UPSC Combined Medical Services Previous Year Question Paper And Answer

Combined Medical Services Examination: Paper I – General Medicine and Pediatrics Questions with Answers and Explanations

The Combined Medical Services (CMS) Examination 2024, Paper I (General Medicine and Pediatrics), is a critical test for medical professionals aiming to excel in their careers. This article provides a detailed breakdown of the questions, multiple-choice options, correct answers, and explanations from the CMS 2024 Paper I. This guide is structured to help candidates understand key concepts, prepare effectively, and boost their performance. Each question is presented clearly, followed by its answer in bold and a concise explanation to ensure clarity and comprehension for all readers, including medical students and professionals.

Question 1: Jugular Venous Pulse Height

The height of the Jugular Venous Pulse is determined by:
(a) Right atrial pressure
(b) Right ventricle pressure
(c) Left atrial pressure
(d) Left ventricular pressure

Answer: (a) Right atrial pressure
Explanation: The jugular venous pulse (JVP) reflects the pressure in the right atrium. It is a clinical measure used to assess proper heart function. The jugular veins are directly connected to the right atrium, and changes in appropriate atrial pressure influence the height of the JVP. Proper ventricular pressure, left atrial pressure, and left ventricular pressure do not directly affect JVP.

Question 2: SA Node Location

The SA node is situated at the junction of:
(a) SVC and RA
(b) SVC and LA
(c) LA and LV
(d) IVC and RA

Answer: (a) SVC and RA
Explanation: The sinoatrial (SA) node, the heart’s primary pacemaker, is located at the junction of the superior vena cava (SVC) and the right atrium (RA). This anatomical position allows it to initiate electrical impulses that regulate the heart rhythm. The other options do not correctly describe the SA node’s location.

Question 3: High Output Cardiac Failure

High-output cardiac failure is caused by which of the following diseases?

Beri-beri
Severe anaemia
Thyrotoxicosis
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

Answer: (d) 1, 2, and 3
Explanation: High-output cardiac failure occurs when the heart pumps a normal or increased volume of blood but cannot meet the body’s demands due to increased metabolic needs. Beri-beri (caused by thiamine deficiency), severe anaemia (reduced oxygen-carrying capacity), and thyrotoxicosis (increased metabolic rate due to excess thyroid hormone) all lead to high-output cardiac failure.

Question 4: Reverse Splitting of Second Heart Sound

Reverse splitting of the second heart sound is most commonly seen in:
(a) ASD
(b) Severe MR
(c) LBBB
(d) Pulmonary hypertension

Answer: (c) LBBB
Explanation: Reverse splitting of the second heart sound occurs when the aortic valve closes after the pulmonary valve, often due to delayed left ventricular depolarization. Left bundle branch block (LBBB) causes this delay, leading to reverse splitting. Atrial septal defect (ASD), severe mitral regurgitation (MR), and pulmonary hypertension do not typically cause this phenomenon.

Question 5: Jones Criteria for Acute Rheumatic Fever

Which of the following are primary criteria under the Jones Criteria for Acute Rheumatic Fever?

Chorea
Erythema Marginatum
Subcutaneous Nodules
Polyarthralgia
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

Answer: (a) 1, 2, and 3
Explanation: The Jones Criteria for diagnosing acute rheumatic fever include major and minor criteria. Primary criteria are carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. Polyarthralgia is a minor criterion, not a major one, making option (a) correct.

Question 6: Diagnosis of Systolic Murmur

A 70-year-old man with dyspnoea on exertion has been found to have a single second heart sound and a loud, diamond-shaped, rough quality systolic murmur best heard at the right 2nd intercostal space, radiating to the right carotid artery. Which one of the following is the likely diagnosis?
(a) Patent ductus arteriosus
(b) Ventricular septal defect
(c) Aortic stenosis
(d) Pulmonary stenosis

Answer: (c) Aortic stenosis
Explanation: The described murmur is characteristic of aortic stenosis, which produces a diamond-shaped systolic murmur heard best at the right second intercostal space, radiating to the carotid arteries. A single second heart sound suggests aortic valve pathology, as seen in aortic stenosis, ruling out other options.

Question 7: Stroke Risk in Atrial Fibrillation

Which one of the following is the appropriate scoring system used to assess the risk of stroke in patients with non-valvular chronic atrial fibrillation on oral anticoagulation?
(a) HAS-BLED
(b) AMT-4
(c) CURB-65
(d) CHA₂DS₂VASc

Answer: (d) CHA₂DS₂VASc
Explanation: The CHA₂DS₂VASc score is used to assess stroke risk in patients with non-valvular atrial fibrillation. It takes into account factors such as age, sex, and comorbidities. HAS-BLED assesses bleeding risk, CURB-65 is for pneumonia severity, and AMT-4 is not a recognized scoring system.

Question 8: Pulmonary Embolism Statements

Consider the following statements about pulmonary embolism:

Unexplained breathlessness is the most common symptom.
When congestive heart failure or pneumonia fail to improve despite standard medical treatment, occult pulmonary embolism should be considered.
Patients with high clinical likelihood of venous thromboembolism should first undergo D-dimer testing alone without obligatory imaging tests.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2, and 3

Answer: (a) 1 and 2 only
Explanation: Unexplained breathlessness is a common symptom of pulmonary embolism, and occult pulmonary embolism should be considered when heart failure or pneumonia does not respond to treatment. However, patients with high clinical likelihood of venous thromboembolism require imaging (e.g., CT pulmonary angiography) rather than D-dimer testing alone, making statement 3 incorrect.

Question 9: Pleural Fluid Exudate Criteria

Consider the following criteria:

Pleural fluid protein: Serum protein ratio > 0.5
Pleural fluid LDH: Serum LDH ratio > 0.6
Pleural fluid LDH > Two-thirds of the upper limit of normal serum LDH
Which of the above criteria, if present in pleural fluid, will indicate an exudate?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2, and 3

Answer: (d) 1, 2, and 3
Explanation: Light’s criteria are used to classify pleural fluid as exudate or transudate. An exudate is indicated if any of the following are present: pleural fluid protein: serum protein ratio > 0.5, pleural fluid LDH: serum LDH ratio > 0.6, or pleural fluid LDH > two-thirds of the upper limit of normal serum LDH.

Question 10: Clubbing Statements

Which of the following statements are correct about clubbing?

It usually affects the fingers symmetrically.
It does not involve the toes.
It may be associated with malignant lung conditions.
It may recede following lung transplantation in cystic fibrosis.
Select the answer using the code given below:
(a) 1, 2, and 3
(b) 1, 3, and 4
(c) 2, 3, and 4
(d) 1, 2, and 4

Answer: (b) 1, 3, and 4
Explanation: Clubbing typically affects fingers symmetrically and can be associated with malignant lung conditions like lung cancer. It may recede after lung transplantation in cystic fibrosis. However, clubbing can also affect toes, making statement 2 incorrect.

Question 11: Lofgren Syndrome

Consider the following statements regarding Lofgren syndrome:

It is an acute illness and is more commonly seen in females.
It is a clinically distinct phenotype of sarcoidosis characterized by peripheral arthropathy and uveitis.
Clinical features include fever, erythema nodosum, and bilateral lymphadenopathy.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2, and 3

Answer: (c) 1 and 3 only
Explanation: Lofgren syndrome is an acute form of sarcoidosis, more common in females, and characterized by fever, erythema nodosum, bilateral hilar lymphadenopathy, and arthritis. Uveitis is not a defining feature of Lofgren syndrome, making statement 2 incorrect.

Question 12: Pulmonary Tuberculosis Diagnosis

Which of the following investigations may be used for the diagnosis of pulmonary tuberculosis?

Nucleic acid amplification
Culture in the Middlebrook medium
Light-emitting diode fluorescent microscopy with auramine staining
Peripheral blood smear
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

Answer: (a) 1, 2, and 3
Explanation: Nucleic acid amplification (e.g., GeneXpert), culture in Middlebrook medium, and LED fluorescent microscopy with auramine staining are standard diagnostic tools for pulmonary tuberculosis. Peripheral blood smear is not used for TB diagnosis.

Question 13: BODE Index and 6-Minute Walk

The distance walked in 6 minutes is an indirect measure of which of the following variables of the ‘BODE Index’, which is used to assess the prognosis in chronic obstructive pulmonary disease?
(a) Body Mass Index
(b) Degree of air flow obstruction
(c) Severity of dyspnoea
(d) Exercise capacity

Answer: (d) Exercise capacity
Explanation: The BODE Index assesses prognosis in COPD using four variables: Body Mass Index, airflow Obstruction, Dyspnoea, and Exercise capacity—the 6-minute walk test measures exercise capacity, reflecting a patient’s functional status.

Question 14: Chest X-Ray Findings

A 65-year-old female, a stone-cutter by occupation, had multiple well-circumscribed nodular opacities in the upper and middle zones of a chest X-ray, along with mediastinal lymph nodes showing egg-shell calcification. Which one of the following is the most likely etiology?
(a) Byssinosis
(b) Silicosis
(c) Berylliosis
(d) Siderosis

Answer: (b) Silicosis
Explanation: Silicosis, caused by silica dust exposure (everyday in stone-cutters), presents with nodular opacities in the upper and middle lung zones and egg-shell calcification of mediastinal lymph nodes on chest X-ray. Byssinosis, berylliosis, and siderosis have different radiographic patterns.

Question 15: Acute Pancreatitis Complications

Which of the following are complications of acute pancreatitis?

Hypoxia
Hypercalcemia
Hyperglycemia
Reduced serum albumin
Select the correct answer using the code given below:
(a) 1, 2, and 3
(b) 1, 3, and 4
(c) 2 and 3 only
(d) 3 and 4 only

Answer: (b) 1, 3, and 4
Explanation: Acute pancreatitis can cause hypoxia (due to ARDS), hyperglycemia (due to pancreatic endocrine dysfunction), and reduced serum albumin (due to inflammation and protein loss). Hypercalcemia is not a typical complication; hypocalcemia is more common.

Question 16: Gold Standard for Celiac Disease

The Gold Standard for diagnosis of Celiac disease is:
(a) Endoscopic small bowel biopsy
(b) Stool routine microscopy and culture
(c) Abdominal ultrasound
(d) Anti-parietal cell antibodies

Answer: (a) Endoscopic small bowel biopsy
Explanation: Endoscopic small bowel biopsy, showing villous atrophy and crypt hyperplasia, is the gold standard for diagnosing celiac disease. Serological tests support the diagnosis, but a biopsy confirms it. The other options are not diagnostic for celiac disease.

Question 17: Helicobacter pylori Eradication

About Helicobacter pylori eradication in peptic ulcer disease, consider the following statements:

A proton-pump inhibitor is taken with two antibiotics.
Treatment is prescribed for at least 7 days.
Treatment of Helicobacter pylori infection leads to vitamin B12 deficiency.
Patients requiring long-term NSAIDs should undergo Helicobacter pylori eradication therapy to reduce ulcer risk.
Which of the statements given above are correct?
(a) 1, 2, and 3
(b) 1, 2, and 4
(c) 1, 3, and 4
(d) 2, 3, and 4

Answer: (b) 1, 2, and 4
Explanation: H. pylori eradication typically involves a proton-pump inhibitor with two antibiotics (e.g., clarithromycin and amoxicillin) for at least 7 days. Eradication reduces ulcer risk in long-term NSAID users. H. pylori treatment does not cause vitamin B12 deficiency; it may improve B12 absorption.

Question 18: Hepatic Encephalopathy Precipitating Factors

Which of the following are precipitating factors for hepatic encephalopathy?

Hypokalemia
Septicemia
Increased dietary protein load
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

Answer: (d) 1, 2, and 3
Explanation: Hepatic encephalopathy can be precipitated by hypokalemia (increases ammonia production), septicemia (increases systemic inflammation), and increased dietary protein load (increases ammonia from protein metabolism).

Question 19: Upper Gastrointestinal Bleeding

Which one of the following statements is correct regarding Upper Gastrointestinal Bleeding (UGIB)?
(a) Esophageal varices are the most common cause.
(b) Eradication of Helicobacter pylori in patients with bleeding ulcers decreases the rebleeding rates to less than 5%.
(c) Patients with cardiovascular disease who are on aspirin for secondary prevention should not restart their aspirin.
(d) Transjugular Intrahepatic Portosystemic Shunt (TIPS) should be considered as therapy only after one week of hospitalization for acute variceal bleeding.

Answer: (b) Eradication of Helicobacter pylori in patients with bleeding ulcers decreases the rebleeding rates to less than 5%.
Explanation motive
Explanation: Eradicating H. pylori in bleeding ulcers significantly reduces rebleeding rates. Esophageal varices are not the most common cause of UGIB (peptic ulcers are). Aspirin can often be restarted in cardiovascular patients after UGIB stabilization. TIPS is considered earlier than one week for variceal bleeding if needed.

Question 20: Crigler-Najjar Syndrome Type I

Crigler-Najjar syndrome Type-I is inherited as an:
(a) Autosomal recessive disorder
(b) Autosomal dominant disorder
(c) X-linked recessive disorder
(d) X-linked dominant disorder

Answer: (a) Autosomal recessive disorder
Explanation: Crigler-Najjar syndrome Type I is caused by mutations in the UGT1A1 gene, inherited in an autosomal recessive manner, requiring two defective alleles for the disease to manifest.

Question 21: Whipple’s Disease Histological Stain

Whipple’s disease is characterized by the infiltration of small intestinal mucosa by ‘foamy’ macrophages. Which one of the following histological stains is characteristically used to stain them?
(a) Sudan Black-B
(b) Gentian violet
(c) Methylene blue
(d) Periodic acid Schiff

Answer: (d) Periodic acid Schiff
Explanation: Periodic acid Schiff (PAS) stain highlights the glycogen and glycoprotein content in the foamy macrophages of Whipple’s disease, aiding in diagnosis. The other stains are not specific to this condition.

Question 22: Hepatic Encephalopathy Antibiotics

Poorly absorbed antibiotics are often used as adjunctive therapies in patients with hepatic encephalopathy. These may include:
(a) Tenofovir or Telbivudine
(b) Sofosbuvir or Velpatasvir
(c) Levofloxacin or Clarithromycin
(d) Neomycin or Rifaximin

Answer: (d) Neomycin or Rifaximin
Explanation: Neomycin and rifaximin are poorly absorbed antibiotics that reduce gut ammonia production, aiding in hepatic encephalopathy management. The other options are used for viral hepatitis or other infections.

Question 23: Causes of Ascites with Low SAAG

When the serum ascites to albumin gradient (SAAG) is less than 1.1 gm/dL, then which of the following causes of ascites may be considered?

Infection
Malignancy
Cardiac ascites
Portal hypertension
Select the correct answer using the code given below:
(a) 1, 3, and 4
(b) 1 and 2 only
(c) 3 and 4 only
(d) 1, 2, and 3

Answer: (d) 1, 2, and 3
Explanation: A SAAG < 1.1 gm/dL indicates non-portal hypertension causes of ascites, such as infection (e.g., tuberculous peritonitis), malignancy (e.g., peritoneal carcinomatosis), and cardiac ascites. Portal hypertension typically results in a SAAG ≥ 1.1 gm/dL.

Question 24: Barium Swallow Finding

A sigmoid configuration, along with a tapering beak-like deformity at the lower esophageal sphincter on barium swallow, is a feature of:
(a) Diffuse esophageal spasm
(b) Squamous cell carcinoma of the esophagus
(c) Achalasia cardia
(d) Barrett’s esophagus

Answer: (c) Achalasia cardia
Explanation: Achalasia cardia is characterized by a sigmoid configuration and a “bird’s beak” appearance at the lower esophageal sphincter on barium swallow due to failure of the sphincter to relax. The other conditions do not produce this specific finding.

Question 25: Hematuria Urine Findings

Consider the following findings in the urine examination of suspected haematuria:

The dipstick test is positive for the following component	Urine microscopy	Etiology
A: Myoglobinuria	D: White blood cells	G: Glomerular bleeding
B: Hematuria	E: No red cells	H: Intravascular hemolysis
C: Hemoglobinuria	F: Red cell casts	I: Rhabdomyolysis
Which one of the following triplets is correctly matched?
(a) B, F, G
(b) A, D, I
(c) B, E, H
(d) C, F, H

Answer: (a) B, F, G
Explanation: Hematuria (B) with red cell casts (F) indicates glomerular bleeding (G), as seen in glomerulonephritis. Myoglobinuria with white blood cells does not typically indicate rhabdomyolysis, and hemoglobinuria with red cell casts does not match intravascular hemolysis.

Question 26: Anti-Glomerular Basement Membrane Disease

Which of the following statements are correct regarding anti-glomerular basement membrane disease?

It is a rare autoimmune disease characterized by rapidly progressive glomerulonephritis.
Antibodies are formed against the α3 chain of type 4 collagen GBM.
The α3 chain is expressed in the basement membrane of the glomerulus and the retina.
The disease may be associated with retinal hemorrhage, which is known as Goodpasture syndrome.
Select the answer using the code given below:
(a) 1 and 2 only
(b) 2, 3, and 4 only
(c) 1, 3, and 4 only
(d) 1, 2, 3, and 4

Answer: (d) 1, 2, 3, and 4
Explanation: Anti-glomerular basement membrane disease is a rare autoimmune condition causing rapidly progressive glomerulonephritis. It involves antibodies against the α3 chain of type 4 collagen in the glomerular and alveolar basement membranes. When pulmonary involvement (including retinal hemorrhage) occurs, it is termed Goodpasture syndrome.

Question 27: Poor Prognostic Indicators in Glomerular Disease

Which of the following are poor prognostic indicators in glomerular disease?

Female sex
Hypertension
Persistent and severe proteinuria
Elevated creatinine levels at presentation
Select the correct answer using the code given below:
(a) 1 and 3 only
(b) 2 and 4 only
(c) 2, 3, and 4 only
(d) 1, 2, 3, and 4

Answer: (c) 2, 3, and 4 only
Explanation: Hypertension, persistent severe proteinuria, and elevated creatinine levels at presentation indicate worse outcomes in glomerular disease due to increased renal damage. Female sex is not a specific poor prognostic indicator.

Question 28: Indications for Renal Biopsy

Which of the following are indications for a renal biopsy?

Chronic kidney disease of uncertain etiology
Nephritic syndrome
Uncontrolled severe hypertension
Renal transplant dysfunction
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

Answer: (b) 1, 2, and 4
Explanation: Renal biopsy is indicated for chronic kidney disease of uncertain etiology, nephritic syndrome (to determine the underlying glomerular pathology), and renal transplant dysfunction (to assess rejection or other issues). Uncontrolled hypertension alone is not a direct indication for biopsy.

Question 29: GFR for Stage 2 Chronic Kidney Disease

Which of the following is the correct range of Glomerular Filtration Rate (GFR) for Stage 2 chronic kidney disease?
(a) 60–89 mL/min/1.73 m²
(b) 45–59 mL/min/1.73 m²
(c) 30–44 mL/min/1.73 m²
(d) 15–29 mL/min/1.73 m²

Answer: (a) 60–89 mL/min/1.73 m²
Explanation: Stage 2 chronic kidney disease is defined by a GFR of 60–89 mL/min/1.73 m² with evidence of kidney damage (e.g., proteinuria). The other ranges correspond to more advanced stages of CKD.

Question 30: Polycystic Ovary Syndrome Diagnosis

A diagnosis of polycystic ovary syndrome requires the presence of which of the following clinical features?

Menstrual irregularity
Clinical or biochemical androgen excess
Multiple cysts in the ovaries
BMI < 18.5 kg/m²
Select the correct answer using the code given below:
(a) 1, 2, and 3
(b) 2, 3, and 4
(c) 1, 3, and 4
(d) 1, 2, and 4

Answer: (a) 1, 2, and 3
Explanation: Polycystic ovary syndrome (PCOS) is diagnosed using the Rotterdam criteria, requiring at least two of: menstrual irregularity, clinical or biochemical androgen excess, and polycystic ovaries on ultrasound. Low BMI (< 18.5 kg/m²) is not a diagnostic criterion.

Question 31: Urethral Discharge Diagnosis

A young male presented with a recent onset of urethral discharge and dysuria. On examination, the discharge was profuse and purulent. Microscopy of smears from the discharge revealed Gram-negative diplococci. What is the likely diagnosis?
(a) Genital herpes
(b) Chlamydia
(c) Gonorrhoea
(d) Syphilis

Answer: (c) Gonorrhoea
Explanation: Profuse purulent urethral discharge with Gram-negative diplococci on microscopy is characteristic of gonorrhoea, caused by Neisseria gonorrhoeae. Chlamydia typically causes milder discharge, and herpes and syphilis do not present with Gram-negative diplococci.

Question 32: Nephritic Proteinuria and Low Complement

A 40-year-old female with nephritic range proteinuria is found to have low serum complement levels. Which of the following can be the likely etiology?

Systemic lupus erythematosus
Post-infectious glomerulonephritis
Infective endocarditis
Mesangio-capillary glomerulonephritis
Select the correct answer using the code given below:
(a) 1 and 2 only
(b) 3 and 4 only
(c) 1, 2, and 3
(d) 1, 2, 3, and 4

Answer: (d) 1, 2, 3, and 4
Explanation: Low serum complement levels with nephritic proteinuria are seen in systemic lupus erythematosus, post-infectious glomerulonephritis, infective endocarditis, and mesangio-capillary glomerulonephritis due to immune complex-mediated inflammation.

Question 33: Parkinsonism Features

Consider the following clinical features:

Hypomimia
Dysphonia
Festination gait
Cogwheel rigidity
Which of the features given above are generally present in Parkinsonism?
(a) 1, 2, 3, and 4
(b) 1, 2, and 4 only
(c) 3 and 4 only
(d) 1, 2, and 3 only

Answer: (a) 1, 2, 3, and 4
Explanation: Parkinsonism is characterized by hypomimia (reduced facial expression), dysphonia (soft voice), festinating gait (short, shuffling steps), and cogwheel rigidity (tremor combined with rigidity), all of which are hallmark features.

Question 34: Extrapyramidal System Lesions

Circuits between the basal ganglia and the motor cortex constitute the extrapyramidal system, which controls muscle tone, body posture, and the initiation of movement. Lesions of the extrapyramidal system present clinically with:
(a) Tremor and rigidity
(b) Seizures
(c) Urinary incontinence
(d) Muscle wasting

Answer: (a) Tremor and rigidity
Explanation: The extrapyramidal system regulates muscle tone and movement. Lesions, as in Parkinson’s disease, cause tremor and rigidity. Seizures, urinary incontinence, and muscle wasting are not typical features of extrapyramidal lesions.

Question 35: Transient Global Amnesia

Consider the following statements regarding Transient Global Amnesia (TGA):

TGA primarily affects middle-aged individuals who present with an abrupt, discrete loss of anterograde memory lasting a few hours.
During the episode, the patients are unable to record new memories, resulting in repetitive questioning.
Consciousness is impaired during the episode, and the patient is unable to perform even simple motor functions.
After 4–6 hours, memory function and behaviour return to normal, but the patient has complete and persistent amnesia for the duration of the episode.
Which of the statements given above are correct?
(a) 1, 2, and 3
(b) 1, 2, and 4
(c) 1, 3, and 4
(d) 2, 3, and 4

Answer: (b) 1, 2, and 4
Explanation: TGA affects middle-aged individuals with sudden anterograde memory loss, leading to repetitive questioning. Memory and behavior normalize after 4–6 hours, but amnesia for the episode persists. Consciousness is not impaired, and motor functions remain intact, making statement 3 incorrect.

Question 36: Contralateral Homonymous Lower Quadrantanopia

Contralateral homonymous lower quadrantanopia is the type of visual loss seen when the lesion is located at which one of the following anatomical locations?
(a) Frontal lobe
(b) Temporal lobe
(c) Parietal lobe
(d) Occipital lobe

Answer: (c) Parietal lobe
Explanation: Contralateral homonymous lower quadrantanopia results from lesions in the parietal lobe, affecting the superior optic radiations. Occipital lobe lesions cause full homonymous hemianopia, while frontal and temporal lobes do not typically produce this specific visual defect.

Question 37: Right 3rd Cranial Nerve Palsy

Which of the following correctly describes the primary position of the right eye in right 3rd cranial nerve palsy?
(a) Downwards and outwards
(b) Downwards and inwards
(c) Upwards and outwards
(d) Upwards and inwards

Answer: (a) Downwards and outwards
Explanation: Third cranial nerve (oculomotor nerve) palsy causes weakness of muscles responsible for upward, inward, and downward eye movements, leaving the unopposed lateral rectus and superior oblique muscles to position the eye downwards and outwards.

Question 38: Cluster Headache Statements

Consider the following statements regarding cluster headache:

The headaches are periodic, beginning at the same time for weeks at a stretch.
Patients experience severe, unilateral periorbital pain, which typically lasts from 30 to 90 minutes.
The headache is accompanied by autonomic features such as ipsilateral tearing, nasal congestion, and conjunctival injection.
Subcutaneous injection of sumatriptan or inhalation of 100% oxygen may be beneficial in halting acute attacks.
Which of the statements given above are correct?
(a) 3 and 4 only
(b) 1 and 2 only
(c) 1, 2, and 3
(d) 1, 2, 3, and 4

Answer: (d) 1, 2, 3, and 4
Explanation: Cluster headaches are periodic, severe, unilateral periorbital pain episodes lasting 30–90 minutes, accompanied by autonomic symptoms like tearing and nasal congestion. Subcutaneous Sumatriptan and 100% oxygen are effective acute treatments.

Question 39: Chronic Daily Headache Diagnosis

A 22-year-old lady presented with a complaint of chronic daily headache. She has a prior history of migraine, but it has become increasingly unrelieved with analgesics. Summary of using Sumatriptan almost daily for the last three weeks. What is the most likely diagnosis?
(a) Sub-arachnoid hemorrhage
(b) Cluster headache
(c) Medication overuse headache
(d) Trigeminal neuralgia

Answer: (c) Medication overuse headache
Explanation: Chronic daily headache in a patient with a history of migraine and frequent sumatriptan use suggests medication overuse headache, caused by excessive use of acute headache medications. The other conditions do not fit the clinical pattern described.

Question 40: Seizure Trigger Factors

Consider the following about trigger factors for seizures:

Flickering lights
Recreational drug misuse
Non-compliance with treatment with antiepileptic drugs
Sleep deprivation
Which of the factors given above are correct?
(a) 1 and 2 only
(b) 1, 2, 3, and 4
(c) 2 and 3 only
(d) 3 and 4 only

Answer: (b) 1, 2, 3, and 4
Explanation: Seizures can be triggered by flickering lights (photosensitive epilepsy), recreational drug misuse, non-compliance with antiepileptic drugs, and sleep deprivation, all of which lower the seizure threshold.

Question 41: Temporal Headache Diagnosis

A 75-year-old man presented with temporal headache and jaw pain exacerbated by chewing and talking. Which one of the following investigations will most likely help in diagnosis?
(a) Temporal artery biopsy
(b) Electromyography
(c) MRI of the brain
(d) Carotid colour Doppler

Answer: (a) Temporal artery biopsy
Explanation: Temporal headache and jaw claudication suggest giant cell arteritis (temporal arteritis). Temporal artery biopsy is the gold standard for diagnosis, confirming vasculitis. The other investigations are less specific to this condition.

Question 42: Rai and Binet Staging Systems

The Rai staging system and Binet staging system are the two widely used staging systems for staging which of the following hematological malignancies?
(a) Acute Myeloid Leukemia
(b) Chronic Myeloid Leukemia
(c) Acute Lymphoid Leukemia
(d) Chronic Lymphocytic Leukemia

Answer: (d) Chronic Lymphocytic Leukemia
Explanation: The Rai and Binet staging systems are used for chronic lymphocytic leukemia (CLL) to assess disease burden and prognosis based on lymphocyte count and organ involvement. They are not used for other types of leukemia.

Question 43: T-Cell Lymphoma Diagnosis

Patients suffering from which of the following conditions commonly present for several years in the dermatology OPD with eczematous or dermatitis skin lesions before being finally diagnosed with a T-cell lymphoma?
(a) Mycosis fungoides
(b) Psoriasis
(c) Acne vulgaris
(d) Onychomycosis

Answer: (a) Mycosis fungoides
Explanation: Mycosis fungoides, a cutaneous T-cell lymphoma, often presents with chronic eczematous or dermatitis-like skin lesions, delaying diagnosis. Psoriasis, acne, and onychomycosis are not lymphomas.

Question 44: Oral Anticoagulant

Which of the following is an oral anticoagulant?
(a) Dabigatran
(b) Heparin
(c) Fondaparinux
(d) Bivalirudin

Answer: (a) Dabigatran
Explanation: Dabigatran is an oral direct thrombin inhibitor used as an anticoagulant. Heparin, fondaparinux, and bivalirudin are parenteral anticoagulants.

Question 45: Autoimmune Hemolytic Anemia Management

A 39-year-old female presents with severe autoimmune hemolytic anemia. Which of the following should be the initial step in its management?
(a) Prednisolone
(b) Rituximab
(c) Emergency splenectomy
(d) Plasmapheresis

Answer: (a) Prednisolone
Explanation: Corticosteroids like prednisolone are the initial treatment for autoimmune hemolytic anemia to suppress the immune response. Rituximab, splenectomy, or plasmapheresis are considered if steroids fail.

Question 46: Secondary Hyperaldosteronism Cause

Which one of the following is a cause of Secondary Hyperaldosteronism?
(a) Adrenal adenoma secreting aldosterone
(b) Idiopathic bilateral adrenal hyperplasia
(c) 11-deoxycorticosterone-secreting adrenal tumour
(d) Inadequate renal perfusion due to renal artery stenosis

Answer: (d) Inadequate renal perfusion due to renal artery stenosis
Explanation: Secondary hyperaldosteronism is caused by conditions increasing renin production, such as renal artery stenosis, which reduces renal perfusion. The other options cause primary hyperaldosteronism.

Question 47: Thyroid Lymphoma Risk

Which one of the following diseases is characterized by destructive lymphoid infiltration of the thyroid gland, leading to fibrosis and enlargement of the thyroid gland with an increased risk of developing thyroid lymphoma?
(a) de Quervain’s Thyroiditis
(b) Multinodular Goitre
(c) Riedel’s thyroiditis
(d) Hashimoto’s thyroiditis

Answer: (c) Riedel’s thyroiditis
Explanation: Riedel’s thyroiditis involves fibrotic and lymphocytic infiltration of the thyroid, leading to a stern, enlarged gland and an increased risk of thyroid lymphoma. Hashimoto’s thyroiditis is also lymphocytic but less commonly associated with lymphoma.

Question 48: Antihypertensives to Avoid in Hypoglycemia

A 52-year-old male diabetic presents with recurrent episodes of hypoglycemia. On examination, Pulse: 84 beats/minute, BP: 160/100 mm Hg, Chest and CVS examination unremarkable. Which of the following antihypertensives should be avoided in this patient?
(a) Propranolol
(b) Telmisartan
(c) Torsemide
(d) Amlodipine

Answer: (a) Propranolol
Explanation: Propranolol, a non-selective beta-blocker, can mask hypoglycemia symptoms and impair glycogenolysis, worsening hypoglycemic episodes in people with diabetes. The other antihypertensives are safer in this context.

Question 49: Cortisol Characteristics

Which of the following are correct regarding Cortisol?

Levels are highest in the morning on waking.
Cortisol falls dramatically during an illness.
More than 95% circulating Cortisol is protein-bound.
It is the principal glucocorticoid in humans and can also activate mineralocorticoid receptors.
Select the answer using the code given below:
(a) 1, 3, and 4
(b) 2, 3, and 4
(c) 1 and 3 only
(d) 1 and 2 only

Answer: (a) 1, 3, and 4
Explanation: Cortisol peaks in the morning, is protein-bound primarily, and acts as the primary glucocorticoid with some mineralocorticoid activity. During illness, cortisol levels typically rise, not fall, making statement 2 incorrect.

Question 50: Discriminatory Test for Hyperparathyroidism

A patient presents with a history of ‘bones, stones and abdominal groans’ – due to generalised aches and pains and renal calculus colic. Which is the most discriminatory blood investigation?
(a) Parathyroid hormone assay
(b) Thyroid function tests (free T3, free T4, TSH)
(c) Cortisol levels
(d) Insulin and C-peptide levels

Answer: (a) Parathyroid hormone assay
Explanation: The symptoms of bones (bone pain), stones (renal calculi), and abdominal groans suggest hyperparathyroidism. A parathyroid hormone (PTH) assay is the most discriminatory test to confirm elevated PTH levels. The other tests are not specific to this condition.

Question 51: Thyrotoxicosis Treatment in Graves’ Disease

About the treatment of thyrotoxicosis of Graves’ disease, consider the following statements:

Propylthiouracil is suitable for breastfeeding patients.
A large goitre is an indication for thyroidectomy.
Radioiodine is recommended for management in pregnancy.
Agranulocytosis is a complication associated with carbimazole.
Which of the statements given above are correct?
(a) 1, 2, and 3
(b) 2, 3, and 4
(c) 1, 2, and 4
(d) 1, 3, and 4

Answer: (c) 1, 2, and 4
Explanation: Propylthiouracil is safe in breastfeeding; large goitre may require thyroidectomy, and agranulocytosis is a known side effect of carbimazole. Radioiodine is contraindicated in pregnancy due to fetal risks, making statement 3 incorrect.

Question 52: Hypothyroidism Management

About management of hypothyroidism, consider the following statements:

Treatment is with levothyroxine replacement.
It is taken as a single daily dose.
Average dose is 1.6 µg/kg/day.
The full dose per weight should be started in those with coronary artery disease.
Which of the statements given above are correct?
(a) 1, 2, and 3
(b) 2, 3, and 4
(c) 1, 2, and 4
(d) 1, 3, and 4

Answer: (a) 1, 2, and 3
Explanation: Hypothyroidism is treated with levothyroxine, taken as a single daily dose, with an average dose of 1.6 µg/kg/day. In patients with coronary artery disease, a lower starting dose is used to avoid cardiac stress, making statement 4 incorrect.

Question 53: Injectable Glucose-Lowering Agent

Which of the following glucose-lowering agents can be given as an injectable drug?
(a) Pioglitazone
(b) Metformin
(c) Sitagliptin
(d) Semaglutide

Answer: (d) Semaglutide
Explanation: Semaglutide is a GLP-1 receptor agonist administered as an injectable for diabetes management. Pioglitazone, metformin, and sitagliptin are oral medications.

Question 54: Diabetic Retinopathy Findings

Which of the following findings are seen in Diabetic Retinopathy on fundus examination?

Microaneurysm
Dot and blot hemorrhage
Retinal thickening
Neovascularization
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

Answer: (b) 1, 2, and 4
Explanation: Diabetic retinopathy is characterized by microaneurysms, dot and blot hemorrhages, and neovascularization in advanced stages. Retinal thickening (edema) is a clinical finding but not typically described on fundus examination alone.

Question 55: Heme Biosynthesis Disorders

Which one of the following disorders is caused by an enzymatic defect in the heme biosynthesis pathway?
(a) Porphyrias
(b) Myelodysplastic syndrome
(c) Hemophilia
(d) Plasma cell disorders

Answer: (a) Porphyrias
Explanation: Porphyrias are caused by enzymatic defects in the heme biosynthesis pathway, leading to porphyrin accumulation. The other conditions involve different pathophysiological mechanisms.

Question 56: Intestinal Cholesterol Absorption Inhibitor

Which of the following is an inhibitor of the intestinal mucosal transporter NPC1L1, responsible for the absorption of dietary and biliary cholesterol?
(a) Atorvastatin
(b) Fenofibrate
(c) Metformin
(d) Ezetimibe

Answer: (d) Ezetimibe
Explanation: Ezetimibe inhibits NPC1L1, reducing cholesterol absorption in the intestine. Atorvastatin and fenofibrate affect cholesterol synthesis and metabolism, respectively, while metformin is a diabetes medication.

Question 57: Severe Hypercalcemia Treatment

Which one of the following is the most appropriate initial treatment for management of severe hypercalcemia?
(a) Intravenous infusion of pamidronate
(b) Oral phosphate supplementation
(c) Intravenous infusion of normal saline
(d) Hemodialysis

Answer: (c) Intravenous infusion of normal saline
Explanation: Intravenous normal saline is the initial treatment for severe hypercalcemia to restore hydration and promote urinary calcium excretion. Pamidronate and hemodialysis are used later if needed, and oral phosphate is not standard initial therapy.

Question 58: Serum Osmolality Calculation

Which of the following are used in calculating the serum osmolality?

Serum sodium
Glucose
Calcium
Blood urea nitrogen
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

Answer: (b) 1, 2, and 4
Explanation: Serum osmolality is calculated using the formula: 2 × [Na⁺] + [Glucose18 + [BUN]/2.8. Sodium, glucose, and blood urea nitrogen contribute significantly, while calcium is not typically included.

Question 59: Slapped Cheek Rash

A ‘slapped cheek’ rash is characteristically seen in which of the following infections?
(a) Measles
(b) Rubella
(c) Chickenpox
(d) Erythema infectiosum

Answer: (d) Erythema infectiosum
Explanation: Erythema infectiosum, caused by parvovirus B19, is characterized by a slapped cheek rash, especially in children. Measles, rubella, and chickenpox have different rash patterns.

Question 60: Visceral Leishmaniasis Treatment

Which of the following pharmacological agents can be used for the treatment of visceral Leishmaniasis?

Pentavalent antimonials
Amphotericin B
Spiramycin
Paromomycin
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

Answer: (b) 1, 2, and 4
Explanation: Pentavalent antimonials, amphotericin B, and paromomycin are effective treatments for visceral Leishmaniasis. Spiramycin is used for other infections, like toxoplasmosis.

Question 61: Sabin-Feldman Dye Test

The Sabin-Feldman dye test is an indirect fluorescent antibody test that is used to detect antibodies against which of the following organisms?
(a) Toxoplasma gondii
(b) Leishmania donovani
(c) Coxiella burnetii
(d) Trypanosoma cruzi

Answer: (a) Toxoplasma gondii
Explanation: The Sabin-Feldman dye test detects antibodies against Toxoplasma gondii, aiding in the diagnosis of toxoplasmosis. It is not used for the other organisms listed.

Question 62: Cat-Scratch Disease

Cat-scratch disease is caused by infection of which of the following organisms?
(a) Chlamydia trachomatis
(b) Coxiella burnetii
(c) Trypanosoma cruzi
(d) Bartonella henselae

Answer: (d) Bartonella henselae
Explanation: Cat-scratch disease is caused by Bartonella henselae, typically transmitted via cat scratches or bites. The other organisms cause different diseases.

Question 63: Clonorchis sinensis Intermediate Host

Which among the following is the first intermediate host for the parasitic fluke Clonorchis sinensis?
(a) Dog
(b) Snail
(c) Encysts on vegetation
(d) Sheep

Answer: (b) Snail
Explanation: Clonorchis sinensis, a liver fluke, uses snails as its first intermediate host, where the parasite undergoes initial development before infecting fish, the second intermediate host.

Question 64: Calabar Swelling

A calabar swelling, which is a short-lived, inflammatory, oedematous swelling close to a limb joint, is characteristically seen in infection caused by which of the following nematodes?
(a) Onchocerca volvulus
(b) Mansonella perstans
(c) Loa loa
(d) Brugia malayi

Answer: (c) Loa loa
Explanation: Calabar swellings are characteristic of Loa loa infection (loiasis), caused by transient subcutaneous migrations of the filarial worm, often near joints.

Question 65: Snowflake Corneal Deposits

An ophthalmologist may observe ‘Snowflake’ deposits on the edges of the cornea in a patient infected with which of the following filarial worms?
(a) Brugia malayi
(b) Loa loa
(c) Mansonella perstans
(d) Onchocerca volvulus

Answer: (d) Onchocerca volvulus
Explanation: Onchocerca volvulus, causing onchocerciasis, is associated with snowflake corneal opacities due to microfilarial infiltration, a hallmark of ocular involvement.

Question 66: Hepatobiliary Flukes

Which among the following are hepatobiliary flukes (trematodes)?

Clonorchis sinensis
Mansonella perstans
Fasciola hepatica
Opisthorchis felineus
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

Answer: (c) 1, 3, and 4
Explanation: Clonorchis sinensis, Fasciola hepatica, and Opisthorchis felineus are hepatobiliary flukes affecting the liver and bile ducts. Mansonella perstans is a filarial nematode, not a fluke.

Question 67: Zoonotic Nematode

Which among the following parasitic helminths is a nematode and has zoonotic transmission?
(a) Taenia saginata
(b) Trichinella spiralis
(c) Fasciola hepatica
(d) Fasciolopsis buski

Answer: (b) Trichinella spiralis
Explanation: Trichinella spiralis is a nematode with zoonotic transmission, typically via undercooked pork. The others are either cestodes (Taenia) or trematodes (Fasciola, Fasciolopsis).

Question 68: BCG Vaccination

Which of the following are correct about BCG vaccination?

It is a live-attenuated vaccine.
It is administered by intramuscular injection.
It is derived from Mycobacterium bovis.
It is highly immunogenic.
Select the answer using the code given below:
(a) 1, 2, and 3
(b) 2, 3, and 4
(c) 1, 3, and 4
(d) 1, 2, and 4

Answer: (c) 1, 3, and 4
Explanation: BCG is a live-attenuated vaccine derived from Mycobacterium bovis and is immunogenic, though efficacy varies. It is administered intradermally, not intramuscularly, making statement 2 incorrect.

Question 69: Immunizations for HIV Patients

Which of the following immunizations are recommended for persons infected with HIV?

Hepatitis B vaccine
Influenza virus vaccine
Pneumococcal vaccine
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

Answer: (d) 1, 2, and 3
Explanation: HIV-infected individuals are recommended to receive hepatitis B, influenza, and pneumococcal vaccines to prevent infections, given their immunocompromised state.

Question 70: Vitamin D Deficiency

Consider the following statements about Vitamin D deficiency:

Vitamin D deficiency is common in northern latitudes.
Vitamin D deficiency is more likely to develop in people with dark skin.
Exposure to UV light is advisable in patients with Vitamin D deficiency.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2, and 3

Answer: (d) 1, 2, and 3
Explanation: Vitamin D deficiency is common in northern latitudes (less sunlight), more likely in dark-skinned individuals (less UV absorption), and treatable with UV light exposure to stimulate vitamin D synthesis.

Question 71: Purpura Fulminans

Which one of the following statements is characteristic of Purpura fulminans?
(a) Non-hemorrhagic bullae usually present over the extremities.
(b) Present as extensive ecchymosis with irregular shapes.
(c) Autoimmune disorder, which is never associated with any infection.
(d) Asplenic patients are protected and do not develop this disease.

Answer: (b) Present as extensive ecchymosis with irregular shapes.
Explanation: Purpura fulminans presents as large, irregular ecchymoses due to widespread thrombosis and hemorrhage, often associated with infections like meningococcemia. It is not an autoimmune disorder, and asplenic patients are at higher risk.

Question 72: Papular Lesions on Face

An elderly male presents with papular lesions on his face. The papules have a pearly telangiectatic border on sun-damaged skin. The likely diagnosis is:
(a) Squamous cell carcinoma
(b) Melanoma
(c) Basal cell carcinoma
(d) Actinic keratosis

Answer: (c) Basal cell carcinoma
Explanation: Pearly papules with telangiectatic borders on sun-damaged skin are characteristic of basal cell carcinoma, a common skin cancer in sun-exposed areas. The other conditions have different appearances.

Question 73: Allergic Contact Dermatitis

Allergic contact dermatitis is a manifestation of:
(a) Type 1 hypersensitivity
(b) Type 2 hypersensitivity
(c) Type 3 hypersensitivity
(d) Type 4 hypersensitivity

Answer: (d) Type 4 hypersensitivity
Explanation: Allergic contact dermatitis is a type 4 (delayed-type) hypersensitivity reaction mediated by T-cells, triggered by allergens like nickel or poison ivy.

Question 74: Non-Scarring Alopecia

Which one of the following is an example of non-scarring alopecia?
(a) Linear scleroderma
(b) Cutaneous metastases
(c) Telogen effluvium
(d) Sarcoidosis

Answer: (c) Telogen effluvium
Explanation: Telogen effluvium is a non-scarring alopecia caused by stress or hormonal changes, leading to temporary hair shedding. The other conditions can cause scarring alopecia.

Question 75: Scabies Statements

Which of the following statements are correct with respect to scabies?

Male mite Sarcoptes scabiei are commonly transferred from an infected person to a non-infected person.
Norwegian scabies occurs in immunodeficient patients.
Permethrin cream (5%) is used for treatment.
Pruritus intensifies at night and after a hot shower.
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

Answer: (d) 2, 3, and 4
Explanation: Norwegian (crusted) scabies occurs in immunodeficient patients, and permethrin 5% cream is a standard treatment. Pruritus worsens at night or after hot showers. Female mites, not male, are primarily responsible for transmission.

Question 76: Heberden’s Nodes

Heberden’s nodes are present mainly in:
(a) Rheumatoid arthritis
(b) Osteoarthritis
(c) Psoriatic arthritis
(d) Gouty arthritis

Answer: (b) Osteoarthritis
Explanation: Heberden’s nodes are bony swellings at the distal interphalangeal joints, characteristic of osteoarthritis. They are not typical in rheumatoid, psoriatic, or gouty arthritis.

Question 77: Drug-Induced Muscle Weakness

A patient developed difficulty in standing from a seated position, walking up steps, squatting, and lifting arms overhead. Chronic therapy with which of the following drugs is likely to result in such a presentation?
(a) Acetaminophen
(b) Fexofenadine
(c) Glucocorticoids
(d) Metformin

Answer: (c) Glucocorticoids
Explanation: Chronic glucocorticoid use can cause steroid myopathy, leading to proximal muscle weakness affecting activities like standing, climbing stairs, and lifting arms. The other drugs do not typically cause this.

Question 78: Hemorrhagic Cystitis

Hemorrhagic cystitis is a profound side effect of:
(a) Leflunomide
(b) Mycophenolate mofetil
(c) Cyclophosphamide
(d) Methotrexate

Answer: (c) Cyclophosphamide
Explanation: Cyclophosphamide, a chemotherapeutic agent, can cause hemorrhagic cystitis due to its metabolite acrolein irritating the bladder mucosa. The other drugs are less commonly associated with this side effect.

Question 79: Schober’s Test

Schober’s test is used in the assessment of which one of the following clinical conditions?
(a) Rheumatoid arthritis
(b) Systemic Lupus Erythematosus
(c) Ankylosing Spondylitis
(d) Psoriasis

Answer: (c) Ankylosing Spondylitis
Explanation: Schober’s test measures lumbar spine flexibility and is used to assess ankylosing spondylitis, which causes spinal stiffness. It is not specific to the other conditions listed.

Question 80: Urate Crystals Shape

Urate crystals are described as having the following shape:
(a) Short and stout
(b) Long and needle-like
(c) Small and triangular
(d) Large and rhomboid

Answer: (b) Long and needle-like
Explanation: Urate crystals, seen in gout, are long, needle-like, and negatively birefringent under polarized microscopy. This distinguishes them from other crystal shapes.

Question 81: Anti-Citrullinated Peptide Antibody

Anti-citrullinated peptide antibody is helpful in the diagnosis of:
(a) Rheumatoid arthritis
(b) Sjogren’s syndrome
(c) Scleroderma
(d) Systemic Lupus Erythematosus

Answer: (a) Rheumatoid arthritis
Explanation: Anti-citrullinated peptide antibodies (ACPA) are specific to rheumatoid arthritis, aiding in its diagnosis. They are not typically associated with the other conditions.

Question 82: Drug-Induced Lupus Antibody

Which one of the following antibodies is commonly associated with Drug-induced Lupus?
(a) Anti-centromere antibody
(b) Anti-Jo-1 antibody
(c) Anti-histone antibody
(d) Anti-RNP antibody

Answer: (c) Anti-histone antibody
Explanation: Anti-histone antibodies are strongly associated with drug-induced lupus, often caused by drugs like hydralazine or procainamide. The other antibodies are linked to other autoimmune diseases.

Question 83: Lithium Adverse Effects

Long-term treatment of bipolar disorder with lithium carbonate can cause which of the following adverse effects?

Weight loss
Hypothyroidism
Increased levels of parathyroid hormone
Nephrogenic diabetes insipidus
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

Answer: (d) 2, 3, and 4
Explanation: Lithium can cause hypothyroidism, increased parathyroid hormone levels (leading to hypercalcemia), and nephrogenic diabetes insipidus. Weight gain, not weight loss, is a common side effect.

Question 84: Monoamine Oxidase Inhibitors

Which of the following antidepressant drugs acts by inhibition of monoamine oxidase?

Phenelzine
Tranylcypromine
Dosulepin
Moclobemide
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

Answer: (b) 1, 2, and 4
Explanation: Phenelzine, tranylcypromine, and moclobemide are monoamine oxidase inhibitors (MAOIs) used as antidepressants. Dosulepin is a tricyclic antidepressant, not an MAOI.

Question 85: Selective Serotonin Reuptake Inhibitors

Which of the following are selective serotonin reuptake inhibitors?

Escitalopram
Amitriptyline
Fluoxetine
Sertraline
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

Answer: (c) 1, 3, and 4
Explanation: Escitalopram, fluoxetine, and sertraline are selective serotonin reuptake inhibitors (SSRIs). Amitriptyline is a tricyclic antidepressant with broader neurotransmitter effects.

Question 86: First Rank Symptoms of Schizophrenia

Which of the following are First Rank Symptoms of acute schizophrenia?

Auditory hallucinations
Broadcasting of thoughts
Delusional perceptions
Delirium
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

Answer: (a) 1, 2, and 3
Explanation: First Rank Symptoms of schizophrenia, per Schneider, include auditory hallucinations, thought broadcasting, and delusional perceptions. Delirium is not a feature of schizophrenia.

Question 87: Wernicke-Korsakoff Syndrome

Consider the following statements regarding Wernicke-Korsakoff syndrome:

It is a rare complication of chronic alcohol misuse characterized by ophthalmoplegia, ataxia, and delirium.
There is damage to the mammillary bodies and dorsomedial nuclei of the thalamus.
The underlying cause is a deficiency of Vitamin B12 (Cobalamin).
The syndrome can also arise due to malabsorption or protracted vomiting.
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

Answer: (b) 1, 2, and 4
Explanation: Wernicke-Korsakoff syndrome, caused by thiamine (Vitamin B1) deficiency, often from chronic alcohol misuse, involves ophthalmoplegia, ataxia, and delirium, with damage to mammillary bodies and thalamic nuclei. It can also result from malabsorption or vomiting. Vitamin B12 deficiency causes different neurological issues.

Question 88: Inherited Causes of Dementia

Which of the following are inherited causes of dementia?

Alzheimer’s disease
Huntington’s disease
Wilson’s disease
Punch-drunk syndrome
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

Answer: (a) 1, 2, and 3
Explanation: Alzheimer’s disease (familial forms), Huntington’s disease, and Wilson’s disease have genetic bases and can cause dementia. Punch-drunk syndrome (chronic traumatic encephalopathy) is acquired, not inherited.

Question 89: Mood-Stabilizing Drugs

Which of the following are classified as mood-stabilizing psychotropic drugs?

Lithium
Valproate
Lamotrigine
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

Answer: (d) 1, 2, and 3
Explanation: Lithium, valproate, and lamotrigine are established mood stabilizers used in bipolar disorder to prevent mood swings.

Question 90: Acetaminophen Characteristics

Which of the following are correct regarding acetaminophen?

It does not interfere with platelet function.
It is toxic to the liver in high doses.
It is a non-narcotic analgesic.
Select the 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

Answer: (d) 1, 2, and 3
Explanation: Acetaminophen does not affect platelet function, is hepatotoxic in high doses, and is a non-narcotic analgesic, making all statements correct.

Question 91: Acquired Systemic Amyloidosis

Which of the following are causes of acquired systemic amyloidosis?

Tuberculosis
Multiple myeloma
Untreated rheumatoid arthritis
Chronic osteomyelitis
Select the correct answer using the code given below:
(a) 2 and 3 only
(b) 1 and 4 only
(c) 2, 3, and 4 only
(d) 1, 2, 3, and 4

Answer: (d) 1, 2, 3, and 4
Explanation: Acquired systemic amyloidosis (AA amyloidosis) results from chronic inflammatory conditions like tuberculosis, rheumatoid arthritis, and chronic osteomyelitis, or from multiple myeloma (AL amyloidosis).

Question 92: Glucose Homeostasis

Which of the following statements are correct about glucose homeostasis?

Insulin level rises postprandially.
A significant portion of postprandial glucose is used by skeletal muscle.
The brain uses glucose in an insulin-dependent manner.
Glucagon is secreted during exercise.
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

Answer: (b) 1, 2, and 4
Explanation: Insulin rises after meals, skeletal muscle uses most postprandial glucose, and glucagon is secreted during exercise to mobilize glucose. The brain uses glucose in an insulin-independent manner, making statement 3 incorrect.

Question 93: Pancreatic Hormones

Consider the following pancreatic hormones:

Insulin
Islet amyloid polypeptide or amylin
Glucagon
Somatostatin
Which of the above is/are secreted by beta cells of the pancreatic islets?
(a) 1 only
(b) 2 and 3
(c) 1 and 2
(d) 1 and 4

Answer: (c) 1 and 2
Explanation: Beta cells in the pancreatic islets secrete insulin and amylin. Glucagon is secreted by alpha cells, and somatostatin by delta cells.

Question 94: Acute Respiratory Distress Syndrome

Consider the following statements regarding Acute Respiratory Distress Syndrome (ARDS):

Exudative phase lasts from day 7 to day 21 after exposure to a precipitating risk factor.
The proliferation of type II pneumocytes characterizes the proliferative phase.
Low tidal volume ventilation (6 mL/kg body weight) has significantly lower mortality in management as compared to high tidal volume ventilation (12 mL/kg body weight).
PaO₂/FiO₂ ≤ 100 mm Hg is classified as severe ARDS.
Which of the statements given above are correct?
(a) 1, 2, and 3
(b) 2, 3, and 4
(c) 1, 3, and 4
(d) 1, 2, and 4

Answer: (b) 2, 3, and 4
Explanation: The proliferative phase of ARDS involves type II pneumocyte proliferation, low tidal volume ventilation reduces mortality, and PaO₂/FiO₂ ≤ 100 mm Hg defines severe ARDS. The exudative phase occurs earlier (days 1–7), making statement 1 incorrect.

Question 95: Organophosphate-Induced Delayed Polyneuropathy

Consider the following statements regarding organophosphate-induced delayed polyneuropathy (OPIDN):

It is a rare complication and occurs 2–3 weeks after acute exposure.
It is a feature of poisoning with certain organophosphorus compounds such as triorthocresyl phosphate.
Inhibition of acetylcholinesterase causes motor polyneuropathy with no evidence of sensory loss.
There is no specific therapy, although regular physiotherapy may limit deformity caused by muscle wasting.
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 1, 2, and 3
(c) 1, 2, and 4
(d) 2, 3, and 4

Answer: (c) 1, 2, and 4
Explanation: OPIDN is a rare delayed neuropathy occurring 2–3 weeks after exposure to certain organophosphates like triorthocresyl phosphate. There is no specific therapy, but physiotherapy can be helpful. It involves inhibition of neuropathy target esterase, not acetylcholinesterase, and includes sensory loss, making statement 3 incorrect.

Question 96: Paracetamol Toxicity

Consider the following statements regarding paracetamol toxicity:

Toxicity is caused by an intermediate reactive metabolite that binds covalently to cellular proteins, causing cell death.
Antidotes for paracetamol act by replenishing hepatic glutathione and should be administered to all patients with acute poisoning.
Intravenous acetylcysteine is a highly efficacious antidote if administered within 8 hours of the overdose.
Methionine may be used as an alternative antidote, but it is less effective than acetylcysteine.
Which of the statements given above are correct?
(a) 1 and 4 only
(b) 1, 2, and 3 only
(c) 2, 3, and 4 only
(d) 1, 2, 3, and 4

Answer: (d) 1, 2, 3, and 4
Explanation: Paracetamol toxicity results from a reactive metabolite (NAPQI), causing liver damage. Acetylcysteine and methionine replenish glutathione, with acetylcysteine being more effective if given within 8 hours. Antidotes are used based on toxicity risk, not universally for all cases.

Question 97: Breastfeeding Physiology

Which one of the following statements is correct regarding the physiology of breastfeeding?
(a) Prolactin is responsible for the ejection of milk from the glands.
(b) Night feeding is essential for maintaining the prolactin reflex.
(c) Oxytocin is responsible for milk secretion by the alveolar epithelial cells.
(d) The anterior pituitary secretes oxytocin.

Answer: (b) Night feeding is essential for maintaining the prolactin reflex.
Explanation: Night feeding stimulates prolactin release, supporting milk production. Oxytocin, not prolactin, causes milk ejection (let-down reflex), and the posterior pituitary secretes oxytocin. Milk secretion is driven by prolactin, not oxytocin.

Question 98: Fine Motor Milestones

Which one of the following fine motor milestones will appear ahead of the others?
(a) Copies a cross
(b) Copies a circle
(c) Draws a circle
(d) Draws a cross

Answer: (c) Draws a circle
Explanation: Drawing a circle (around age 3) typically precedes copying a circle or cross (age 4) and drawing a cross (age 4–5) in fine motor development milestones.

Question 99: Hypertensive Emergency in Children

In case of a hypertensive emergency in a child, blood pressure should be reduced by up to:
(a) 10% over the first 8 hours
(b) 15% over the first 8 hours
(c) 10% in the first hour
(d) 15% in the first hour

Answer: (b) 15% over the first 8 hours
Explanation: In pediatric hypertensive emergencies, blood pressure should be reduced gradually by about 15% over the first 8 hours to avoid complications like cerebral ischemia.

Question 100: Fast Breathing in a 2-Year-Old

At what cut-off respiratory rate will you consider “fast breathing” in a 2-year-old child?
(a) ≥ 60 per minute
(b) ≥ 50 per minute
(c) ≥ 40 per minute
(d) ≥ 30 per minute

Answer: (c) ≥ 40 per minute
Explanation: For a 2-year-old, a respiratory rate ≥ 40 breaths per minute is considered fast breathing, per WHO criteria for assessing pneumonia.

Question 101: Hyperkalemia Management

Which of the following are used in the management of hyperkalemia?

10% calcium gluconate intravenously
Regular insulin and intravenous glucose
Nebulized ipratropium bromide
Intravenous sodium bicarbonate
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

Answer: (b) 1, 2, and 4
Explanation: Hyperkalemia is managed with calcium gluconate (stabilizes cardiac membranes), insulin with glucose (drives potassium into cells), and sodium bicarbonate (corrects acidosis and shifts potassium intracellularly). Ipratropium bromide is used for respiratory conditions, not hyperkalemia.

Question 102: Nebulized Salbutamol

Nebulized salbutamol is used in the management of which of the following electrolyte abnormalities?
(a) Hypernatremia
(b) Hyperkalemia
(c) Hyponatremia
(d) Hypomagnesemia

Answer: (b) Hyperkalemia
Explanation: Nebulized salbutamol, a beta-2 agonist, drives potassium into cells, aiding in the acute management of hyperkalemia. It is not used for other electrolyte abnormalities listed.

Question 103: Weekly Iron and Folic Acid Supplementation

Which of the following are correct regarding activities under the Weekly Iron and Folic Acid Supplementation (WIFS) programme?

Administration of supervised weekly iron-folic acid supplements of 100 mg elemental iron and 500 µg folic acid
Administration of supervised weekly iron-folic acid supplements of 60 mg elemental iron and 0.5 mg folic acid
Biannual deworming with albendazole
Annual deworming with albendazole
Select the answer using the code given below:
(a) 1 and 4
(b) 1 and 3
(c) 2 and 4
(d) 2 and 3

Answer: (b) 1 and 3
Explanation: The WIFS program involves weekly supplements of 100 mg elemental iron and 500 µg folic acid and biannual deworming with albendazole to address anemia and parasitic infections.

Question 104: IMNCI Return Indications

Under the Integrated Management of Neonatal and Childhood Illness, caretakers are advised to return immediately to a health facility if:

Any sick child is not able to drink or breastfeed.
Fast breathing or difficult breathing in a child who has no pneumonia.
Blood in stool in a child with diarrhoea

4. Conjunctivitis in a child with measles

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

Answer: (a) 1, 2, and 3
Explanation: Under the Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines, caretakers are advised to return immediately to a health facility if a child cannot drink or breastfeed, has fast or difficult breathing (even without pneumonia), or has blood in stool with diarrhoea, as these are danger signs requiring urgent care. Conjunctivitis in measles is not a specific IMNCI danger sign for immediate return.

Question 105: Fluid Management in Pediatric Burn Injuries

Which of the following statements are correct regarding the fluid management of pediatric inpatients with burn injuries?

The Parkland formula estimates the amount of fluid to be replaced over 24 hours.
Volume of fluid (mL) = 4 mL × Weight (kg) × Total body surface area burn (%).
Additional maintenance fluid therapy is also to be given to the child.
Half of the resuscitation volume should be given over 6 hours, and the remaining half over the next 18 hours.
Select the answer using the code given below:
(a) 1, 2, and 4
(b) 1, 2, and 3
(c) 1, 3, and 4
(d) 2, 3, and 4

Answer: (b) 1, 2, and 3
Explanation: The Parkland formula calculates fluid requirements for burn patients as 4 mL × weight (kg) × % total body surface area burned, given over 24 hours. Maintenance fluids are also required in children to account for ongoing needs. However, half the resuscitation volume is typically given over the first 8 hours, not 6 hours, making statement 4 incorrect.

Question 106: Whole Bowel Irrigation

Whole Bowel Irrigation (WBI) as a method of gastrointestinal decontamination is beneficial for poisoning with:
(a) Alcohol
(b) Iron
(c) Kerosene
(d) Organophosphorus

Answer: (b) Iron
Explanation: Whole Bowel Irrigation is adequate for gastrointestinal decontamination in cases of iron poisoning, as it helps remove unabsorbed iron from the gut. It is not typically used for alcohol, kerosene, or organophosphorus poisoning, which require other management strategies.

Question 107: Folic Acid for Neural Tube Defect Prevention

To prevent recurrence, expectant mothers with a previous fetus with a neural tube defect should receive folic acid daily at the dose of:
(a) 4 µg
(b) 400 µg
(c) 4 mg
(d) 400 mg

Answer: (c) 4 mg
Explanation: Women with a history of a fetus with a neural tube defect are at higher risk and should receive 4 mg of folic acid daily before and during early pregnancy to prevent recurrence, significantly higher than the standard 400 µg dose.

Question 108: Non-Invasive Prenatal Screening

Consider the following statements regarding non-invasive prenatal screening (NIPS) for screening high-risk pregnancies for aneuploidies:

It is carried out on maternal blood.
It is done before 10 weeks of gestation.
It has a negative predictive value of about 98%.
Invasive testing is needed for confirmation of a positive test.
Which of the statements given above are correct?
(a) 1, 2, and 3
(b) 1, 2, and 4
(c) 1, 3, and 4
(d) 2, 3, and 4

Answer: (c) 1, 3, and 4
Explanation: Non-invasive prenatal screening (NIPS) analyzes cell-free fetal DNA in maternal blood, typically after 10 weeks of gestation, with a high negative predictive value (~98%). Positive results require confirmation with invasive testing (e.g., amniocentesis). Statement 2 is incorrect as NIPS is usually performed after 10 weeks.

Question 109: Down Syndrome Risk

The risk of Down syndrome is 100% in the offspring if:
(a) The mother is the carrier of a balanced translocation
(b) Father only is the carrier of a balanced translocation
(c) Both parents are carriers of a balanced translocation
(d) Either parent is a carrier of a translocation between chromosomes 21

Answer: (d) Either parent is a carrier of a translocation between chromosomes 21
Explanation: A balanced translocation involving two chromosome 21s (e.g., Robertsonian translocation) in either parent can result in a 100% risk of Down syndrome in offspring if the unbalanced translocation (trisomy 21) is inherited. Single-parent balanced translocations carry variable risks, and having both parents as carriers is less likely to result in a 100% risk.

Question 110: Genomic Imprinting

Which of the following are examples of genomic imprinting?

Angelman syndrome
Williams syndrome
Prader-Willi syndrome
DiGeorge syndrome
Select the correct answer using the code given below:
(a) 1 and 3
(b) 1 and 2
(c) 2 and 3
(d) 2 and 4

Answer: (a) 1 and 3
Explanation: Angelman syndrome and Prader-Willi syndrome are caused by genomic imprinting, where gene expression depends on the parent of origin (maternal deletion for Angelman, paternal for Prader-Willi). Williams and DiGeorge syndromes are due to microdeletions, not imprinting.

Question 111: Hypothermia-Causing Poison

Poisoning with which of the following drugs causes hypothermia?
(a) Digoxin
(b) Chlorpromazine
(c) Iron
(d) Alcohol

Answer: (b) Chlorpromazine
Explanation: Chlorpromazine, a phenothiazine antipsychotic, can cause hypothermia by impairing thermoregulation. Alcohol can also cause hypothermia, but chlorpromazine is the more specific answer among the options. Digoxin and iron do not typically cause hypothermia.

Question 112: Urine Color in Poisoning

Consider the following pairs:
Urine colour | Possible causative agent in a child with suspected poisoning

Pink | Cephalosporin
Brown | Chloroquine
Greenish blue | Phenazopyridine
Red-orange | Amitriptyline
How many of the pairs given above are correctly matched?
(a) Only one pair
(b) Only two pairs
(c) Only three pairs
(d) All four pairs

Answer: (b) Only two pairs
Explanation: Phenazopyridine causes greenish-blue urine, and chloroquine can cause brown urine, making pairs 2 and 3 correct. Cephalosporins do not typically cause pink urine, and amitriptyline is associated with green-blue urine, not red-orange, making pairs 1 and 4 incorrect.

Question 113: Cardiac Effects in Poisoning

Consider the following agents and the cardiac effects in case of overdose or poisoning:

Prolonged PR interval | Lithium
Prolonged QTc interval | Amiodarone
Wide QRS complex | Kerosene ingestion
Tachycardia | Organophosphates
How many of the pairs given above are correctly matched?
(a) Only one pair
(b) Only two pairs
(c) Only three pairs
(d) All four pairs

Answer: (c) Only three pairs
Explanation: Lithium can prolong the PR interval, Amiodarone prolongs the QTc interval, and organophosphates cause tachycardia due to cholinergic effects. Kerosene ingestion typically causes respiratory or neurological symptoms, not an expansive QRS complex, making pair three incorrect.

Question 114: Primary Apnea in Neonates

If a baby does not begin breathing in response to tactile stimulation, then the baby is assumed to be in:
(a) Primary apnea
(b) Secondary apnea
(c) Tertiary apnea
(d) Cardiorespiratory arrest

Answer: (b) Secondary apnea
Explanation: Primary apnea responds to tactile stimulation with spontaneous breathing. If a neonate does not respond, it is likely in secondary apnea, requiring more aggressive resuscitation measures. Tertiary apnea is not a recognized term, and cardiorespiratory arrest is a more severe condition.

Question 115: Primary Apnea Characteristics

Consider the following conditions:

	Response to tactile stimulation	Heart Rate	Blood Pressure	Tone
A	Yes	Normal	Normal	Normal
B	Yes	Falling	Normal	Decreasing
C	No	Falling	Falling	Decreasing
D	No	Rising	Normal	Normal
Primary apnea in a neonate is characterized by which one of the above conditions?
(a) A
(b) B
(c) C
(d) D

Answer: (b) B
Explanation: Primary apnea in neonates is characterized by a response to tactile stimulation, falling heart rate, normal blood pressure, and decreasing tone, as seen in condition B. Secondary apnea (C) does not respond to stimulation, and A and D do not fit the clinical picture.

Question 116: Human Breast Milk

Consider the following statements about human breast milk:

75% of breast milk content is water.
Breast milk is poor in taurine and cysteine.
Breast milk is particularly rich in omega-2 and omega-6 fatty acids.
The high lactose content of breast milk helps in the absorption of calcium.
Which of the statements given above are correct?
(a) 1, 3, and 4
(b) 1 and 4 only
(c) 1 and 3 only
(d) 3 and 4 only

Answer: (b) 1 and 4 only
Explanation: Breast milk is approximately 75% water, and its high lactose content aids calcium absorption. It is rich in taurine and cysteine, which are essential for infant development, making statement 2 incorrect. Omega fatty acids are present, but not specifically omega-2; statement 3 is misleading.

Question 117: Signs of Good Breastfeeding Attachment

Which of the following are signs of good attachment during breastfeeding?

The baby’s nose is at the level of the nipple.
The baby’s mouth is wide open.
The baby’s mouth touches the breast.
The baby’s lower lip is everted.
Select the correct answer using the code given below:
(a) 1, 2, and 3
(b) 2, 3, and 4
(c) 1, 3, and 4
(d) 1, 2, and 4

Answer: (b) 2, 3, and 4
Explanation: Good breastfeeding attachment includes a wide-open mouth, the mouth touching the breast (areola), and an everted lower lip. The baby’s nose should be close to but not at the level of the nipple, allowing breathing, making statement 1 incorrect.

Question 118: Developmental Quotient in Language

A 6-year-old boy has recently started telling his full name, although he cannot recite a poem. His Developmental Quotient (DQ) in the language sphere is:
(a) 33%
(b) 50%
(c) 66%
(d) 83%

Answer: (c) 66%
Explanation: Telling one’s full name is a language milestone typically achieved by age 4. A 6-year-old achieving this milestone has a developmental age of 4 years in the language sphere. DQ is calculated as (Developmental Age/Chronological Age) × 100 = (4/6) × 100 = 66%.

Question 119: Vaccination Statements

Consider the following statements:

The hepatitis B vaccine has reduced efficacy when administered intramuscularly.
The maximum time allowed between reconstitution of the MMR vaccine and use is 30 minutes.
Maternal antibodies do not interfere with the cellular immune response to the BCG vaccine.
DTwP is preferred to DTaP for primary immunization in most children.
Which of the statements given above are correct?
(a) 1 and 2
(b) 1 and 3
(c) 2 and 4
(d) 3 and 4

Answer: (d) 3 and 4
Explanation: Maternal antibodies do not significantly interfere with the cellular immune response to BCG, and DTwP is preferred over DTaP in many settings due to cost and efficacy. Hepatitis B vaccine is effective intramuscularly, and MMR vaccine can be used up to 4–6 hours after reconstitution, making statements 1 and 2 incorrect.

Question 120: Rotavirus Vaccination

Rotavirus vaccination is avoided during an episode of diarrhoea because:
(a) It might compromise the uptake of the vaccine
(b) It could trigger an episode of intussusception
(c) Rotavirus vaccine is a live vaccine and hence may cause rotavirus diarrhoea and worsen the diarrhoeal episode
(d) Vomiting is a significant adverse effect of the Rotavirus vaccine

Answer: (a) It might compromise the uptake of the vaccine
Explanation: Rotavirus vaccination, a live oral vaccine, may have reduced uptake during diarrhoea due to altered gut motility and absorption. While intussusception is a rare risk, it is not the primary reason to avoid vaccination during diarrhoea. The vaccine does not typically cause rotavirus diarrhoea or significant vomiting.

This complete guide to the CMS 2024 Paper I questions, answers, and explanations is designed to help medical professionals and students prepare effectively. By understanding these key concepts and their clinical applications, candidates can enhance their knowledge and performance in the examination. For further details on medical topics or exam preparation, explore trusted medical resources or consult with healthcare professionals.