UPSC-CMS 2025 — Surgery

Q: A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

Triangle of safety. ***Triangle of safety*** - The **triangle of safety** is the universally accepted site for safe **intercostal drain (chest tube)** insertion to treat **pneumothorax**. - Its boundaries help avoid injury to vital organs; it is bordered by the **anterior border of the latissimus dorsi**, the **lateral border of the pectoralis major**, and the **fifth intercostal space**. *Petit's triangle* - This anatomical landmark, also known as the **lumbar triangle**, is located in the **lumbar region** of the back. - It defines a weaker area in the abdominal wall and is a common site for **lumbar hernias**, not chest tube insertion for pneumothorax. *Hesselbach's triangle* - This triangle is located in the **groin region** and is an important anatomical landmark for **inguinal hernias**. - It is bordered by the inferior epigastric vessels, the lateral border of the rectus abdominis, and the inguinal ligament, and is entirely unrelated to chest procedures. *Triangle of auscultation* - The **triangle of auscultation** is a small region of the back, bordered by the **latissimus dorsi**, **trapezius**, and **medial border of the scapula**. - It is a thinner area of musculature, making it an ideal location for **listening to breath sounds** with a stethoscope, but it is not used for invasive procedures like chest tube insertion. [Practice more Surgery PYQs on OnCourse]

Q: Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?

I, III and IV. ***I, III and IV*** - **Diabetes** impairs wound healing through microvascular complications, neuropathy, and increased infection risk. - **Renal failure** (III) leads to uremia, malnutrition, and impaired collagen synthesis, all of which compromise wound integrity. - **Jaundice** (IV) is associated with impaired collagen synthesis, reduced fibroblast activity, and increased risk of infection, contributing to poor wound healing. *II, III and IV* - **Hypertension** (II) alone is not a direct risk factor for post-operative wound dehiscence; its complications (e.g., end-organ damage) might indirectly affect healing. - **Renal failure** (III) and **jaundice** (IV) are indeed significant risk factors, but the exclusion of diabetes makes this option incomplete. *I, II and III* - While **diabetes** (I) and **renal failure** (III) are major risk factors, **hypertension** (II) in isolation does not directly cause wound dehiscance. - This option incorrectly omits **jaundice** (IV), which is a known independent risk factor for impaired wound healing. *I, II and IV* - **Diabetes** (I) and **jaundice** (IV) are strong risk factors, but **hypertension** (II) does not directly contribute. - This option incorrectly excludes **renal failure** (III), which is a significant predisposing factor for wound dehiscence. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :

I, II and III. ***I, II and III*** - **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound. - **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin. - **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening. *I, II and IV* - While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction. - It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures. *II, III and IV* - Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation. - Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results. *I, III and IV* - Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following about Minimal Access Surgery are correct? I. Decreased intraoperative heat loss II. Improved visualization III. Increased chances of herniation IV. Improved mobility Select the answer using the code given below :

I, II and IV. ***I, II and IV (Correct Answer)*** **Statement I - Decreased intraoperative heat loss:** Correct. MAS involves smaller incisions with reduced exposure of internal organs to the operating room environment, resulting in significantly less heat loss compared to open surgery. **Statement II - Improved visualization:** Correct. Endoscopic cameras provide magnified, high-definition, and well-illuminated views of the surgical field, offering superior visualization compared to the naked eye in open procedures. **Statement IV - Improved mobility:** Correct. Patients experience faster post-operative recovery with less pain and earlier return to normal activities due to minimal tissue trauma from smaller incisions. **Statement III - Increased chances of herniation:** This statement is **INCORRECT** and is the key reason why options containing it are wrong. MAS typically results in *decreased* risk of incisional hernias due to smaller access points. While trocar-site hernias can occur, they are less common than the large incisional hernias seen in open surgery when proper fascial closure techniques are employed. *I, III and IV* - Incorrect because Statement III (increased herniation) is false. MAS reduces, not increases, herniation risk. *I, II and III* - Incorrect because Statement III (increased herniation) is false. Properly performed MAS has lower incisional hernia rates than open surgery. *II, III and IV* - Incorrect because Statement III (increased herniation) is false. Smaller incisions in MAS lead to reduced hernia formation compared to traditional open approaches. [Practice more Surgery PYQs on OnCourse]

Q: Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - The **Limberg procedure** (rhomboid flap) and **Karydakis flap** are the most widely established plastic surgical techniques used to close the defect after pilonidal sinus excision. - These techniques aim to **flatten the natal cleft** and move the scar away from the midline, reducing tension and recurrence rates. - **Y-V plasty** is less commonly used specifically for pilonidal sinus compared to Limberg and Karydakis procedures, though it can be employed for tissue advancement in selected cases. - This combination excludes Z-plasty, which is not a primary technique for pilonidal sinus closure. *II, III and IV* - While **Karydakis procedure** is indeed a standard technique, this option incorrectly includes **Z-plasty**, which is generally used for **scar revision** or releasing contractures rather than primary closure of large excisional defects. - It also excludes the **Limberg flap**, which is one of the most commonly used techniques worldwide for pilonidal sinus surgery. *I, III and IV* - This option incorrectly includes **Z-plasty** while excluding **Y-V plasty**. - Z-plasty is not a primary technique for closing pilonidal sinus defects as it doesn't provide adequate tissue coverage for large excisions. - The **Limberg and Karydakis procedures** are the mainstay techniques from this list. *I, II and III* - This combination incorrectly includes **Z-plasty** as a primary technique for closing the excisional defect. - It omits the **Karydakis procedure**, which is one of the most widely recognized and effective flaps for pilonidal disease with excellent outcomes. - The Karydakis flap specifically focuses on **modifying the natal cleft contour** and displacing the incision laterally for better healing and lower recurrence rates. [Practice more Surgery PYQs on OnCourse]

11 Previous Year Questions with Answers & Explanations

Questions

A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?

Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :

Which of the following about Minimal Access Surgery are correct? I. Decreased intraoperative heat loss II. Improved visualization III. Increased chances of herniation IV. Improved mobility Select the answer using the code given below :

Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :

A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

Resection of which part of intestine does not significantly affect fluid and electrolyte balance?

Which one of the following is correct regarding splenic artery aneurysm?

Which of the following statements are correct regarding primary survey/management of traumatic head injury patient? I. Ensure adequate oxygenation and circulation II. Exclude hypoglycaemia III. Check for mechanism of injury IV. Check pupil size and response Select the answer using the code given below :

Q10

Which of the following statements are correct regarding ABCDE of trauma care ? I. A stands for Airway with cervical spine protection II. B stands for Breathing and ventilation III. C stands for Control of massive external haemorrhage IV. D stands for Disability (Neurological status) Select the answer using the code given below :

UPSC-CMS 2025 - Surgery UPSC-CMS Practice Questions and MCQs

Question 1: A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?

A. Petit's triangle
B. Hesselbach's triangle
C. Triangle of auscultation
D. Triangle of safety (Correct Answer)

Explanation: ***Triangle of safety*** - The **triangle of safety** is the universally accepted site for safe **intercostal drain (chest tube)** insertion to treat **pneumothorax**. - Its boundaries help avoid injury to vital organs; it is bordered by the **anterior border of the latissimus dorsi**, the **lateral border of the pectoralis major**, and the **fifth intercostal space**. *Petit's triangle* - This anatomical landmark, also known as the **lumbar triangle**, is located in the **lumbar region** of the back. - It defines a weaker area in the abdominal wall and is a common site for **lumbar hernias**, not chest tube insertion for pneumothorax. *Hesselbach's triangle* - This triangle is located in the **groin region** and is an important anatomical landmark for **inguinal hernias**. - It is bordered by the inferior epigastric vessels, the lateral border of the rectus abdominis, and the inguinal ligament, and is entirely unrelated to chest procedures. *Triangle of auscultation* - The **triangle of auscultation** is a small region of the back, bordered by the **latissimus dorsi**, **trapezius**, and **medial border of the scapula**. - It is a thinner area of musculature, making it an ideal location for **listening to breath sounds** with a stethoscope, but it is not used for invasive procedures like chest tube insertion.

Question 2: Consider the following : I. Diabetes II. Hypertension III. Renal failure IV. Jaundice Which of the above are the risk factors for post-operative wound dehiscence?

A. II, III and IV
B. I, II and III
C. I, III and IV (Correct Answer)
D. I, II and IV

Explanation: ***I, III and IV*** - **Diabetes** impairs wound healing through microvascular complications, neuropathy, and increased infection risk. - **Renal failure** (III) leads to uremia, malnutrition, and impaired collagen synthesis, all of which compromise wound integrity. - **Jaundice** (IV) is associated with impaired collagen synthesis, reduced fibroblast activity, and increased risk of infection, contributing to poor wound healing. *II, III and IV* - **Hypertension** (II) alone is not a direct risk factor for post-operative wound dehiscence; its complications (e.g., end-organ damage) might indirectly affect healing. - **Renal failure** (III) and **jaundice** (IV) are indeed significant risk factors, but the exclusion of diabetes makes this option incomplete. *I, II and III* - While **diabetes** (I) and **renal failure** (III) are major risk factors, **hypertension** (II) in isolation does not directly cause wound dehiscance. - This option incorrectly omits **jaundice** (IV), which is a known independent risk factor for impaired wound healing. *I, II and IV* - **Diabetes** (I) and **jaundice** (IV) are strong risk factors, but **hypertension** (II) does not directly contribute. - This option incorrectly excludes **renal failure** (III), which is a significant predisposing factor for wound dehiscence.

Question 3: Which of the following statements are correct regarding sutures in surgery? I. Barbed sutures have the advantage of eliminating the need for knots. II. Vertical mattress sutures help in eversion of wound edges. III. Aberdeen knot is used for continuous suturing. IV. Silk is preferred for subcuticular suturing. Select the answer using the code given below :

A. I, II and IV
B. II, III and IV
C. I, II and III (Correct Answer)
D. I, III and IV

Explanation: ***I, II and III*** - **I. Barbed sutures** have unidirectional or bidirectional barbs that grip tissue, negating the need for traditional knots to secure the suture line. This property can significantly **reduce operating time** and the volume of foreign material left in the wound. - **II. Vertical mattress sutures** are designed to achieve precise wound edge approximation and eversion, which are crucial for optimal healing and cosmesis, particularly in areas under tension or for thick skin. - **III. The Aberdeen knot** is a slip knot technique specifically designed to secure the end of a **continuous suture line** efficiently and reliably. It provides a flat, secure knot that minimizes bulk and is less prone to loosening. *I, II and IV* - While statements I and II are correct, statement IV is incorrect. **Silk is a braided, non-absorbable multifilament suture** that can cause significant tissue reaction. - It is generally not preferred for subcuticular suturing due to its increased risk of infection, visibility, and foreign body reaction compared to monofilament, absorbable sutures. *II, III and IV* - Statements II and III are correct, but statement IV is incorrect. **Silk is avoided for subcuticular closure** due to its inflammatory properties and potential for suture extrusion or sinus formation. - Subcuticular sutures typically use **absorbable monofilament sutures** (e.g., poliglecaprone 25 or polydioxanone) to minimize tissue reaction and achieve good cosmetic results. *I, III and IV* - Statements I and III are correct regarding barbed sutures and the Aberdeen knot, respectively. However, statement IV is incorrect because **silk suture is a non-absorbable, braided material that is highly reactive and not suitable for subcuticular placement**, where monofilament absorbable sutures are preferred for minimal tissue reaction and good cosmesis.

Question 4: Which of the following about Minimal Access Surgery are correct? I. Decreased intraoperative heat loss II. Improved visualization III. Increased chances of herniation IV. Improved mobility Select the answer using the code given below :

A. I, III and IV
B. I, II and III
C. I, II and IV (Correct Answer)
D. II, III and IV

Explanation: ***I, II and IV (Correct Answer)*** **Statement I - Decreased intraoperative heat loss:** Correct. MAS involves smaller incisions with reduced exposure of internal organs to the operating room environment, resulting in significantly less heat loss compared to open surgery. **Statement II - Improved visualization:** Correct. Endoscopic cameras provide magnified, high-definition, and well-illuminated views of the surgical field, offering superior visualization compared to the naked eye in open procedures. **Statement IV - Improved mobility:** Correct. Patients experience faster post-operative recovery with less pain and earlier return to normal activities due to minimal tissue trauma from smaller incisions. **Statement III - Increased chances of herniation:** This statement is **INCORRECT** and is the key reason why options containing it are wrong. MAS typically results in *decreased* risk of incisional hernias due to smaller access points. While trocar-site hernias can occur, they are less common than the large incisional hernias seen in open surgery when proper fascial closure techniques are employed. *I, III and IV* - Incorrect because Statement III (increased herniation) is false. MAS reduces, not increases, herniation risk. *I, II and III* - Incorrect because Statement III (increased herniation) is false. Properly performed MAS has lower incisional hernia rates than open surgery. *II, III and IV* - Incorrect because Statement III (increased herniation) is false. Smaller incisions in MAS lead to reduced hernia formation compared to traditional open approaches.

Question 5: Which of the following are the techniques commonly used to close the raw area after excision of a pilonidal sinus in order to avoid a midline wound? I. Limberg procedure II. Y-V plasty III. Z-plasty IV. Karydakis procedure Select the correct answer using the code given below :

A. II, III and IV
B. I, III and IV
C. I, II and III
D. I, II and IV (Correct Answer)

Explanation: ***I, II and IV*** - The **Limberg procedure** (rhomboid flap) and **Karydakis flap** are the most widely established plastic surgical techniques used to close the defect after pilonidal sinus excision. - These techniques aim to **flatten the natal cleft** and move the scar away from the midline, reducing tension and recurrence rates. - **Y-V plasty** is less commonly used specifically for pilonidal sinus compared to Limberg and Karydakis procedures, though it can be employed for tissue advancement in selected cases. - This combination excludes Z-plasty, which is not a primary technique for pilonidal sinus closure. *II, III and IV* - While **Karydakis procedure** is indeed a standard technique, this option incorrectly includes **Z-plasty**, which is generally used for **scar revision** or releasing contractures rather than primary closure of large excisional defects. - It also excludes the **Limberg flap**, which is one of the most commonly used techniques worldwide for pilonidal sinus surgery. *I, III and IV* - This option incorrectly includes **Z-plasty** while excluding **Y-V plasty**. - Z-plasty is not a primary technique for closing pilonidal sinus defects as it doesn't provide adequate tissue coverage for large excisions. - The **Limberg and Karydakis procedures** are the mainstay techniques from this list. *I, II and III* - This combination incorrectly includes **Z-plasty** as a primary technique for closing the excisional defect. - It omits the **Karydakis procedure**, which is one of the most widely recognized and effective flaps for pilonidal disease with excellent outcomes. - The Karydakis flap specifically focuses on **modifying the natal cleft contour** and displacing the incision laterally for better healing and lower recurrence rates.

Question 6: A 45-year-old lady presents with history of a painless lump in the right breast since 1 month. On examination, the lump is hard, 3 x 4 cm in size in the upper outer quadrant and is not fixed to the skin or the underlying structures. The axilla reveals firm mobile lymph nodes (level I). Rest of systemic examination is normal. The clinical stage of this disease is :

A. cT₃ N₁ Mₓ
B. cT₂ N₁ Mₓ (Correct Answer)
C. cT₁ N₁ Mₓ
D. cT₃ N₂ Mₓ

Explanation: **cT₂ N₁ Mₓ** - The tumor size of **3 x 4 cm** falls within the T2 classification (>2 cm but ≤5 cm). The description of the lump being "not fixed to the skin or the underlying structures" further supports a T2 (or lower) classification, as fixation would suggest a more advanced T stage (T4). - The presence of "firm mobile lymph nodes (level I)" indicates involvement of regional lymph nodes, which is classified as **N1** in breast cancer staging. An "Mx" designation means that distant metastasis cannot be assessed clinically without further investigation. *cT₃ N₁ Mₓ* - A **T3 classification** would apply if the tumor measured **greater than 5 cm** in its largest dimension, which is not the case here, as the lump is 3 x 4 cm. - While the **N1 and Mx** components are consistent with the findings, the T component is incorrect for the given tumor size. *cT₁ N₁ Mₓ* - A **T1 classification** is used for tumors that are **2 cm or less in greatest dimension**. The given tumor size of 3 x 4 cm clearly exceeds this limit. - The **N1 and Mx** components are consistent, but the T component is inappropriate for the described tumor size. *cT₃ N₂ Mₓ* - This option is incorrect on two counts: the **T3 classification** is wrong for a 3 x 4 cm tumor (should be >5 cm), and the **N2 classification** is also incorrect. - **N2** would indicate metastases to **ipsilateral axillary lymph nodes that are fixed or matted**, or in ipsilateral internal mammary lymph nodes in the absence of clinically apparent axillary lymph node metastases. The description states "firm mobile lymph nodes (level I)," which corresponds to N1, not N2.

Question 7: Resection of which part of intestine does not significantly affect fluid and electrolyte balance?

A. Ileum
B. Proximal jejunum
C. Distal jejunum (Correct Answer)
D. Colon

Explanation: ***Distal jejunum*** - The distal jejunum has significant **adaptive capacity** to take over the absorptive functions of other parts of the small intestine if they are resected. - Its resection typically has the **least impact** on fluid and electrolyte balance compared to other segments of the intestine, as critical absorption of most nutrients, water, and electrolytes occurs more proximally or distally. *Ileum* - The ileum is crucial for the absorption of **vitamin B12** and **bile salts**; its resection can lead to **malabsorption** and severe diarrhea. - Loss of bile salt absorption can result in **fat malabsorption** and lead to fluid and electrolyte disturbances. *Proximal jejunum* - The proximal jejunum is the primary site for the absorption of most **nutrients** (carbohydrates, proteins, fats), **water**, and **electrolytes**. - Its resection can lead to significant **malnutrition** and severe fluid and electrolyte imbalances due to widespread malabsorption. *Colon* - The colon is responsible for the final absorption of **water** and **electrolytes**, compacting stool for elimination. - Its resection can severely impair the body's ability to conserve water and electrolytes, leading to **dehydration** and electrolyte disturbances.

Question 8: Which one of the following is correct regarding splenic artery aneurysm?

A. It is generally multiple in number.
B. It is caused due to blunt trauma to the abdomen.
C. It is twice as common in men.
D. It is most commonly located in the middle third of the splenic artery. (Correct Answer)

Explanation: ***It is most commonly located in the middle third of the splenic artery.*** - The **splenic artery** is the most common site for **visceral artery aneurysms**, accounting for approximately 60% of all visceral aneurysms. - These aneurysms are most commonly located in the **middle third (50-60%)** of the splenic artery, followed by the distal third (20-30%) and proximal third (10-20%). - The middle segment's tortuosity and hemodynamic stress may contribute to aneurysm formation. - Though distal aneurysms are more prone to rupture, the **middle third remains the most frequent location**. *It is generally multiple in number.* - **Solitary aneurysms** are more common (60-80% of cases) than multiple aneurysms. - **Multiple splenic artery aneurysms** occur in 20-30% of cases and are associated with conditions like **fibromuscular dysplasia**, portal hypertension, or systemic vasculitis. *It is caused due to blunt trauma to the abdomen.* - **Splenic artery aneurysms** are rarely caused by blunt abdominal trauma. - Most are **degenerative or atherosclerotic** in origin (>60% of cases). - Other etiologies include **fibromuscular dysplasia**, portal hypertension, pancreatitis, and connective tissue disorders. - Blunt trauma typically causes **acute splenic injury** (laceration, hematoma) rather than aneurysm formation. *It is twice as common in men.* - **Splenic artery aneurysms** are approximately **four times more common in women** than in men (4:1 female-to-male ratio). - This female predominance is attributed to **multiparity** (which increases arterial wall stress), hormonal factors, and the association with **fibromuscular dysplasia**.

Question 9: Which of the following statements are correct regarding primary survey/management of traumatic head injury patient? I. Ensure adequate oxygenation and circulation II. Exclude hypoglycaemia III. Check for mechanism of injury IV. Check pupil size and response Select the answer using the code given below :

A. II, III and IV
B. I, III and IV
C. I, II and III
D. I, II and IV (Correct Answer)

Explanation: ***I, II and IV*** - **Primary survey** in trauma management, including head injury, focuses on immediately life-threatening conditions (Airway, Breathing, Circulation, Disability, Exposure). Ensuring adequate **oxygenation and circulation** (Statement I) is paramount to prevent secondary brain injury. - Exclude **hypoglycemia** (Statement II) is critical because altered mental status due to low blood sugar can mimic head injury and delay appropriate treatment, making it an essential part of the 'D' (disability) assessment. Checking **pupil size and response** (Statement IV) is also part of the 'D' assessment, providing vital information about potential brain stem compromise or intracranial pressure changes. *II, III and IV* - While excluding hypoglycemia and checking pupil response are crucial parts of the primary survey, Statement III, "Check for mechanism of injury," is typically part of the **secondary survey** or initial assessment but not immediately life-saving like ABCD. - The primary survey prioritizes immediate threats to life, and while understanding the mechanism of injury informs subsequent care, it does not directly address a patient's immediate physiologic stability. *I, III and IV* - This option includes checking the mechanism of injury (Statement III) as part of the primary survey, which is generally conducted after the **life-threatening conditions** are addressed. - It omits the critical step of excluding **hypoglycemia** (Statement II), which is an immediate reversible cause of altered mental status that must be ruled out during the primary assessment. *I, II and III* - This option correctly includes ensuring adequate **oxygenation and circulation** (Statement I) and excluding **hypoglycemia** (Statement II) as part of the primary survey. - However, it incorrectly includes checking for the **mechanism of injury** (Statement III) as a primary survey component and omits checking **pupil size and response** (Statement IV), which is an essential part of the 'Disability' assessment in the primary survey for head injury.

Question 10: Which of the following statements are correct regarding ABCDE of trauma care ? I. A stands for Airway with cervical spine protection II. B stands for Breathing and ventilation III. C stands for Control of massive external haemorrhage IV. D stands for Disability (Neurological status) Select the answer using the code given below :

A. I, II and III
B. I, II and IV (Correct Answer)
C. II, III and IV
D. I, III and IV

Explanation: ***I, II and IV*** - All statements I, II, and IV accurately describe components of the **ABCDE approach in trauma care**. - **A** is for **Airway maintenance with cervical spine protection**, **B** for **Breathing and ventilation**, and **D** for **Disability (neurological status)**. - These are the core components as per **ATLS (Advanced Trauma Life Support) guidelines**. *I, II and III* - This option is incorrect because statement III is **incomplete and inaccurate**. - In the standard ATLS primary survey, **C stands for Circulation with hemorrhage control**, not just "Control of massive external haemorrhage." - While controlling hemorrhage is a critical part of 'C', the primary focus is on assessing and managing **circulation** (shock, perfusion, bleeding). - Note: ATLS 10th edition introduced **<C> for catastrophic hemorrhage** in tactical settings, but this is a separate step before A, not a replacement for C. *II, III and IV* - This option is incorrect as it omits statement I, which correctly describes **A as Airway with cervical spine protection**, the first and most critical step in trauma management. - Statement III also incorrectly describes what 'C' represents in the ABCDE approach. *I, III and IV* - This option is incorrect because it omits statement II, which correctly identifies **B as Breathing and ventilation**, an essential assessment following airway management. - Statement III is incomplete as it fails to mention that **C primarily stands for Circulation** (with hemorrhage control as one component).