CMS 2020 Paper I \u2013 Part 4 (Q91\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms20p1d \u2500\u2500 *\/\n#cms20p1d *,#cms20p1d *::before,#cms20p1d *::after{box-sizing:border-box;margin:0;padding:0}\n\n#cms20p1d{\n --ter:#C0603A;\n --ter-light:#e8825f;\n --ter-pale:#fdf1ec;\n --teal:#2A7A6F;\n --teal-light:#3da394;\n --teal-pale:#eaf4f3;\n --ink:#1a1a1a;\n --ink-mid:#444;\n --ink-soft:#777;\n --line:#e0d8d4;\n --bg:#fdfaf8;\n --white:#ffffff;\n --correct:#1e6f46;\n --correct-bg:#eaf7ef;\n --correct-border:#43a047;\n --wrong:#b83232;\n --wrong-bg:#fdf0f0;\n --wrong-border:#e53935;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;\n color:var(--ink);\n background:var(--bg);\n line-height:1.7;\n padding:0 0 48px;\n}\n\n#cms20p1d .cq-sentinel{height:1px}\n\n\/* Fixed 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var(--teal);color:var(--teal);\n border-radius:8px;padding:10px 28px;\n font-family:'Playfair Display',serif;\n font-size:0.95rem;font-weight:700;cursor:pointer;\n transition:background 0.2s,color 0.2s;\n}\n#cms20p1d .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n\n@media(max-width:480px){\n #cms20p1d .cq-header h1{font-size:1.15rem}\n #cms20p1d .cq-qtext{font-size:0.88rem}\n #cms20p1d .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n\n<div id=\"cms20p1d\">\n\n <div class=\"cq-sentinel\" id=\"cms20p1d-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms20p1d-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p1d-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p1d-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p1d-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p1d-sn\">0<\/strong> \/ <strong id=\"cms20p1d-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p1d-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper I \u00b7 Part 4<\/h1>\n <p>Emergency Medicine \u00b7 Paediatrics<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 91 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p1d-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p1d-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p1d-score\">\n <div class=\"cq-score-ring\" id=\"cms20p1d-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p1d-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms20p1d-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p1d-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p1d-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p1d-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p1d-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p1d-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function(){\n 'use strict';\n\n const NS = 'cms20p1d';\n const TOTAL = 30;\n const MAX = TOTAL * 4;\n\n const QUESTIONS = [\n {\n id:91,\n stem:'A young primigravida at 11 weeks pregnancy presents with sudden onset pain and swelling of left lower limb. Homan\\'s sign is positive. Duplex ultrasonogram shows non-compressibility of veins with absent flow. The drug of choice for treatment is:',\n correct:'Enoxaparin',\n options:['Enoxaparin','Amoxycillin\u2013Clavulanic acid','Warfarin','Limb elevation only'],\n exp:'LMWH (enoxaparin) is the anticoagulant of choice for DVT in pregnancy. Warfarin is teratogenic (especially in first trimester \u2014 causes warfarin embryopathy) and crosses the placenta. Enoxaparin does not cross the placental barrier and is safe throughout pregnancy.'\n },\n {\n id:92,\n stem:'All of the following are clinical features of hypovolaemic shock EXCEPT:',\n correct:'Bradycardia',\n options:['Cold clammy skin','Bradycardia','Hypotension','Oliguria'],\n exp:'Hypovolaemic shock causes compensatory tachycardia (not bradycardia) \u2014 the sympathetic nervous system increases heart rate to maintain cardiac output. Cold clammy skin (peripheral vasoconstriction), hypotension, and oliguria are all expected features.'\n },\n {\n id:93,\n stem:'Which one of the following is most appropriate to describe classic heat stroke?',\n correct:'Core body temperature above 40\u00b0C with muscle tremors, confusion, loss of consciousness and loss of sweating',\n options:[\n 'Core body temperature rises above 44\u00b0C with headache, nausea and loss of consciousness',\n 'Core body temperature above 40\u00b0C with muscle tremors, confusion, loss of consciousness and loss of sweating',\n 'Core body temperature rises above 38\u00b0C with increased sweating, tachypnoea, tachycardia and loss of consciousness',\n 'Core body temperature above 40\u00b0C with disorientation, increased sweating, peripheral vasodilation, tachycardia and loss of consciousness'\n ],\n exp:'Classic heat stroke is defined by core temperature >40\u00b0C + CNS dysfunction (confusion, coma) + anhidrosis (loss of sweating \u2014 distinguishing it from heat exhaustion where sweating is preserved). Anhidrosis reflects failure of thermoregulation. Option (d) describes heat exhaustion (sweating intact).'\n },\n {\n id:94,\n stem:'Which of the following is NOT a priority in the initial management of shock from venomous snake?',\n correct:'Vasopressor support',\n options:['Aggressive volume resuscitation','Vasopressor support','Anti-venom administration','All of these are undertaken simultaneously'],\n exp:'In venom-induced shock, aggressive volume resuscitation and specific anti-venom are the immediate priorities. Vasopressors are not first-line and may be harmful depending on the envenomation type \u2014 they are considered only if volume resuscitation fails. Anti-venom addresses the primary cause.'\n },\n {\n id:95,\n stem:'Which one of the following is NOT an appropriate criterion for diagnosis of Systemic Inflammatory Response Syndrome (SIRS)?',\n correct:'Total leucocyte count > 16 \u00d7 10\u2079 per litre',\n options:['Respiratory rate > 20\/min','Heart rate > 90\/min','Total leucocyte count > 16 \u00d7 10\u2079 per litre','Temperature > 38\u00b0C'],\n exp:'The SIRS leucocyte criterion is WBC >12 \u00d7 10\u2079\/L (or <4 \u00d7 10\u2079\/L, or >10% immature bands) \u2014 not >16 \u00d7 10\u2079\/L. The other three criteria (RR >20\/min, HR >90\/min, temp >38\u00b0C or <36\u00b0C) are correct SIRS criteria. Two or more criteria are required for SIRS diagnosis.'\n },\n {\n id:96,\n stem:'All of the following predispose to Acute Respiratory Distress Syndrome EXCEPT:',\n correct:'Severe Bronchial Asthma',\n options:['Acute Pancreatitis','Toxic gas inhalation','Aspiration of gastric contents','Severe Bronchial Asthma'],\n exp:'Severe bronchial asthma causes airflow obstruction and air trapping \u2014 it does not cause the diffuse alveolar damage that defines ARDS. ARDS risk factors include both direct lung injuries (aspiration, toxic inhalation, pneumonia) and indirect insults (pancreatitis, sepsis, trauma, massive transfusion).'\n },\n {\n id:97,\n stem:'An 8-year-old child has consumed a few tablets of a drug being taken by his mother on a regular basis. The child develops gastric necrosis, acidosis, shock and hepatic necrosis. Which is the most likely drug?',\n correct:'Iron',\n options:['Multivitamins','Calcium carbonate','Folic acid','Iron'],\n exp:'Iron poisoning is the classic cause of this four-phase toxidrome in children: (1) GI mucosal necrosis, (2) apparent recovery, (3) cardiovascular collapse with metabolic acidosis, (4) hepatic necrosis and late cicatricial scarring. Iron tablets are a significant paediatric poisoning risk \u2014 treatment is deferoxamine chelation.'\n },\n {\n id:98,\n stem:'A newborn weighing 1.5 kg at birth presents at 6 hours of age with lethargy, weak and high-pitched cry and difficulty in feeding. What is the next step in management?',\n correct:'Estimation of blood sugar',\n options:['Estimation of blood sugar','Estimation of serum calcium','Supplementary oxygen','Bedside electrocardiogram'],\n exp:'In a low birth weight neonate presenting at 6 hours with lethargy and poor feeding, hypoglycaemia is the most likely and immediately treatable cause. Blood glucose estimation (bedside glucometry) is the first and most urgent step \u2014 LBW neonates have limited glycogen stores and high metabolic demands.'\n },\n {\n id:99,\n stem:'In a child with acute organophosphorus poisoning, which one of the following drugs will act as anti-sialogogue and peripheral parasympatholytic agent?',\n correct:'Atropine',\n options:['Carbamates','Atropine','Benzodiazepine','Pralidoxime'],\n exp:'Atropine competitively blocks muscarinic acetylcholine receptors \u2014 it dries secretions (anti-sialogogue), reverses bronchospasm, bradycardia, and miosis, and is the cornerstone of OP poisoning treatment. It has no effect on nicotinic (NMJ) features. Pralidoxime reactivates cholinesterase if given early but is not an anti-muscarinic agent.'\n },\n {\n id:100,\n stem:'A 6-year-old child needs to undergo central catheter placement for total parenteral nutrition. The procedure is likely to evoke pain and anxiety. Which of the following is the most appropriate drug for sedation and analgesia?',\n correct:'Ketamine',\n options:['Chloral hydrate','Midazolam','Propofol','Ketamine'],\n exp:'Ketamine provides dissociative anaesthesia with profound analgesia, amnesia, and bronchodilation while maintaining airway reflexes and haemodynamic stability \u2014 making it ideal for painful procedural sedation in children. Midazolam provides sedation but no analgesia. Propofol causes respiratory depression and lacks analgesia.'\n },\n {\n id:101,\n stem:'Which one of the following is the drug of choice in a child presenting with supraventricular tachycardia?',\n correct:'Adenosine',\n options:['Atropine','Lidocaine','Adenosine','Naloxone'],\n exp:'Adenosine transiently blocks AV nodal conduction, interrupting the re-entry circuit responsible for most SVTs. It has an ultrashort half-life (~10 seconds), making it both effective and safe in children. It is given as a rapid IV bolus \u2014 the drug of choice for haemodynamically stable SVT.'\n },\n {\n id:102,\n stem:'Which one of the following drugs is used in cardiopulmonary resuscitation for pulseless ventricular fibrillation?',\n correct:'Amiodarone',\n options:['Atropine','Adenosine','Lidocaine','Amiodarone'],\n exp:'Amiodarone is the antiarrhythmic of choice in shock-refractory pulseless VF\/pulseless VT during CPR (given after the 3rd defibrillation shock per ACLS\/PALS protocols). Atropine is used for bradycardia\/PEA. Adenosine is for SVT. Lidocaine is an alternative if amiodarone is unavailable.'\n },\n {\n id:103,\n stem:'Which one of the following is a sign of good attachment during breastfeeding?',\n correct:\"The baby's chin touches the breast\",\n options:[\n \"The baby's nose is at the level of the nipple\",\n \"The baby's chin touches the breast\",\n 'Most of the nipple is in the mouth and the lower areola is visible',\n \"The baby's lower lip is inverted\"\n ],\n exp:\"Signs of good latch: chin touching breast, mouth wide open, lower lip turned outward (everted \u2014 not inverted), more areola visible ABOVE than below the mouth, and the baby's nose is CLEAR of (not at the level of) the nipple. The chin touching the breast is the single most reliable sign of correct attachment.\"\n },\n {\n id:104,\n stem:'Which one of the following signs is NOT included as an indicator of a vigorous baby immediately after delivery of an infant born through meconium-stained liquor?',\n correct:'Pink colour',\n options:['Pink colour','Strong respiratory efforts','Good muscle tone','Active movements of the baby'],\n exp:'The three criteria for a vigorous meconium-stained newborn (per NRP\/ILCOR) are: (1) strong respiratory effort, (2) good muscle tone, and (3) heart rate >100 bpm. Pink colour and active movements are not part of the formal vigorous assessment \u2014 cyanosis is expected initially and does not determine the management pathway.'\n },\n {\n id:105,\n stem:'All are true for a Cephalohematoma in a newborn EXCEPT:',\n correct:'It is located over the parietal bones in the subcutaneous plane',\n options:[\n 'It is located over the parietal bones in the subcutaneous plane',\n 'It may be associated with hyperbilirubinaemia',\n 'It increases in size in the first 12\u201324 hours',\n 'It can take 3\u20136 weeks to resolve'\n ],\n exp:'Cephalohematoma is a subperiosteal haemorrhage \u2014 blood collects between the periosteum and skull bone, NOT in the subcutaneous plane (that is caput succedaneum). Because it is subperiosteal, it does not cross suture lines. It may calcify, cause neonatal jaundice, and takes weeks to resolve.'\n },\n {\n id:106,\n stem:'Which of the following sick neonates can be started on \"Minimal Enteral Feeding\", if haemodynamically stable?',\n correct:'Neonate on mechanical ventilation',\n options:[\n 'Septic neonate with sclerema',\n 'Neonate with necrotising enterocolitis (NEC)',\n 'Neonate on mechanical ventilation',\n 'Symptomatic hypoglycaemia'\n ],\n exp:'Minimal enteral feeding (trophic feeds) can and should be initiated in haemodynamically stable ventilated neonates \u2014 it maintains gut integrity, stimulates gut hormones, and reduces cholestasis. NEC and sclerema are absolute contraindications. Symptomatic hypoglycaemia requires IV dextrose, not enteral feeds.'\n },\n {\n id:107,\n stem:'Which one of the following drugs is contraindicated in a mother who is breastfeeding her infant?',\n correct:'Bromocriptine',\n options:['Bromocriptine','Chlorpromazine','Acyclovir','Morphine'],\n exp:'Bromocriptine is a dopamine agonist used specifically to suppress lactation \u2014 it inhibits prolactin secretion and dries up breast milk. It is therefore contraindicated if the mother wishes to continue breastfeeding. The other drugs may require monitoring but are not absolutely contraindicated during lactation.'\n },\n {\n id:108,\n stem:'A term neonate presents with tachypnoea on day 1 after birth. Chest X-ray reveals hyperexpanded lung fields, prominent vascular markings, and prominent interlobar fissure. Which of the following is the most probable diagnosis?',\n correct:'Transient tachypnoea of the newborn',\n options:[\n 'Congenital lobar emphysema',\n 'Diaphragmatic hernia',\n 'Transient tachypnoea of the newborn',\n 'Tracheoesophageal fistula'\n ],\n exp:\"Transient tachypnoea of the newborn (TTN \/ 'wet lung') results from delayed resorption of fetal lung fluid. Classic CXR findings: bilateral perihilar streaking, hyperinflation, fluid in interlobar fissures (prominent interlobar fissure), and small pleural effusions. Resolves within 24\u201372 hours with supportive care.\"\n },\n {\n id:109,\n stem:'A pre-school boy can go upstairs on alternate feet and has also started copying a circle. How many blocks should he be able to build a tower with, without toppling over?',\n correct:'9',\n options:['5','7','9','More than 10'],\n exp:\"Going upstairs on alternate feet (3 years) and copying a circle (3 years) places this child at ~3 years of age developmentally. The tower of blocks milestone: 2 years = 6 blocks, 2.5 years = 8 blocks, 3 years = 9\u201310 blocks. Nine blocks is the expected answer for a 3-year-old.\"\n },\n {\n id:110,\n stem:'Which one of the following drugs is the antidote for benzodiazepine poisoning?',\n correct:'Flumazenil',\n options:['Flumazenil','Atropine','Naloxone','Pralidoxime aldoxime methiodide'],\n exp:'Flumazenil is a specific competitive antagonist at the GABA-A benzodiazepine receptor site \u2014 it reverses benzodiazepine-induced sedation and respiratory depression. Naloxone reverses opioids, atropine reverses cholinergic excess, and pralidoxime is used in organophosphate poisoning.'\n },\n {\n id:111,\n stem:'A 3-year-old child develops severe respiratory distress after inhalation of fumes from burning plastic. The child is started on supportive ventilation. Which one of the following antidotes needs to be given?',\n correct:'Hydroxycobalamin',\n options:['Hydroxycobalamin','Amyl nitrite','Sodium nitrite','N-acetyl cysteine'],\n exp:'Burning plastic releases hydrogen cyanide (HCN). Hydroxycobalamin (vitamin B12a) is the preferred antidote \u2014 it chelates cyanide ions to form cyanocobalamin, which is renally excreted. It is safe, effective, and does not cause methaemoglobinaemia (unlike nitrites). N-acetylcysteine is for paracetamol poisoning.'\n },\n {\n id:112,\n stem:'A child has an incurving of the little finger. What is this condition known as?',\n correct:'Clinodactyly',\n options:['Camptodactyly','Brachydactyly','Partial cutaneous syndactyly','Clinodactyly'],\n exp:\"Clinodactyly is lateral (radial or ulnar) curvature of a digit \u2014 most commonly the little finger, due to a delta-shaped (trapezoidal) middle phalanx. It is a common isolated finding but is also associated with Down syndrome and other chromosomal disorders. Camptodactyly = flexion contracture of a digit.\"\n },\n {\n id:113,\n stem:'A 4-week-old infant presents with repeated episodes of non-bilious vomiting since 7 days. The infant seems active and hungry after vomiting. Examination reveals an olive-shaped mass in the epigastrium. Which metabolic abnormality is expected?',\n correct:'Metabolic alkalosis',\n options:['Hyperchloraemia','Metabolic alkalosis','Hyperkalaemia','Hyponatraemia'],\n exp:'Hypertrophic pyloric stenosis causes projectile non-bilious vomiting with loss of gastric HCl \u2192 hypochloraemic, hypokalaemic metabolic alkalosis. The kidney initially retains H\u207a to conserve K\u207a (paradoxical aciduria), then excretes K\u207a to retain H\u207a as depletion worsens. Confirmed by ultrasound (pyloric muscle thickness >4 mm, channel length >17 mm).'\n },\n {\n id:114,\n stem:'Which one of the following is the correct dose and route of administration of Hepatitis B vaccine in children?',\n correct:'0.5 mL dose with 10 microgram of antigen intramuscularly',\n options:[\n '0.5 mL dose with 10 microgram of antigen subcutaneously',\n '0.5 mL dose with 10 microgram of antigen intramuscularly',\n '1 mL dose with 5 microgram of antigen subcutaneously',\n '1 mL dose with 5 microgram of antigen intramuscularly'\n ],\n exp:'Hepatitis B vaccine in children is given as 0.5 mL (10 mcg of HBsAg antigen) intramuscularly into the anterolateral thigh (infants) or deltoid (older children). Subcutaneous administration gives suboptimal immune response. The adult dose is 1 mL (20 mcg) IM.'\n },\n {\n id:115,\n stem:'Which one of the following statements is correct for approved acellular pertussis vaccine?',\n correct:'It contains at least 3 pathogenic pertussis antigens',\n options:[\n 'It contains at least 3 IU of inactivated pertussis toxin',\n 'It contains at least 3 pathogenic pertussis antigens',\n 'Its efficacy is superior to the whole-cell pertussis vaccine',\n 'Presence of nonfimbrial protein is a mandatory component'\n ],\n exp:'Licensed acellular pertussis (aP) vaccines contain purified pertussis antigens \u2014 WHO requires at least pertussis toxoid (PT) as the minimum, with multi-component vaccines containing 2\u20135 antigens (PT, FHA, pertactin, fimbriae). Three or more antigens (PT + FHA + pertactin) are standard in most approved formulations. Efficacy is comparable to, not superior to, whole-cell vaccines.'\n },\n {\n id:116,\n stem:'Which of the following is recommended in the follow-up health visits of a child with Down syndrome?',\n correct:'Annual thyroid function test from birth to 2 years',\n options:[\n 'Growth assessment twice a year in the first year and annually till 5 years',\n 'Annual auditory screening from 1 to 5 years',\n 'Screening for refractory error if visual impairment is suspected',\n 'Annual thyroid function test from birth to 2 years'\n ],\n exp:'Down syndrome surveillance guidelines recommend thyroid function testing at birth, 6 months, 12 months, and annually thereafter \u2014 due to high prevalence of hypothyroidism (occurring in up to 15\u201320%). Visual screening should be routine (not just if impairment is suspected), and hearing screening should begin from birth, not 1 year.'\n },\n {\n id:117,\n stem:'A 12-year-old child presents with delayed puberty and delayed bone age. His growth records reveal he was growing normally till 1 year of age, after which both height and weight fell below the third centile. Subsequently he continued to grow below the third centile with normal height velocity. What is the most likely diagnosis?',\n correct:'Constitutional growth delay',\n options:[\n 'Familial short stature',\n 'Constitutional growth delay',\n 'Growth hormone deficiency',\n 'Skeletal dysplasia'\n ],\n exp:'Constitutional growth delay (CGD): child grows normally, falls to below 3rd centile in early childhood, then tracks parallel to (but below) the normal curve with normal height velocity, and has delayed bone age. Puberty is also delayed but ultimately occurs. Familial short stature has normal bone age. GHD shows subnormal height velocity.'\n },\n {\n id:118,\n stem:'According to IMNCI classification of young infants up to 2 months, which one of the following signs is NOT included in \"Possible Serious Bacterial Infection\"?',\n correct:'Fast breathing (50 breaths or more per minute)',\n options:[\n 'Fast breathing (50 breaths or more per minute)',\n 'Severe chest indrawing',\n 'Axillary temperature less than 36.5\u00b0C',\n 'Movement only when stimulated or no movement at all'\n ],\n exp:'In IMNCI for young infants (0\u20132 months), fast breathing is defined as \u226560 breaths\/minute \u2014 not 50. The threshold of 50\/min applies to the 2\u201312 month age group. Severe chest indrawing, hypothermia (<35.5\u00b0C), and depressed activity are all included criteria for possible serious bacterial infection in this age group.'\n },\n {\n id:119,\n stem:'Neonatal tetanus elimination in India is defined as less than one case per:',\n correct:'1000 live births per year',\n options:[\n '100 live births per year',\n '1000 live births per year',\n '10000 live births per year',\n '100000 live births per year'\n ],\n exp:\"WHO and India's National Health Mission define neonatal tetanus elimination as fewer than 1 case per 1000 live births per year at the district level. India achieved elimination status in 2015. This threshold reflects a level of incidence low enough that routine immunisation and clean delivery practices can sustain control.\"\n },\n {\n id:120,\n stem:'Which one of the following facilities has been established at district hospitals in India to strengthen the care of low birth weight babies and sick newborns?',\n correct:'Special Newborn Care Units (SNCU)',\n options:[\n 'Special Newborn Care Units (SNCU)',\n 'Newborn Treatment Units (NTU)',\n 'Newborn Stabilization Units (NSU)',\n 'Shishu Suraksha Units (SSU)'\n ],\n exp:\"Special Newborn Care Units (SNCUs) are established at district and sub-district hospitals under India's Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy. They provide care for LBW, preterm, and sick newborns. 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Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36517","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 P1 Part-4 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/08\/cms-2020-p1-part-4\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta 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{"id":36517,"date":"2026-04-08T07:42:29","date_gmt":"2026-04-08T02:12:29","guid":{"rendered":"https:\/\/atsixty.com\/?p=36517"},"modified":"2026-04-08T08:32:34","modified_gmt":"2026-04-08T03:02:34","slug":"cms-2020-p1-part-4","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/04\/08\/cms-2020-p1-part-4\/","title":{"rendered":"CMS 2020 P1 Part-4"},"content":{"rendered":"\n\n\n\n\n\nCMS 2020 Paper I \u2013 Part 4 (Q91\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms20p1d \u2500\u2500 *\/\n#cms20p1d *,#cms20p1d *::before,#cms20p1d *::after{box-sizing:border-box;margin:0;padding:0}\n\n#cms20p1d{\n --ter:#C0603A;\n --ter-light:#e8825f;\n --ter-pale:#fdf1ec;\n --teal:#2A7A6F;\n --teal-light:#3da394;\n --teal-pale:#eaf4f3;\n --ink:#1a1a1a;\n --ink-mid:#444;\n --ink-soft:#777;\n --line:#e0d8d4;\n --bg:#fdfaf8;\n --white:#ffffff;\n --correct:#1e6f46;\n --correct-bg:#eaf7ef;\n --correct-border:#43a047;\n --wrong:#b83232;\n --wrong-bg:#fdf0f0;\n --wrong-border:#e53935;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;\n color:var(--ink);\n background:var(--bg);\n line-height:1.7;\n padding:0 0 48px;\n}\n\n#cms20p1d .cq-sentinel{height:1px}\n\n\/* Fixed status bar *\/\n#cms20p1d .cq-statusbar{\n position:fixed;\n top:0;left:0;right:0;\n z-index:99999;\n background:var(--white);\n border-bottom:2px solid var(--line);\n border-left:4px solid var(--ter);\n box-shadow:0 2px 12px rgba(0,0,0,0.11);\n opacity:0;pointer-events:none;\n transform:translateY(-110%);\n transition:opacity 0.22s ease,transform 0.22s ease;\n}\n#cms20p1d .cq-statusbar.visible{\n opacity:1;pointer-events:auto;transform:translateY(0);\n}\n#cms20p1d .cq-sb-stats{\n display:flex;align-items:center;\n padding:0.38rem 0.7rem;\n font-size:0.73rem;color:var(--ink-soft);\n}\n#cms20p1d .cq-sb-item{\n display:flex;align-items:center;gap:0.18rem;\n padding:0.1rem 0.5rem;\n border-right:1px solid var(--line);\n white-space:nowrap;line-height:1;\n}\n#cms20p1d .cq-sb-item:last-child{border-right:none}\n#cms20p1d .cq-sb-item strong{color:var(--ink);font-size:0.8rem;font-weight:700}\n#cms20p1d .cq-sb-sep{flex:1}\n#cms20p1d .cq-sb-progress{height:4px;background:var(--line);overflow:hidden;}\n#cms20p1d .cq-sb-fill{\n height:100%;\n background:linear-gradient(90deg,var(--ter),var(--teal));\n width:0%;transition:width 0.4s ease;\n}\n\n\/* Header *\/\n#cms20p1d .cq-header{\n background:var(--teal);color:var(--white);\n padding:28px 24px 22px;text-align:center;\n}\n#cms20p1d .cq-header h1{\n font-family:'Playfair Display',serif;\n font-size:1.45rem;font-weight:700;\n letter-spacing:0.01em;line-height:1.3;\n}\n#cms20p1d .cq-header p{\n font-size:0.85rem;opacity:0.85;margin-top:6px;font-style:italic;\n}\n#cms20p1d .cq-meta{\n display:flex;justify-content:center;gap:20px;margin-top:14px;flex-wrap:wrap;\n}\n#cms20p1d .cq-badge{\n background:rgba(255,255,255,0.15);\n border:1px solid rgba(255,255,255,0.3);\n border-radius:20px;padding:4px 14px;\n font-size:0.78rem;letter-spacing:0.03em;\n}\n\n\/* Body *\/\n#cms20p1d .cq-body{max-width:760px;margin:0 auto;padding:0 16px;}\n\n\/* Cards *\/\n#cms20p1d .cq-card{\n background:var(--white);border:1px solid var(--line);\n border-radius:var(--radius);margin:24px 0;\n overflow:hidden;transition:box-shadow 0.2s;\n}\n#cms20p1d .cq-card:hover{box-shadow:0 2px 12px rgba(192,96,58,0.1)}\n#cms20p1d .cq-qhead{\n background:var(--ter-pale);border-bottom:1px solid var(--line);\n padding:14px 18px;display:flex;gap:12px;align-items:flex-start;\n}\n#cms20p1d .cq-qnum{\n flex-shrink:0;width:26px;height:26px;border-radius:50%;\n background:var(--ter);color:#fff;\n font-size:0.72rem;font-weight:700;\n display:flex;align-items:center;justify-content:center;\n margin-top:2px;transition:background 0.2s;\n}\n#cms20p1d .cq-qnum.ans-c{background:var(--correct-border)}\n#cms20p1d .cq-qnum.ans-w{background:var(--wrong-border)}\n#cms20p1d .cq-qtext{font-size:0.93rem;color:var(--ink);line-height:1.65;}\n\n\/* Options *\/\n#cms20p1d .cq-options{padding:14px 18px;display:flex;flex-direction:column;gap:8px;}\n#cms20p1d .cq-opt{\n display:flex;align-items:flex-start;gap:10px;\n padding:10px 14px;border:1.5px solid var(--line);\n border-radius:8px;cursor:pointer;\n transition:border-color 0.15s,background 0.15s;\n background:var(--white);-webkit-tap-highlight-color:transparent;\n}\n#cms20p1d .cq-opt:hover:not(.cq-locked){\n border-color:var(--teal);background:var(--teal-pale);\n}\n#cms20p1d .cq-opt-letter{\n flex-shrink:0;width:20px;height:20px;border-radius:50%;\n border:1.5px solid var(--line);\n display:flex;align-items:center;justify-content:center;\n font-size:0.65rem;font-weight:700;color:var(--ink-soft);\n transition:all 0.15s;margin-top:1px;\n}\n#cms20p1d .cq-opt-text{font-size:0.89rem;color:var(--ink-mid);line-height:1.55;}\n#cms20p1d .cq-opt.cq-correct{border-color:var(--correct-border);background:var(--correct-bg);cursor:default;}\n#cms20p1d .cq-opt.cq-correct .cq-opt-letter{background:var(--correct-border);border-color:var(--correct-border);color:#fff;}\n#cms20p1d .cq-opt.cq-correct .cq-opt-text{color:var(--correct);font-weight:600}\n#cms20p1d .cq-opt.cq-wrong{border-color:var(--wrong-border);background:var(--wrong-bg);cursor:default;}\n#cms20p1d .cq-opt.cq-wrong .cq-opt-letter{background:var(--wrong-border);border-color:var(--wrong-border);color:#fff;}\n#cms20p1d .cq-opt.cq-wrong .cq-opt-text{color:var(--wrong)}\n#cms20p1d .cq-opt.cq-dimmed{opacity:0.42;cursor:default}\n#cms20p1d .cq-opt.cq-locked{cursor:default}\n\n\/* Explanation *\/\n#cms20p1d .cq-explanation{\n display:none;background:var(--teal-pale);\n border-top:1px solid #b2d8d3;\n padding:10px 18px 12px;\n font-size:0.82rem;color:#1a4f49;line-height:1.62;\n}\n#cms20p1d .cq-exp-label{\n font-size:0.7rem;font-weight:700;letter-spacing:0.08em;\n text-transform:uppercase;color:var(--teal);margin-bottom:4px;\n}\n\n\/* Submit \u2014 teal *\/\n#cms20p1d .cq-submit-wrap{text-align:center;padding:28px 16px 8px;}\n#cms20p1d .cq-btn{\n background:var(--teal);color:var(--white);border:none;\n border-radius:8px;padding:13px 36px;\n font-family:'Playfair Display',serif;\n font-size:1rem;font-weight:700;cursor:pointer;\n letter-spacing:0.02em;transition:background 0.2s,transform 0.1s;\n}\n#cms20p1d .cq-btn:hover{background:var(--teal-light)}\n#cms20p1d .cq-btn:active{transform:scale(0.98)}\n\n\/* Score panel *\/\n#cms20p1d .cq-score{\n display:none;background:var(--white);\n border:2px solid var(--teal);border-radius:var(--radius);\n margin:28px 0 0;padding:28px 24px;text-align:center;\n}\n#cms20p1d .cq-score-ring{\n width:110px;height:110px;border-radius:50%;\n background:conic-gradient(var(--teal) 0%,var(--line) 0%);\n display:flex;align-items:center;justify-content:center;\n margin:0 auto 20px;position:relative;\n}\n#cms20p1d .cq-score-ring::before{\n content:'';position:absolute;width:86px;height:86px;\n border-radius:50%;background:var(--white);\n}\n#cms20p1d .cq-ring-inner{\n position:relative;display:flex;flex-direction:column;\n align-items:center;line-height:1.2;\n}\n#cms20p1d .cq-ring-pct{\n font-family:'Playfair Display',serif;font-size:1.3rem;\n font-weight:700;color:var(--teal);\n}\n#cms20p1d .cq-ring-sub{\n font-size:0.6rem;color:var(--ink-soft);\n text-transform:uppercase;letter-spacing:0.05em;\n}\n#cms20p1d .cq-score h2{\n font-family:'Playfair Display',serif;font-size:1.2rem;\n color:var(--ink);margin-bottom:8px;\n}\n#cms20p1d .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px;}\n#cms20p1d .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px;}\n#cms20p1d .cq-score-bands{\n display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem;\n}\n#cms20p1d .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms20p1d .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms20p1d .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms20p1d .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms20p1d .cq-retry-btn{\n margin-top:22px;background:transparent;\n border:2px solid var(--teal);color:var(--teal);\n border-radius:8px;padding:10px 28px;\n font-family:'Playfair Display',serif;\n font-size:0.95rem;font-weight:700;cursor:pointer;\n transition:background 0.2s,color 0.2s;\n}\n#cms20p1d .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n\n@media(max-width:480px){\n #cms20p1d .cq-header h1{font-size:1.15rem}\n #cms20p1d .cq-qtext{font-size:0.88rem}\n #cms20p1d .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n\n<div id=\"cms20p1d\">\n\n <div class=\"cq-sentinel\" id=\"cms20p1d-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms20p1d-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p1d-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p1d-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p1d-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p1d-sn\">0<\/strong> \/ <strong id=\"cms20p1d-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p1d-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper I \u00b7 Part 4<\/h1>\n <p>Emergency Medicine \u00b7 Paediatrics<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 91 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p1d-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p1d-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p1d-score\">\n <div class=\"cq-score-ring\" id=\"cms20p1d-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p1d-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms20p1d-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p1d-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p1d-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p1d-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p1d-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p1d-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function(){\n 'use strict';\n\n const NS = 'cms20p1d';\n const TOTAL = 30;\n const MAX = TOTAL * 4;\n\n const QUESTIONS = [\n {\n id:91,\n stem:'A young primigravida at 11 weeks pregnancy presents with sudden onset pain and swelling of left lower limb. Homan\\'s sign is positive. Duplex ultrasonogram shows non-compressibility of veins with absent flow. The drug of choice for treatment is:',\n correct:'Enoxaparin',\n options:['Enoxaparin','Amoxycillin\u2013Clavulanic acid','Warfarin','Limb elevation only'],\n exp:'LMWH (enoxaparin) is the anticoagulant of choice for DVT in pregnancy. Warfarin is teratogenic (especially in first trimester \u2014 causes warfarin embryopathy) and crosses the placenta. Enoxaparin does not cross the placental barrier and is safe throughout pregnancy.'\n },\n {\n id:92,\n stem:'All of the following are clinical features of hypovolaemic shock EXCEPT:',\n correct:'Bradycardia',\n options:['Cold clammy skin','Bradycardia','Hypotension','Oliguria'],\n exp:'Hypovolaemic shock causes compensatory tachycardia (not bradycardia) \u2014 the sympathetic nervous system increases heart rate to maintain cardiac output. Cold clammy skin (peripheral vasoconstriction), hypotension, and oliguria are all expected features.'\n },\n {\n id:93,\n stem:'Which one of the following is most appropriate to describe classic heat stroke?',\n correct:'Core body temperature above 40\u00b0C with muscle tremors, confusion, loss of consciousness and loss of sweating',\n options:[\n 'Core body temperature rises above 44\u00b0C with headache, nausea and loss of consciousness',\n 'Core body temperature above 40\u00b0C with muscle tremors, confusion, loss of consciousness and loss of sweating',\n 'Core body temperature rises above 38\u00b0C with increased sweating, tachypnoea, tachycardia and loss of consciousness',\n 'Core body temperature above 40\u00b0C with disorientation, increased sweating, peripheral vasodilation, tachycardia and loss of consciousness'\n ],\n exp:'Classic heat stroke is defined by core temperature >40\u00b0C + CNS dysfunction (confusion, coma) + anhidrosis (loss of sweating \u2014 distinguishing it from heat exhaustion where sweating is preserved). Anhidrosis reflects failure of thermoregulation. Option (d) describes heat exhaustion (sweating intact).'\n },\n {\n id:94,\n stem:'Which of the following is NOT a priority in the initial management of shock from venomous snake?',\n correct:'Vasopressor support',\n options:['Aggressive volume resuscitation','Vasopressor support','Anti-venom administration','All of these are undertaken simultaneously'],\n exp:'In venom-induced shock, aggressive volume resuscitation and specific anti-venom are the immediate priorities. Vasopressors are not first-line and may be harmful depending on the envenomation type \u2014 they are considered only if volume resuscitation fails. Anti-venom addresses the primary cause.'\n },\n {\n id:95,\n stem:'Which one of the following is NOT an appropriate criterion for diagnosis of Systemic Inflammatory Response Syndrome (SIRS)?',\n correct:'Total leucocyte count > 16 \u00d7 10\u2079 per litre',\n options:['Respiratory rate > 20\/min','Heart rate > 90\/min','Total leucocyte count > 16 \u00d7 10\u2079 per litre','Temperature > 38\u00b0C'],\n exp:'The SIRS leucocyte criterion is WBC >12 \u00d7 10\u2079\/L (or <4 \u00d7 10\u2079\/L, or >10% immature bands) \u2014 not >16 \u00d7 10\u2079\/L. The other three criteria (RR >20\/min, HR >90\/min, temp >38\u00b0C or <36\u00b0C) are correct SIRS criteria. Two or more criteria are required for SIRS diagnosis.'\n },\n {\n id:96,\n stem:'All of the following predispose to Acute Respiratory Distress Syndrome EXCEPT:',\n correct:'Severe Bronchial Asthma',\n options:['Acute Pancreatitis','Toxic gas inhalation','Aspiration of gastric contents','Severe Bronchial Asthma'],\n exp:'Severe bronchial asthma causes airflow obstruction and air trapping \u2014 it does not cause the diffuse alveolar damage that defines ARDS. ARDS risk factors include both direct lung injuries (aspiration, toxic inhalation, pneumonia) and indirect insults (pancreatitis, sepsis, trauma, massive transfusion).'\n },\n {\n id:97,\n stem:'An 8-year-old child has consumed a few tablets of a drug being taken by his mother on a regular basis. The child develops gastric necrosis, acidosis, shock and hepatic necrosis. Which is the most likely drug?',\n correct:'Iron',\n options:['Multivitamins','Calcium carbonate','Folic acid','Iron'],\n exp:'Iron poisoning is the classic cause of this four-phase toxidrome in children: (1) GI mucosal necrosis, (2) apparent recovery, (3) cardiovascular collapse with metabolic acidosis, (4) hepatic necrosis and late cicatricial scarring. Iron tablets are a significant paediatric poisoning risk \u2014 treatment is deferoxamine chelation.'\n },\n {\n id:98,\n stem:'A newborn weighing 1.5 kg at birth presents at 6 hours of age with lethargy, weak and high-pitched cry and difficulty in feeding. What is the next step in management?',\n correct:'Estimation of blood sugar',\n options:['Estimation of blood sugar','Estimation of serum calcium','Supplementary oxygen','Bedside electrocardiogram'],\n exp:'In a low birth weight neonate presenting at 6 hours with lethargy and poor feeding, hypoglycaemia is the most likely and immediately treatable cause. Blood glucose estimation (bedside glucometry) is the first and most urgent step \u2014 LBW neonates have limited glycogen stores and high metabolic demands.'\n },\n {\n id:99,\n stem:'In a child with acute organophosphorus poisoning, which one of the following drugs will act as anti-sialogogue and peripheral parasympatholytic agent?',\n correct:'Atropine',\n options:['Carbamates','Atropine','Benzodiazepine','Pralidoxime'],\n exp:'Atropine competitively blocks muscarinic acetylcholine receptors \u2014 it dries secretions (anti-sialogogue), reverses bronchospasm, bradycardia, and miosis, and is the cornerstone of OP poisoning treatment. It has no effect on nicotinic (NMJ) features. Pralidoxime reactivates cholinesterase if given early but is not an anti-muscarinic agent.'\n },\n {\n id:100,\n stem:'A 6-year-old child needs to undergo central catheter placement for total parenteral nutrition. The procedure is likely to evoke pain and anxiety. Which of the following is the most appropriate drug for sedation and analgesia?',\n correct:'Ketamine',\n options:['Chloral hydrate','Midazolam','Propofol','Ketamine'],\n exp:'Ketamine provides dissociative anaesthesia with profound analgesia, amnesia, and bronchodilation while maintaining airway reflexes and haemodynamic stability \u2014 making it ideal for painful procedural sedation in children. Midazolam provides sedation but no analgesia. Propofol causes respiratory depression and lacks analgesia.'\n },\n {\n id:101,\n stem:'Which one of the following is the drug of choice in a child presenting with supraventricular tachycardia?',\n correct:'Adenosine',\n options:['Atropine','Lidocaine','Adenosine','Naloxone'],\n exp:'Adenosine transiently blocks AV nodal conduction, interrupting the re-entry circuit responsible for most SVTs. It has an ultrashort half-life (~10 seconds), making it both effective and safe in children. It is given as a rapid IV bolus \u2014 the drug of choice for haemodynamically stable SVT.'\n },\n {\n id:102,\n stem:'Which one of the following drugs is used in cardiopulmonary resuscitation for pulseless ventricular fibrillation?',\n correct:'Amiodarone',\n options:['Atropine','Adenosine','Lidocaine','Amiodarone'],\n exp:'Amiodarone is the antiarrhythmic of choice in shock-refractory pulseless VF\/pulseless VT during CPR (given after the 3rd defibrillation shock per ACLS\/PALS protocols). Atropine is used for bradycardia\/PEA. Adenosine is for SVT. Lidocaine is an alternative if amiodarone is unavailable.'\n },\n {\n id:103,\n stem:'Which one of the following is a sign of good attachment during breastfeeding?',\n correct:\"The baby's chin touches the breast\",\n options:[\n \"The baby's nose is at the level of the nipple\",\n \"The baby's chin touches the breast\",\n 'Most of the nipple is in the mouth and the lower areola is visible',\n \"The baby's lower lip is inverted\"\n ],\n exp:\"Signs of good latch: chin touching breast, mouth wide open, lower lip turned outward (everted \u2014 not inverted), more areola visible ABOVE than below the mouth, and the baby's nose is CLEAR of (not at the level of) the nipple. The chin touching the breast is the single most reliable sign of correct attachment.\"\n },\n {\n id:104,\n stem:'Which one of the following signs is NOT included as an indicator of a vigorous baby immediately after delivery of an infant born through meconium-stained liquor?',\n correct:'Pink colour',\n options:['Pink colour','Strong respiratory efforts','Good muscle tone','Active movements of the baby'],\n exp:'The three criteria for a vigorous meconium-stained newborn (per NRP\/ILCOR) are: (1) strong respiratory effort, (2) good muscle tone, and (3) heart rate >100 bpm. Pink colour and active movements are not part of the formal vigorous assessment \u2014 cyanosis is expected initially and does not determine the management pathway.'\n },\n {\n id:105,\n stem:'All are true for a Cephalohematoma in a newborn EXCEPT:',\n correct:'It is located over the parietal bones in the subcutaneous plane',\n options:[\n 'It is located over the parietal bones in the subcutaneous plane',\n 'It may be associated with hyperbilirubinaemia',\n 'It increases in size in the first 12\u201324 hours',\n 'It can take 3\u20136 weeks to resolve'\n ],\n exp:'Cephalohematoma is a subperiosteal haemorrhage \u2014 blood collects between the periosteum and skull bone, NOT in the subcutaneous plane (that is caput succedaneum). Because it is subperiosteal, it does not cross suture lines. It may calcify, cause neonatal jaundice, and takes weeks to resolve.'\n },\n {\n id:106,\n stem:'Which of the following sick neonates can be started on \"Minimal Enteral Feeding\", if haemodynamically stable?',\n correct:'Neonate on mechanical ventilation',\n options:[\n 'Septic neonate with sclerema',\n 'Neonate with necrotising enterocolitis (NEC)',\n 'Neonate on mechanical ventilation',\n 'Symptomatic hypoglycaemia'\n ],\n exp:'Minimal enteral feeding (trophic feeds) can and should be initiated in haemodynamically stable ventilated neonates \u2014 it maintains gut integrity, stimulates gut hormones, and reduces cholestasis. NEC and sclerema are absolute contraindications. Symptomatic hypoglycaemia requires IV dextrose, not enteral feeds.'\n },\n {\n id:107,\n stem:'Which one of the following drugs is contraindicated in a mother who is breastfeeding her infant?',\n correct:'Bromocriptine',\n options:['Bromocriptine','Chlorpromazine','Acyclovir','Morphine'],\n exp:'Bromocriptine is a dopamine agonist used specifically to suppress lactation \u2014 it inhibits prolactin secretion and dries up breast milk. It is therefore contraindicated if the mother wishes to continue breastfeeding. The other drugs may require monitoring but are not absolutely contraindicated during lactation.'\n },\n {\n id:108,\n stem:'A term neonate presents with tachypnoea on day 1 after birth. Chest X-ray reveals hyperexpanded lung fields, prominent vascular markings, and prominent interlobar fissure. Which of the following is the most probable diagnosis?',\n correct:'Transient tachypnoea of the newborn',\n options:[\n 'Congenital lobar emphysema',\n 'Diaphragmatic hernia',\n 'Transient tachypnoea of the newborn',\n 'Tracheoesophageal fistula'\n ],\n exp:\"Transient tachypnoea of the newborn (TTN \/ 'wet lung') results from delayed resorption of fetal lung fluid. Classic CXR findings: bilateral perihilar streaking, hyperinflation, fluid in interlobar fissures (prominent interlobar fissure), and small pleural effusions. Resolves within 24\u201372 hours with supportive care.\"\n },\n {\n id:109,\n stem:'A pre-school boy can go upstairs on alternate feet and has also started copying a circle. How many blocks should he be able to build a tower with, without toppling over?',\n correct:'9',\n options:['5','7','9','More than 10'],\n exp:\"Going upstairs on alternate feet (3 years) and copying a circle (3 years) places this child at ~3 years of age developmentally. The tower of blocks milestone: 2 years = 6 blocks, 2.5 years = 8 blocks, 3 years = 9\u201310 blocks. Nine blocks is the expected answer for a 3-year-old.\"\n },\n {\n id:110,\n stem:'Which one of the following drugs is the antidote for benzodiazepine poisoning?',\n correct:'Flumazenil',\n options:['Flumazenil','Atropine','Naloxone','Pralidoxime aldoxime methiodide'],\n exp:'Flumazenil is a specific competitive antagonist at the GABA-A benzodiazepine receptor site \u2014 it reverses benzodiazepine-induced sedation and respiratory depression. Naloxone reverses opioids, atropine reverses cholinergic excess, and pralidoxime is used in organophosphate poisoning.'\n },\n {\n id:111,\n stem:'A 3-year-old child develops severe respiratory distress after inhalation of fumes from burning plastic. The child is started on supportive ventilation. Which one of the following antidotes needs to be given?',\n correct:'Hydroxycobalamin',\n options:['Hydroxycobalamin','Amyl nitrite','Sodium nitrite','N-acetyl cysteine'],\n exp:'Burning plastic releases hydrogen cyanide (HCN). Hydroxycobalamin (vitamin B12a) is the preferred antidote \u2014 it chelates cyanide ions to form cyanocobalamin, which is renally excreted. It is safe, effective, and does not cause methaemoglobinaemia (unlike nitrites). N-acetylcysteine is for paracetamol poisoning.'\n },\n {\n id:112,\n stem:'A child has an incurving of the little finger. What is this condition known as?',\n correct:'Clinodactyly',\n options:['Camptodactyly','Brachydactyly','Partial cutaneous syndactyly','Clinodactyly'],\n exp:\"Clinodactyly is lateral (radial or ulnar) curvature of a digit \u2014 most commonly the little finger, due to a delta-shaped (trapezoidal) middle phalanx. It is a common isolated finding but is also associated with Down syndrome and other chromosomal disorders. Camptodactyly = flexion contracture of a digit.\"\n },\n {\n id:113,\n stem:'A 4-week-old infant presents with repeated episodes of non-bilious vomiting since 7 days. The infant seems active and hungry after vomiting. Examination reveals an olive-shaped mass in the epigastrium. Which metabolic abnormality is expected?',\n correct:'Metabolic alkalosis',\n options:['Hyperchloraemia','Metabolic alkalosis','Hyperkalaemia','Hyponatraemia'],\n exp:'Hypertrophic pyloric stenosis causes projectile non-bilious vomiting with loss of gastric HCl \u2192 hypochloraemic, hypokalaemic metabolic alkalosis. The kidney initially retains H\u207a to conserve K\u207a (paradoxical aciduria), then excretes K\u207a to retain H\u207a as depletion worsens. Confirmed by ultrasound (pyloric muscle thickness >4 mm, channel length >17 mm).'\n },\n {\n id:114,\n stem:'Which one of the following is the correct dose and route of administration of Hepatitis B vaccine in children?',\n correct:'0.5 mL dose with 10 microgram of antigen intramuscularly',\n options:[\n '0.5 mL dose with 10 microgram of antigen subcutaneously',\n '0.5 mL dose with 10 microgram of antigen intramuscularly',\n '1 mL dose with 5 microgram of antigen subcutaneously',\n '1 mL dose with 5 microgram of antigen intramuscularly'\n ],\n exp:'Hepatitis B vaccine in children is given as 0.5 mL (10 mcg of HBsAg antigen) intramuscularly into the anterolateral thigh (infants) or deltoid (older children). Subcutaneous administration gives suboptimal immune response. The adult dose is 1 mL (20 mcg) IM.'\n },\n {\n id:115,\n stem:'Which one of the following statements is correct for approved acellular pertussis vaccine?',\n correct:'It contains at least 3 pathogenic pertussis antigens',\n options:[\n 'It contains at least 3 IU of inactivated pertussis toxin',\n 'It contains at least 3 pathogenic pertussis antigens',\n 'Its efficacy is superior to the whole-cell pertussis vaccine',\n 'Presence of nonfimbrial protein is a mandatory component'\n ],\n exp:'Licensed acellular pertussis (aP) vaccines contain purified pertussis antigens \u2014 WHO requires at least pertussis toxoid (PT) as the minimum, with multi-component vaccines containing 2\u20135 antigens (PT, FHA, pertactin, fimbriae). Three or more antigens (PT + FHA + pertactin) are standard in most approved formulations. Efficacy is comparable to, not superior to, whole-cell vaccines.'\n },\n {\n id:116,\n stem:'Which of the following is recommended in the follow-up health visits of a child with Down syndrome?',\n correct:'Annual thyroid function test from birth to 2 years',\n options:[\n 'Growth assessment twice a year in the first year and annually till 5 years',\n 'Annual auditory screening from 1 to 5 years',\n 'Screening for refractory error if visual impairment is suspected',\n 'Annual thyroid function test from birth to 2 years'\n ],\n exp:'Down syndrome surveillance guidelines recommend thyroid function testing at birth, 6 months, 12 months, and annually thereafter \u2014 due to high prevalence of hypothyroidism (occurring in up to 15\u201320%). Visual screening should be routine (not just if impairment is suspected), and hearing screening should begin from birth, not 1 year.'\n },\n {\n id:117,\n stem:'A 12-year-old child presents with delayed puberty and delayed bone age. His growth records reveal he was growing normally till 1 year of age, after which both height and weight fell below the third centile. Subsequently he continued to grow below the third centile with normal height velocity. What is the most likely diagnosis?',\n correct:'Constitutional growth delay',\n options:[\n 'Familial short stature',\n 'Constitutional growth delay',\n 'Growth hormone deficiency',\n 'Skeletal dysplasia'\n ],\n exp:'Constitutional growth delay (CGD): child grows normally, falls to below 3rd centile in early childhood, then tracks parallel to (but below) the normal curve with normal height velocity, and has delayed bone age. Puberty is also delayed but ultimately occurs. Familial short stature has normal bone age. GHD shows subnormal height velocity.'\n },\n {\n id:118,\n stem:'According to IMNCI classification of young infants up to 2 months, which one of the following signs is NOT included in \"Possible Serious Bacterial Infection\"?',\n correct:'Fast breathing (50 breaths or more per minute)',\n options:[\n 'Fast breathing (50 breaths or more per minute)',\n 'Severe chest indrawing',\n 'Axillary temperature less than 36.5\u00b0C',\n 'Movement only when stimulated or no movement at all'\n ],\n exp:'In IMNCI for young infants (0\u20132 months), fast breathing is defined as \u226560 breaths\/minute \u2014 not 50. The threshold of 50\/min applies to the 2\u201312 month age group. Severe chest indrawing, hypothermia (<35.5\u00b0C), and depressed activity are all included criteria for possible serious bacterial infection in this age group.'\n },\n {\n id:119,\n stem:'Neonatal tetanus elimination in India is defined as less than one case per:',\n correct:'1000 live births per year',\n options:[\n '100 live births per year',\n '1000 live births per year',\n '10000 live births per year',\n '100000 live births per year'\n ],\n exp:\"WHO and India's National Health Mission define neonatal tetanus elimination as fewer than 1 case per 1000 live births per year at the district level. India achieved elimination status in 2015. This threshold reflects a level of incidence low enough that routine immunisation and clean delivery practices can sustain control.\"\n },\n {\n id:120,\n stem:'Which one of the following facilities has been established at district hospitals in India to strengthen the care of low birth weight babies and sick newborns?',\n correct:'Special Newborn Care Units (SNCU)',\n options:[\n 'Special Newborn Care Units (SNCU)',\n 'Newborn Treatment Units (NTU)',\n 'Newborn Stabilization Units (NSU)',\n 'Shishu Suraksha Units (SSU)'\n ],\n exp:\"Special Newborn Care Units (SNCUs) are established at district and sub-district hospitals under India's Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy. They provide care for LBW, preterm, and sick newborns. Newborn Stabilisation Units (NSUs) are smaller facilities at CHC level \u2014 a step below SNCUs.\"\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){\n const j=Math.floor(Math.random()*(i+1));\n [a[i],a[j]]=[a[j],a[i]];\n }\n return a;\n }\n\n function esc(s){\n return s.replace(\/&\/g,'&').replace(\/<\/g,'<').replace(\/>\/g,'>').replace(\/\"\/g,'"');\n }\n\n const LETTERS=['A','B','C','D'];\n let userAnswers={};\n let answered=0;\n let shuffledOpts={};\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n container.innerHTML='';\n userAnswers={};\n answered=0;\n shuffledOpts={};\n document.getElementById(NS+'-score').style.display='none';\n updateStats();\n\n QUESTIONS.forEach(function(q){\n const opts=shuffle(q.options);\n shuffledOpts[q.id]=opts;\n\n const card=document.createElement('div');\n card.className='cq-card';\n\n card.innerHTML=\n '<div class=\"cq-qhead\">'+\n '<div class=\"cq-qnum\" 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Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36517","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 P1 Part-4 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/08\/cms-2020-p1-part-4\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta 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