrual symptoms, though not everyone opts for it.

69. Clinical features of an infant with Fetal growth 73. Bilateral total salpingectomy is recommended
retardation at birth include which of the following ? surgical procedure to reduce the risk of :
1. Physical features give ‘an old man look’. (a) Epithelial ovarian cancer
2. Baby is alert, reflexes are normal. (b) Uterine cancer
3. There is presence of weight deficit. (c) Fallopian tube cancer
4. Thick fat accumulates around shoulders of (d) Peritoneal cancer
baby.
(a)

Sol
Epithelial ovarian cancer.

Increasing evidence suggests many high-grade serous ovarian carcinomas actually originate in the distal fallopian tubes. Therefore, prophylactic or opportunistic bilateral salpingectomy (removal of both fallopian tubes) has been advocated to lower the future risk of epithelial ovarian cancer. This is recommended particularly in women undergoing pelvic surgery for other reasons (e.g., hysterectomy) who have completed childbearing, and in certain higher-risk individuals. It does not specifically prevent uterine or primary peritoneal malignancies.

Select the correct answer using the code given below:

(a) 1, 2 and 3 74. Tongue bite occurs in eclampsia at :
(b) 1, 2 and 4 (a) Tonic stage
(c) 1, 3 and 4 (b) Clonic stage
(d) 2, 3 and 4 (c) Coma stage

(a)

Sol
1, 2 and 3.

Intrauterine growth-restricted (IUGR) babies often appear “wizened” or with an “old man look” owing to poor subcutaneous fat (1). They have a notable weight deficit at birth (3). Despite being small, many such babies can still be relatively alert with preserved reflexes if they are not in acute distress (2). In contrast, thick fat around the shoulders is more characteristic of infants of diabetic mothers; an IUGR infant generally lacks extra adipose tissue (so 4 is incorrect).
(d) Postictal stage

(a)

Sol
Tonic stage.

In a generalized tonic–clonic seizure (as seen in eclampsia), the jaw may clamp shut suddenly during the tonic phase, putting the tongue at risk of being bitten. The subsequent clonic phase involves rhythmic jerking movements, but the abrupt sustained contraction of the orofacial muscles in the tonic phase is classically where tongue-biting is most likely to occur. Afterward, the patient may enter a postictal phase of altered consciousness or coma.
MEDINK Question Paper 2023 page 43

75. Indication for removal of IUDs include which of the cancer.

following ? Select the correct answer using the code given below:
1. Perforation of uterus (a) 1, 2 and 3
2. Pregnancy with device in situ (b) 1, 2 and 4
3. One year after menopause (c) 1, 3 and 4
4. Persistent migraine (d) 2, 3 and 4
Select the correct answer using the code given below:
(c)

Sol
1, 3 and 4.

Female sterilization can be done soon after childbirth—usually within 24–48 hours postpartum—before the uterus descends significantly (1). It also can be done concurrently with medical termination of pregnancy (3). Bilateral tubal ligation has been linked with reduced risk of serous ovarian cancer because many high-grade serous carcinomas arise from the fallopian tubes (4). However, the usual time for interval ligation (if not postpartum or post-abortal) is early in the follicular phase (right after a menstrual period), not the luteal phase.

(a) 1, 2 and 3
(b) 1, 2 and 4 80. The most popular technique of tubal ligation is :
(c) 1, 3 and 4 (a) Madlener Operation
(d) 2, 3 and 4 (b) Pomeroy Technique

(a)

Sol
1, 2 and 3

IUD removal is indicated if there is uterine perforation (1) or if pregnancy occurs while the device remains in situ (2), because continuing with an embedded IUD can raise risks of infection or miscarriage. Once a woman is firmly past menopause (commonly one year after her last menstrual period), the IUD is no longer needed for contraception (3). “Persistent migraine” (4) is usually a concern with combined hormonal methods, not typically a strict removal indication for non-hormonal or even LNG IUDs.
(c) Uchida method
(d) Cornual resection
76. Which of the following are the absolute
(b)

Sol
Pomeroy Technique.

The classic Pomeroy (or Modified Pomeroy) method is the most widely used tubal ligation technique. It involves creating a loop of the fallopian tube, ligating it, then excising a small segment. The resulting ends scar and seal, preventing passage of the ovum. Other methods (Madlener, Uchida, Irving, etc.) are also performed, but the simple, reliable Pomeroy remains particularly popular for postpartum sterilizations. It provides a decent chance of reversibility if needed, though success rates vary.

contraindications for the use of combined oral

contraceptive pills ? 81. Which one of the following is defined as ‘the average
1. Severe hypertension number of children a woman would have if she
2. Pregnancy were to pass through her reproductive years, bearing
3. Diabetes with retinopathy children at the same rates as the women now in each
4. Gall bladder disease age group’ ?
Select the correct answer using the code given below: (a) Age-Specific Fertility Rate (ASFR)
(a) 1, 2 and 3 (b) General Fertility Rate (GFR)
(b) 1, 2 and 4 (c) Net Reproduction Rate (NRR)
(c) 1, 3 and 4 (d) Total Fertility Rate (TFR)
(d) 2, 3 and 4

(d)

Sol
Total Fertility Rate (TFR).

The Total Fertility Rate (TFR) is the average number of children a woman would bear during her lifetime if she experienced the current age-specific fertility rates throughout her reproductive years (usually 15–49). Age-Specific Fertility Rate (ASFR) measures births to women within a specific age band per 1,000 women of that age. The General Fertility Rate (GFR) measures the ratio of births to women aged 15–44. The Net Reproduction Rate (NRR) tracks daughters replacing mothers at current mortality/fertility rates.

(a)

Sol
1, 2 and 3.

82.
Absolute contraindications to combined oral contraceptives (COCs) include severe or uncontrolled hypertension, advanced diabetes with vascular complications (e.g., retinopathy), and of course existing pregnancy. Gallbladder disease (4) may be a caution—particularly if acute or complicated—but it is generally a relative rather than absolute contraindication. WHO/CDC guidelines highlight severe hypertension (≥160/100 mmHg) and diabetes with end-organ damage as high-risk for COC use.

Which among the following is correct about yellow

77. A 27-year-old recently married female comes to fever vaccination requirement for international
family planning clinic requesting for long term travellers ?
reversible contraception. Which one of the following 1. Term of validity of the certificate is changed
is the best suited option for her ? from 10 years to the duration of the life of the
(a) Combined oral contraceptives vaccinated person, some years ago.
(b) Diaphragm 2. Lifetime validity of the certificate applies
(c) Nexplanon automatically to all existing and new
(d) Chhaya certificates.

(c)

Sol
Nexplanon.

Nexplanon (the etonogestrel-releasing subdermal implant) is a classic “Long-Acting Reversible Contraceptive” (LARC). It remains effective for up to 3 years, offers a high efficacy rate, and fertility returns rapidly upon removal. Combined oral pills require daily compliance, the diaphragm is barrier-based and less effective, and Chhaya (Centchroman) is a weekly pill that is not as long-acting. For someone wanting a reliable, maintenance-free method, an implant or an IUD is generally the best LARC choice.
3. Validity of the certificate begins 4 days after
vaccination.
78. Which one of the following is an indication for cold 4. In India, booster dose of yellow fever vaccine
knife conisation ? is required for those whose certificate is prior to
(a) Treatment of Nabothian follicle on ectocervix the year 2016.
(b) Inconsistent findings of colposcopy, cytology Select the correct answer using the code given below:
and directed biopsy (a) 1 and 2
(c) Negative endocervical curettage (b) 1 and 3
(d) Squamous cell carcinoma cervix stage IIA (c) 2 and 3

(b)

Sol
Inconsistent findings of colposcopy, cytology and directed biopsy.

Cold knife conization (CKC) is indicated when there is a discrepancy between Pap smear, colposcopy, and biopsy results—i.e., suspicion of high-grade or invasive pathology that has not been definitively diagnosed. Conization allows a larger, intact cone of tissue from the transformation zone for thorough histopathology. Treating a benign Nabothian cyst (a) or purely negative endocervical curettage (c) would not require CKC. Stage IIA cervical cancer (d) typically requires more definitive management (e.g., radical surgery/radiation).
(d) 2 and 4

(a)

Sol
1 and 2.

79.
The WHO amended its International Health Regulations to make a single yellow fever vaccination valid for the life of the recipient (1). This lifetime validity applies retroactively to existing certificates and prospectively to new ones, so no further booster is required for international travel (2). Officially, a yellow fever certificate becomes valid 10 days after vaccination (not 4 days), making statement 3 incorrect. India does not currently require a routine booster if vaccinated previously, so statement 4 is also incorrect.

Which of the following statements are correct

regarding female sterilization ? 83. Regarding active immunization against Typhoid
1. It can be done 24 – 48 hours following delivery. fever, consider the following statements :
2. Ideal time for interval ligation is luteal phase 1. The typhoid polysaccharide vaccine is
preceding menstruation. injectable and can be given subcutaneously or
3. It can be combined with medical termination of intramuscularly.
pregnancy. 2. The typhoid polysaccharide vaccine is required
4. It is a preventive measure against serous ovarian to be given in two doses and administered on 0
CMS Paper-II Question Paper 2023 MEDINK

and 7th day. 87. Smoking is considered to be a modifiable risk factor

3. The typhoid oral Ty21a vaccine requires to be for Coronary Heart Disease. Consider the following
given in three doses on 0, 3rd and 7th days. statements with regard to possible mechanisms on
4. Protective immunity with typhoid vaccines the basis of which it acts as a risk factor :
is achieved immediately after the vaccine is 1. Nicotine stimulation of adrenergic drive raises
received. the blood pressure and myocardial oxygen
Which of the statements given above is/are correct ? demand.
(a) 1 only 2. It increases carbon monoxide and induces
(b) 1, 3 and 4 atherogenesis.
(c) 1 and 2 only 3. It leads to fall in protective high density
(d) 2 only lipoproteins.

(a)

Sol
1 only.

Currently, the purified Vi polysaccharide vaccine is indeed injectable and can be given subcut or IM (1). It is typically administered as a single dose, not a two-dose schedule (2 is incorrect). The oral Ty21a vaccine is given in three or four doses spaced 48 hours apart—often on days 1, 3, and 5, not 0, 3, 7 (3 is incorrect in that stated schedule). Immunity is not immediate; it takes about 1–2 weeks to develop protective levels (4 is incorrect).
4. It reduces the apolipoprotein-B plasma levels.
Which of the statements given above are correct ?
84. Which of the following statements are correct (a) 1 and 2 only
regarding Mantoux test for tuberculosis ? (b) 1 and 3 only
1. It entails injecting 1 TU (Tuberculin Unit) of (c) 1, 2 and 3
PPD (Purified Protein Derivative) in 0·1 mL (d) 2, 3 and 4
intradermally.