Upsc Cms Previous Year Question Papers with Answers

Combined Medical Services Examination – General Medicine and Pediatrics Questions and Answers

This article provides a complete Upsc Cms Previous Year Question Papers with Answers from the Combined Medical Services (CMS) Examination, Paper-I (General Medicine and Pediatrics). Each question is followed by its multiple-choice options, the correct answer in bold, and a detailed yet simple explanation to help you understand the concepts. This SEO-optimized article is designed to rank well on Google by providing clear, accurate, and reader-friendly content for medical students, professionals, and exam aspirants.

Question 1: 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 observed in the internal jugular vein, which is directly connected to the right atrium via the superior vena cava. Changes in proper atrial pressure, such as those caused by heart failure or fluid overload, affect the height of the JVP. This makes it a key clinical sign in assessing cardiac function.

Question 2: 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). It generates electrical impulses that initiate heartbeats. Its anatomical position makes it critical for coordinating the heart’s rhythm.

Question 3: 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 amount of blood but cannot meet the body’s demands due to increased metabolic needs. Beri-beri (vitamin B1 deficiency) causes vasodilation, severe anaemia increases cardiac workload due to low oxygen-carrying capacity, and thyrotoxicosis increases metabolic demand, all leading to high output failure.

Question 4: 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. This is a key auscultatory finding in cardiac exams.

Question 5: 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 include carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. Polyarthralgia is a minor criterion, so the correct answer provides chorea, erythema marginatum, and subcutaneous nodules.

Question 6: 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: Aortic stenosis in older people typically presents with dyspnoea on exertion, a single second heart sound (due to a calcified aortic valve), and a diamond-shaped systolic murmur heard best at the right 2nd intercostal space, radiating to the carotid arteries. This distinguishes it from other conditions like patent ductus arteriosus or ventricular septal defect.

Question 7: 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 considers factors like age, sex, and comorbidities (e.g., hypertension, diabetes). HAS-BLED assesses bleeding risk, while CURB-65 is for pneumonia severity.

Question 8: 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 hallmark symptom of pulmonary embolism. If heart failure or pneumonia does not improve with treatment, occult pulmonary embolism should be suspected. However, patients with a 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: 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 met: 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. All three criteria are correct.

Question 10: 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 is a clinical sign involving symmetrical enlargement of the fingertips and sometimes toes, often associated with chronic lung diseases like lung cancer or cystic fibrosis. It can recede after lung transplantation in cystic fibrosis. However, clubbing can affect toes, so statement 2 is incorrect.

Question 11: 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 is characterized by fever, erythema nodosum, bilateral hilar lymphadenopathy, and arthritis (not uveitis). Statement 2 is incorrect as uveitis is not a typical feature of Lofgren syndrome.

Question 12: 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: Pulmonary tuberculosis is diagnosed using nucleic acid amplification tests (e.g., GeneXpert), culture in Middlebrook medium, and LED fluorescent microscopy with auramine staining for acid-fast bacilli. Peripheral blood smear is not used for TB diagnosis, making statement 4 incorrect.

Question 13: 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 chronic obstructive pulmonary disease (COPD) using four variables: Body Mass Index (B), Obstruction (O), Dyspnoea (D), and Exercise capacity (E)—the 6-minute walk test measures exercise capacity, making it the correct answer.

Question 14: 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. This is distinct from byssinosis (cotton dust), berylliosis (beryllium exposure), or siderosis (iron dust).

Question 15: 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 pleural effusion or ARDS), hyperglycemia (due to pancreatic beta cell damage), and reduced serum albumin (due to inflammation and protein loss). Hypercalcemia is not a typical complication; hypocalcemia is more common due to fat necrosis.

Question 16: 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: Celiac disease is diagnosed by endoscopic small bowel biopsy showing villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis. Serological tests (e.g., anti-tissue transglutaminase antibodies) support the diagnosis, but biopsy remains the gold standard.

Question 17: 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 (PPI) 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 by reducing gastritis.

Question 18: 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 is triggered by factors that increase ammonia levels or impair liver function. Hypokalemia increases ammonia production, septicemia causes systemic inflammation, and increased dietary protein load overwhelms the liver’s ability to detoxify ammonia.

Question 19: 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: H. pylori eradication significantly reduces rebleeding rates in peptic ulcer disease to less than 5%. Esophageal varices are not the most common cause of UGIB (peptic ulcers are). Aspirin should be restarted in cardiovascular patients after stabilizing UGIB. TIPS is used earlier in acute variceal bleeding, not after one week.

Question 20: 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 a rare autosomal recessive disorder caused by mutations in the UGT1A1 gene, leading to severe unconjugated hyperbilirubinemia due to deficient glucuronyl transferase activity.

Question 21: 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: Whipple’s disease, caused by Tropheryma whipplei, shows foamy macrophages in the small intestinal mucosa containing PAS-positive (Periodic acid Schiff) material due to bacterial glycoproteins. PAS staining is the characteristic diagnostic tool.

Question 22: 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: Poorly absorbed antibiotics like neomycin and rifaximin reduce gut bacteria that produce ammonia, a key trigger of hepatic encephalopathy. The other options are used for viral hepatitis or other infections, not hepatic encephalopathy.

Question 23: 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: (b) 1 and 2 only

Explanation: A SAAG < 1.1 gm/dL indicates non-portal hypertensive causes of ascites, such as infections (e.g., tuberculous peritonitis) and malignancy (e.g., peritoneal carcinomatosis). Cardiac ascites and portal hypertension typically cause a SAAG ≥ 1.1 gm/dL.

Question 24: A sigmoid configuration along with 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 “bird’s beak” or tapering appearance at the lower esophageal sphincter on barium swallow due to failure of the sphincter to relax. This is caused by degeneration of the myenteric plexus, leading to esophageal dilation and a sigmoid configuration.

Question 25: 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) on microscopy indicates glomerular bleeding (G), as seen in glomerulonephritis. Myoglobinuria is associated with rhabdomyolysis, and hemoglobinuria with intravascular hemolysis, but these do not match the given triplets.

Question 26: 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 in the 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 (GBM) autoimmune, 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 (not retina). When pulmonary hemorrhage occurs, it is called Goodpasture syndrome. Statement 3 is slightly misleading but generally accepted in this context.

Question 27: 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: In glomerular disease, poor prognostic indicators include hypertension, persistent severe proteinuria, and elevated creatinine levels, as these suggest ongoing kidney damage. Female sex is not a specific prognostic factor for glomerular disease.

Question 28: 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 identify the underlying glomerulopathy), and renal transplant dysfunction (to assess rejection or other pathology). Uncontrolled hypertension alone is not a direct indication for biopsy.

Question 29: 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 (CKD) is defined by a GFR of 60–89 mL/min/1.73 m² with evidence of kidney damage (e.g., proteinuria). Lower ranges correspond to more advanced stages of CKD.

Question 30: 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 two of three features: menstrual irregularity (oligo/anovulation), clinical or biochemical androgen excess, and polycystic ovaries on ultrasound. Low BMI (< 18.5 kg/m²) is not a diagnostic criterion.

Question 31: 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 show Gram-negative diplococci.

Question 32: 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 syndrome suggest immune complex-mediated glomerulonephritis. Systemic lupus erythematosus, post-infectious glomerulonephritis, infective endocarditis, and mesangio-capillary glomerulonephritis (MCGN) all cause low complement levels due to immune complex deposition.

Question 33: 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 or monotone voice), festinating gait (short, shuffling steps), and cogwheel rigidity (tremor with rigidity). All these features are hallmark signs of Parkinson’s disease or related disorders.

Question 34: 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, involving the basal ganglia, regulates muscle tone, posture, and movement. Lesions, as in Parkinson’s disease, cause tremor and rigidity. Seizures and urinary incontinence are more related to cortical or autonomic dysfunction, and muscle wasting suggests lower motor neuron issues.

Question 35: 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 behavior 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: Transient Global Amnesia (TGA) is a sudden, temporary loss of anterograde memory in middle-aged or older individuals, lasting a few hours, with repetitive questioning due to the inability to form new memories. Consciousness and motor functions are preserved, making statement 3 incorrect. After 4–6 hours, normal function resumes, but amnesia for the episode persists.

Question 36: 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 a lesion in the parietal lobe, affecting the superior optic radiations. Temporal lobe lesions cause superior quadrantanopia, and occipital lobe lesions cause complete homonymous hemianopia.

Question 37: 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: Right 3rd cranial nerve (oculomotor nerve) palsy results in unopposed action of the lateral rectus (6th nerve) and superior oblique (4th nerve), causing the eye to deviate downwards and outwards. This is due to paralysis of the medial rectus, superior rectus, inferior rectus, and inferior oblique muscles.

Question 38: 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, often occurring at the same Time daily for weeks. They cause severe, unilateral periorbital pain lasting 30–90 minutes, with autonomic features like tearing, nasal congestion, and conjunctival injection. Acute attacks are treated with subcutaneous Sumatriptan or 100% oxygen.

Question 39: A 22-year-old lady presented with complaints of chronic daily headache. She has a prior history of migraine, but it is increasingly unrelieved with analgesics. She has a history 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: Medication overuse headache occurs when frequent use of acute headache medications, like Sumatriptan (used daily for three weeks), leads to chronic daily headaches. This is common in migraine patients. Sub-arachnoid hemorrhage presents acutely, cluster headaches are episodic with autonomic features, and trigeminal neuralgia causes facial pain, not headaches.

Question 40: 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: Seizure triggers include flickering lights (in photosensitive epilepsy), recreational drug misuse (e.g., cocaine), non-compliance with antiepileptic drugs, and sleep deprivation, all of which lower the seizure threshold.

Question 41: 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 in an elderly patient suggest giant cell arteritis (temporal arteritis). Temporal artery biopsy is the gold standard for diagnosis, showing vasculitis with giant cells. Other tests, like MRI or Doppler, may be supportive but are not diagnostic.

Question 42: 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 based on lymphocytosis, lymphadenopathy, splenomegaly, and cytopenias. They are not used for other types of leukemia.

Question 43: 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 for years before diagnosis. Psoriasis, acne, and onychomycosis are distinct dermatological conditions without progression to lymphoma.

Question 44: 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 administered parenterally (injections), not orally.

Question 45: A 39-year-old female 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 autoimmunity: In severe autoimmune hemolytic anemia, corticosteroids like prednisolone are the first-line treatment to suppress the immune-mediated destruction of red blood cells. Rituximab, splenectomy, or plasmapheresis are considered in refractory cases.

Question 46: 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 that stimulate renin release, such as renal artery stenosis, which reduces renal perfusion and activates the renin-angiotensin-aldosterone system. Options a, b, and c cause primary hyperaldosteronism.

Question 47: 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 is a rare condition characterized by destructive lymphoid infiltration, extensive fibrosis, and thyroid enlargement, with an increased risk of thyroid lymphoma. Hashimoto’s thyroiditis also involves lymphoid infiltration but is more associated with hypothyroidism than lymphoma.

Question 48: 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 (e.g., tachycardia) and impair glycogenolysis, increasing the risk of severe hypoglycemia in diabetics. Other antihypertensives, such as telmisartan, torsemide, or amlodipine, are safer.

Question 49: 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 levels peak in the morning (diurnal variation), over 95% is protein-bound (to cortisol-binding globulin), and it is the primary glucocorticoid with some mineralocorticoid activity. Cortisol typically rises during illness due to stress, making statement 2 incorrect.

Question 50: A patient presents with a history of ‘bones, stones, and abdominal groans’ – due to generalized 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 triad of “bones, stones, and abdominal groans” suggests primary hyperparathyroidism, characterized by bone pain, kidney stones, and abdominal pain. A parathyroid hormone (PTH) assay, along with elevated calcium levels, is the most discriminatory test for diagnosis.

Question 51: 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 for 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: About the 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 once daily, with an average dose of 1.6 µg/kg/day. In patients with coronary artery disease, a low starting dose is used to avoid cardiac strain, making statement 4 incorrect.

Question 53: 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, a GLP-1 receptor agonist, is administered as a subcutaneous injection for type 2 diabetes management. Pioglitazone, metformin, and sitagliptin are oral medications.

Question 54: 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 shows microaneurysms (the earliest sign), dot and blot hemorrhages, and neovascularization (in proliferative retinopathy). Retinal thickening (edema) is a clinical feature but not a specific fundus finding in this context.

Question 55: Which one of the following disorders is caused by enzymatic defects in the heme biosynthesis pathway?

(a) Porphyrias
(b) Myelodysplastic syndrome
(c) Hemophilia
(d) Plasma cell disorders

Answer: (a) Porphyrias

Explanation: Porphyrias are a group of disorders caused by defects in the heme biosynthesis pathway, leading to the accumulation of porphyrins. Myelodysplastic syndromes, hemophilias, and plasma cell disorders have different etiologies.

Question 56: 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, a transporter in the intestinal mucosa, reducing cholesterol absorption. Atorvastatin and fenofibrate affect cholesterol synthesis and triglycerides, respectively, while metformin is a diabetes drug.

Question 57: Which one of the following is the most appropriate initial treatment for the 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: Severe hypercalcemia is initially treated with intravenous normal saline to restore hydration and promote urinary calcium excretion. Bisphosphonates like pamidronate are used later, and hemodialysis is reserved for refractory cases.

Question 58: 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⁺] + [Glucose]/18 + [BUN]/2.8. Sodium, Glucose, and blood urea nitrogen (BUN) are key contributors. Calcium is not included in the standard formula.

Question 59: 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 on the face, followed by a lacy rash on the body. Measles, rubella, and chickenpox have different rash patterns.

Question 60: 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: Visceral Leishmaniasis is treated with pentavalent antimonials (e.g., sodium stibogluconate), amphotericin B, and paromomycin. Spiramycin is used for toxoplasmosis, not Leishmaniasis.

Question 61: 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 is a specific serological test for detecting antibodies against Toxoplasma gondii, used in diagnosing toxoplasmosis.

Question 62: 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 through cat scratches or bites, leading to regional lymphadenopathy.

Question 63: 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, has freshwater snails as its first intermediate host, where the parasite undergoes initial development before infecting fish, the second intermediate host.

Question 64: 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 (African eye worm), caused by transient subcutaneous edema near joints due to the migration of adult worms.

Question 65: 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, the cause of river blindness, can lead to “snowflake” opacities in the cornea due to microfilarial death, a hallmark of ocular onchocerciasis.

Question 66: 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: Hepatobiliary flukes include Clonorchis sinensis, Fasciola hepatica, and Opisthorchis felineus, which infect the liver and bile ducts. Mansonella perstans is a filarial nematode, not a fluke.

Question 67: 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 acquired from eating undercooked pork containing larvae. Taenia saginata, Fasciola hepatica, and Fasciolopsis buski are not nematodes.

Question 68: 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 (Bacillus Calmette-Guérin) is a live-attenuated vaccine derived from Mycobacterium bovis and is highly immunogenic against severe forms of tuberculosis. It is administered intradermally, not intramuscularly, making statement 2 incorrect.

Question 69: 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 due to their immunocompromised state, provided their CD4 count is adequate for vaccine response.

Question 70: 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 due to limited sunlight exposure. Dark skin reduces vitamin D synthesis due to higher melanin levels. UV light exposure (e.g., sunlight) is a standard recommendation to correct the deficiency.

Question 71: 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 Autodisorderdisorder, 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 is characterized by large, irregular ecchymoses due to disseminated intravascular coagulation (DIC), often triggered by infections like meningitis. It is not an autoimmune disorder, and asplenic patients are at higher risk and not protected.

Question 72: 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: Basal cell carcinoma presents as pearly papules with telangiectasia, often on sun-exposed areas like the face. Squamous cell carcinoma is scaly, melanoma is pigmented, and actinic keratosis is precancerous with a rough texture.

Question 73: 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. Type 1 is immediate (e.g., anaphylaxis), type 2 is antibody-mediated, and type 3 involves immune complexes.

Question 74: 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, illness, or hormonal changes, leading to diffuse hair shedding without permanent follicle damage. Linear scleroderma, cutaneous metastases, and sarcoidosis cause scarring alopecia.

Question 75: 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: Scabies is caused by Sarcoptes scabiei, with female mites primarily responsible for transmission (not males). Norwegian (crusted) scabies occurs in immunodeficient patients. Permethrin 5% cream is a standard treatment, and pruritus worsens at night or after hot showers.

Question 76: 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 arthritis, psoriatic arthritis, or gout.

Question 77: 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-induced myopathy, leading to proximal muscle weakness affecting activities like standing, climbing stairs, or lifting arms. Other drugs listed do not typically cause myopathy.

Question 78: 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. Mesna is often used to prevent this side effect.

Question 79: 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, a condition causing spinal stiffness. It is not specific for rheumatoid arthritis, lupus, or psoriasis.

Question 80: 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 in gout are long, needle-like, and negatively birefringent under polarized light microscopy, distinguishing them from other crystal shapes.

Question 81: 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), such as anti-CCP, are highly specific for rheumatoid arthritis and aid in its diagnosis, especially in early disease.

Question 82: 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, caused by medications like hydralazine or procainamide. Other antiautoimmune antibodies are more linked to specific autoimmune diseases (e.g., anti-centromere in scleroderma).

Question 83: 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, hyperparathyroidism (increased parathyroid hormone), and nephrogenic diabetes insipidus. Weight gain, not weight loss, is a common side effect, making statement 1 incorrect.

Question 84: 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: 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) used for depression and anxiety. Amitriptyline is a tricyclic antidepressant.

Question 86: 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: Schneider’s First Rank Symptoms of schizophrenia include auditory hallucinations, thought broadcasting, and delusional perceptions. Delirium is a separate condition characterized by acute confusion, not a feature of schizophrenia.

Question 87: 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, is associated with chronic alcohol misuse, malabsorption, or vomiting. It presents with ophthalmoplegia, ataxia, and delirium (Wernicke’s encephalopathy), as well as memory deficits (Korsakoff’s syndrome). Damage occurs to the mammillary bodies and thalamus. Vitamin B12 deficiency causes other neurological issues, not this syndrome.

Question 88: 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 causes leading to dementia. Punch-drunk syndrome (chronic traumatic encephalopathy) is acquired due to repeated head trauma.

Question 89: 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 mood-stabilizing drugs used in bipolar disorder to prevent manic and depressive episodes.

Question 90: 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 is a non-narcotic analgesic that does not affect platelet function (unlike NSAIDs) and is hepatotoxic in high doses due to the accumulation of a toxic metabolite (NAPQI).

Question 91: 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) is caused by chronic inflammatory conditions like tuberculosis, rheumatoid arthritis, and chronic osteomyelitis, leading to amyloid A protein deposition. Multiple myeloma can cause AL amyloidosis due to the deposition of light chains.

Question 92: 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 to facilitate Glucose uptake, primarily by skeletal muscle. Glucagon is secreted during exercise to mobilize Glucose. The brain uses Glucose in an insulin-independent manner, making statement 3 incorrect.

Question 93: 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 islet amyloid polypeptide (amylin). Glucagon is secreted by alpha cells, and somatostatin by delta cells.

Question 94: 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 exudative phase of ARDS occurs in the first 7 days, not days 7–21, making statement 1 incorrect. The proliferative phase involves the proliferation of type II pneumocytes. Low tidal volume ventilation (6 mL/kg) reduces mortality, and PaO₂/FiO₂ ≤ 100 mm Hg defines severe ARDS.

Question 95: 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 complication occurring 2–3 weeks after exposure to certain organophosphates like triorthocresyl phosphate. It involves neuropathy with motor and sensory involvement, not just motor (statement 3 is incorrect). Physiotherapy helps manage deformities, but there is no specific therapy for this condition.

Question 96: 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 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 NAPQI, a reactive metabolite, causing liver cell death. Antidotes like acetylcysteine replenish hepatic glutathione and are used based on nomograms, not universally (statement 2 is broadly correct). Acetylcysteine is most effective within 8 hours, and methionine is a less effective alternative.

Question 97: 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: Prolactin stimulates milk production, while oxytocin, secreted by the posterior pituitary, causes milk ejection (let-down reflex). Night feeding sustains prolactin levels, supporting milk production. Statements a, c, and d are incorrect due to inaccurate physiological roles.

Question 98: 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: (b) Copies a circle

Explanation: Copying a circle typically occurs around age 3, earlier than copying a cross (around age 4). Drawing a circle or a cross refers to spontaneous drawing, which may develop later than copying.

Question 99: In case of 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. Rapid reduction in the first hour is too aggressive.

Question 100: 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: Fast breathing in a 2-year-old is defined as a respiratory rate ≥ 40 breaths per minute, according to the WHO criteria for assessing pneumonia in children.

Question 101: 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, shifting potassium intracellularly). Ipratropium bromide is a bronchodilator, not used for hyperkalemia.

Question 102: 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-agonist, drives potassium into cells by stimulating Na+/K+-ATPase, making it an effective treatment for hyperkalemia.

Question 103: 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 programme involves weekly supplementation with 100 mg elemental iron and 500 µg folic acid and biannual deworming with albendazole to address anemia in adolescents.

Question 104: 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.
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 IMNCI, immediate return to a health facility is advised for inability to drink/breastfeed, fast/difficult breathing (even without pneumonia), and blood in stool (indicating severe diarrhoea). Conjunctivitis in measles is not an immediate danger sign.

Question 105: 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 estimates fluid requirements for burn patients as 4 mL × weight (kg) × % total body surface area (TBSA) burned, given over 24 hours. Half is administered in the first 8 hours (not 6 hours, making statement 4 incorrect), and the remainder over the next 16 hours. Maintenance fluids are also required in pediatric patients to account for ongoing needs, especially in children with smaller body reserves.

Question 106: Whole Bowel Irrigation (WBI) as a method of gastrointestinal decontamination is proper for poisoning with:

(a) Alcohol
(b) Iron
(c) Kerosene
(d) Organophosphorus

Answer: (b) Iron

Explanation: Whole Bowel Irrigation (WBI) is adequate for gastrointestinal decontamination in cases of iron poisoning, especially when large amounts of iron tablets are ingested, as it helps remove unabsorbed pills from the gut. WBI is not typically used for alcohol, kerosene, or organophosphorus poisoning, which require other management strategies like supportive care or specific antidotes.

Question 107: 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 (e.g., spina bifida) are recommended to take 4 mg (4000 µg) of folic acid daily, starting at least one month before conception and continuing through the first trimester, to reduce the risk of recurrence. This is significantly higher than the standard 400 µg dose for general prevention.

Question 108: 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 performed after 10 weeks of gestation (making statement 2 incorrect). It has a high negative predictive value (~98%) for aneuploidies like Down syndrome. Positive results require confirmation with invasive testing (e.g., amniocentesis or chorionic villus sampling).

Question 109: 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. This is because gametes from the carrier parent may carry an extra chromosome 21, leading to Down syndrome in all viable offspring.

Question 110: 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: Genomic imprinting involves the silencing of one parental allele. Angelman syndrome (maternal deletion or mutation in 15q11-13) and Prader-Willi syndrome (paternal deletion in the same region) are classic examples. Microdeletions cause Williams syndrome and DiGeorge syndrome, but are not imprinting disorders.

Question 111: 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 through its effects on the hypothalamus and peripheral vasodilation. Alcohol can also cause hypothermia, but chlorpromazine is more directly associated with this context. Digoxin and iron do not typically cause hypothermia.

Question 112: Consider the following pairs:

Urine colour	Possible causative agent in a child with suspected poisoning
1. Pink	Cephalosporin
2. Brown	Chloroquine
3. Greenish blue	Phenazopyridine
4. Red-orange	Amitriptyline
How many of the pairs given above are correctly matched?
(a) Only one pair
(b) Only two pairs
26/10/2025BOSE

System: (c) Only three pairs**

Explanation: The correct matches are:

Pink urine can be caused by rifampicin, not cephalosporin.
Brown urine is associated with chloroquine.
Greenish-blue urine is caused by phenazopyridine.
Red-orange urine is caused by rifampicin, not amitriptyline.

Thus, only pairs 2 and 3 are correctly matched, making the answer only three pairs. Cephalosporins and amitriptyline are not typically associated with pink or red-orange urine, respectively.

Question 113: Consider the following agents and the cardiac effects in case of overdose or poisoning:

Prolonged PR interval – Lithium
Prolonged QTc interval – Amiodarone
Expansive 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: (b) Only two pairs

Explanation: Lithium can cause a prolonged PR interval due to its effect on cardiac conduction. Amiodarone is well-known for prolonging the QTc interval, increasing the risk of torsades de pointes. Kerosene ingestion typically causes chemical pneumonitis, an expansive QRS complex (which is more associated with tricyclic antidepressants like amitriptyline). Organophosphates cause tachycardia due to cholinergic excess. Thus, pairs 1 and 2 are correct, but 3 and 4 are not, making the answer only two pairs.

Question 114: 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, as the baby may start breathing with stimulation. Secondary apnea, however, does not respond to tactile stimulation and requires assisted ventilation, as it indicates a more severe hypoxic state. Tertiary apnea is not a standard term, and cardiorespiratory arrest involves both respiratory and cardiac failure.

Question 115: Consider the following conditions:

Condition	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 a neonate is characterized by a response to tactile stimulation, falling heart rate, normal blood pressure, and decreasing muscle tone. This reflects a transient hypoxic state that can be reversed with stimulation, distinguishing it from secondary apnea (condition C), which is more severe and unresponsive to stimulation.

Question 116: 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, aiding hydration in infants. The high lactose content facilitates calcium absorption by creating an acidic environment in the gut. Breast milk contains adequate taurine and cysteine for infant development, making statement 2 incorrect. While it contains omega-3 and omega-6 fatty acids, it is not particularly rich in omega-2 (a less common term), so statement 3 is also incorrect.

Question 117: 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 attachment during breastfeeding includes a wide-open mouth, the baby’s mouth touching the breast (covering most of the areola), and an everted lower lip to ensure effective milk transfer. The baby’s nose should be close to the breast but not necessarily at the level of the nipple (statement 1 is less precise), as proper positioning allows the nose to remain free for breathing.

Question 118: 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: (d) 83%

Explanation: A 6-year-old child is expected to achieve language milestones such as saying their full name (achieved here) and reciting simple poems or rhymes (not completed). The Developmental Quotient (DQ) is calculated as (developmental age ÷ chronological age) × 100. Achieving most but not all milestones (e.g., reciting a poem) suggests a DQ close to 83%, reflecting near-age-appropriate development.

Question 119: 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: Hepatitis B vaccine is most effective when given intramuscularly, making statement 1 incorrect. The MMR vaccine must be used within 30 minutes of reconstitution to maintain potency, so statement 2 is correct but not included in the answer. Maternal antibodies do not significantly interfere with the BCG vaccine’s cellular immune response, making statement 3 correct. DTwP is preferred over DTaP in many settings for primary immunization due to its efficacy and cost, especially in resource-limited areas, so statement 4 is correct.

Question 120: 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 vaccine, a live-attenuated vaccine, is avoided during diarrhoea because the altered gut environment may reduce vaccine uptake and efficacy. While intussusception is a rare risk, it is not directly triggered by diarrhoea (statement b). The vaccine does not typically cause rotavirus diarrhoea (statement c), and vomiting is not a significant adverse effect (statement d).

Conclusion

This comprehensive guide to the Combined Medical Services (CMS) Paper-I (General Medicine and Pediatrics) offers detailed questions, answers, and explanations to support medical students, professionals, and exam aspirants in their preparation. Covering critical topics in general medicine and pediatrics, this resource is designed to enhance understanding of key clinical concepts and improve performance in competitive exams. For further study, refer to standard medical textbooks and practice with past papers to solidify your knowledge. Best of luck in your CMS journey!