CMS 2020 Paper II \u2013 Part 3 (Q81\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: cms20p2c \u2500\u2500 *\/\n#cms20p2c *,#cms20p2c *::before,#cms20p2c *::after{box-sizing:border-box;margin:0;padding:0}\n#cms20p2c{\n --ter:#C0603A;--ter-light:#e8825f;--ter-pale:#fdf1ec;\n --teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#e0d8d4;--bg:#fdfaf8;--white:#ffffff;\n --correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;\n --wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--bg);\n line-height:1.7;padding:0 0 48px;\n}\n#cms20p2c .cq-sentinel{height:1px}\n#cms20p2c .cq-statusbar{\n 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var(--teal);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms20p2c .cq-score-ring{width:110px;height:110px;border-radius:50%;background:conic-gradient(var(--teal) 0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms20p2c .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms20p2c .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms20p2c .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms20p2c .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms20p2c .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms20p2c .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms20p2c 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id=\"cms20p2c\">\n\n <div class=\"cq-sentinel\" id=\"cms20p2c-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms20p2c-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms20p2c-timer-item\">\u23f1 <strong id=\"cms20p2c-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p2c-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p2c-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p2c-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p2c-sn\">0<\/strong> \/ <strong id=\"cms20p2c-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p2c-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-grace\" id=\"cms20p2c-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time’s Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms20p2c-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms20p2c-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper II \u00b7 Part 3<\/h1>\n <p>Preventive & Social Medicine \u00b7 Community Medicine<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 81 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms20p2c-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p2c-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p2c-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p2c-score\">\n <div class=\"cq-score-ring\" id=\"cms20p2c-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p2c-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=\"cms20p2c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p2c-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p2c-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p2c-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p2c-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p2c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms20p2c', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60;\n const GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:81,\n stem:'Which of the following represent the properties of an ideal disinfectant?\\n1. It is broad spectrum\\n2. It is fast acting\\n3. It is non-toxic',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'An ideal disinfectant should be broad-spectrum (effective against bacteria, viruses, fungi, spores), fast-acting, non-toxic and non-irritant to tissues, stable, non-corrosive, affordable, and with no unpleasant odour. All three listed properties are correct \u2014 the answer is all three.'\n },\n {\n id:82,\n stem:'Which of the following measures can help reduce the risk of systemic hypertension?\\n1. Reduction in dietary intake of common salt\\n2. Controlling weight for age\\n3. Increasing potassium-rich foods in the diet',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'All three are evidence-based lifestyle modifications for hypertension prevention and control: (1) sodium restriction lowers BP by ~5 mmHg systolic, (2) weight reduction is one of the most effective interventions (~1 mmHg per kg lost), (3) potassium-rich diet (fruits, vegetables) counters sodium retention and promotes vasodilation.'\n },\n {\n id:83,\n stem:'Keeping biological determinants in perspective, consider the following statements:\\n1. Presence of a normal karyotype is the first requisite for human health\\n2. Genetic screening can play an important role in prevention of a wide spectrum of diseases\\n3. If an individual is allowed to live in healthy relationship with the environment, the person\\'s genetic potentialities can transform into phenotypic realities\\nWhich of the above statements is\/are correct?',\n correct:'1, 2 and 3',\n options:['1 and 2 only','1 and 3 only','1, 2 and 3','2 and 3 only'],\n exp:'All three statements are correct. Normal karyotype is fundamental to biological health. Genetic screening (neonatal, carrier, prenatal) prevents a wide range of hereditary and metabolic diseases. Gene-environment interaction underpins the concept that genetic potential is realised only under favourable environmental conditions \u2014 central to public health genetics.'\n },\n {\n id:84,\n stem:'NITI Aayog has the following roles EXCEPT:',\n correct:'It focuses on the development of \"Referral Service Complex\"',\n options:['It provides critical directional and strategic input in the development process','It provides relevant technical advice with focus on technology upgradation','It focuses on capacity building','It focuses on the development of \"Referral Service Complex\"'],\n exp:'\"Referral Service Complex\" is a health infrastructure concept under the National Rural Health Mission (NRHM) \/ NHM framework \u2014 not a NITI Aayog mandate. NITI Aayog (National Institution for Transforming India) functions as a policy think tank: strategic direction, technical advice, capacity building, cooperative federalism, and monitoring of government programmes.'\n },\n {\n id:85,\n stem:'Poor hand hygiene of a mess worker in a university college mess led to Hepatitis A cases in the hostel inmates. What type of epidemic will this exposure present with?\\n1. Propagated\\n2. Common source \u2014 continuous exposure\\n3. Common source \u2014 point exposure',\n correct:'2 only',\n options:['1 and 2','1 and 3','1 only','2 only'],\n exp:\"A single food handler continuously contaminating meals over a period = common source, continuous exposure epidemic. Cases accumulate gradually as long as the source persists, producing a plateau rather than a sharp peak on the epidemic curve. Point source = single event (one meal); propagated = person-to-person chain. Here the worker's ongoing poor hygiene = continuous common source.\"\n },\n {\n id:86,\n stem:'What is the specificity of sputum microscopy in detection of Pulmonary Tuberculosis (PTB) as per the information given below?\\n\\nPTB Present \/ PTB Absent \/ Total\\nPositive: 270 \/ 20 \/ 290\\nNegative: 30 \/ 180 \/ 210\\nTotal: 300 \/ 200 \/ 500',\n correct:'90%',\n options:['10%','36%','90%','94%'],\n exp:'Specificity = True Negatives \/ (True Negatives + False Positives) = TN \/ (TN + FP) = 180 \/ (180 + 20) = 180 \/ 200 = 0.90 = 90%. Sensitivity = 270\/300 = 90%. PPV = 270\/290 = 93%. NPV = 180\/210 = 86%.'\n },\n {\n id:87,\n stem:'In a cohort of 500 women attending antenatal clinic, 70% had ultrasonography (USG). Of women who had USG, 70 delivered LBW babies; whereas of women who did not undergo USG, 50 delivered LBW babies. The incidence of LBW babies among women who had USG is:',\n correct:'20%',\n options:['10%','15%','20%','25%'],\n exp:'70% of 500 = 350 women had USG. Of these, 70 delivered LBW babies. Incidence = 70\/350 = 0.20 = 20%. (Note: 30% = 150 women had no USG; 50 LBW among them = 50\/150 = 33% \u2014 higher incidence in non-USG group, suggesting selection bias or confounding.)'\n },\n {\n id:88,\n stem:'Major source of vitamin K1 is:',\n correct:'Fresh dark green vegetables',\n options:['Fresh dark green vegetables','Exposure of body to sunlight','Citrus fruits','Foods rich in polyunsaturated fatty acids'],\n exp:'Vitamin K1 (phylloquinone) is found primarily in green leafy and dark green vegetables \u2014 spinach, kale, broccoli, cabbage. Sunlight is the source for vitamin D, not K. Citrus fruits provide vitamin C. Vitamin K2 (menaquinone) is produced by gut bacteria and found in fermented foods.'\n },\n {\n id:89,\n stem:'Which one of the following is NOT a function of Epidemiology?',\n correct:'Making clinical diagnosis',\n options:['To study historically the rise and fall of disease in the population','Searching for the causes and risk factors','Identifying syndromes','Making clinical diagnosis'],\n exp:\"Making clinical diagnosis is a function of clinical medicine \u2014 not epidemiology. The functions of epidemiology (MacMahon and Pugh) include: describing disease distribution, identifying causes and risk factors, studying natural history, evaluating interventions, identifying syndromes, and providing the scientific basis for preventive and curative health services.\"\n },\n {\n id:90,\n stem:'Which one of the following is NOT a contagious disease?',\n correct:'Malaria',\n options:['Malaria','Scabies','Trachoma','Leprosy'],\n exp:\"Contagious diseases are those transmitted by direct contact from person to person. Scabies (direct skin contact), trachoma (contact with eye secretions), and leprosy (droplet\/contact) are all contagious. Malaria is transmitted via the bite of an infected Anopheles mosquito \u2014 it is a vector-borne disease, NOT contagious (does not spread person-to-person directly).\"\n },\n {\n id:91,\n stem:'In primary immune response, how much more antigenic dose is required to induce IgG antibodies as against the induction of IgM antibodies?',\n correct:'100 times more',\n options:['10 times more','25 times more','50 times more','100 times more'],\n exp:'In the primary immune response, IgM is induced at low antigen doses. IgG production requires class switching, which needs T-cell help and higher antigen doses \u2014 approximately 100 times more antigen than needed to induce IgM. This is relevant to vaccine design and the rationale for adjuvants and booster doses.'\n },\n {\n id:92,\n stem:'Pentavalent vaccine provides protection against which of the following diseases?',\n correct:'Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib',\n options:['Diphtheria, Pertussis, Tuberculosis, Measles and Hepatitis B','Diphtheria, Pertussis, Measles, Hepatitis B and Hib','Diphtheria, Pertussis, Tetanus, Hepatitis B and Rubella','Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib'],\n exp:\"Pentavalent vaccine (introduced under UIP in India) = DPT + Hepatitis B + Hib (Haemophilus influenzae type b) \u2014 5 antigens in one injection. It replaced the separate DPT and HepB vaccines. Given at 6, 10, and 14 weeks of age.\"\n },\n {\n id:93,\n stem:'Consider the following data for a country:\\nPopulation 0\u201314 years: 391,558,367\\nPopulation 15\u201364 years: 856,076,200\\nPopulation above 65 years: 71,943,390\\nWhat shall be the dependency ratio of this country?',\n correct:'54.1%',\n options:['42.4%','54.1%','66.2%','78.6%'],\n exp:'Dependency ratio = (Population 0\u201314 + Population 65+) \/ Population 15\u201364 \u00d7 100 = (391,558,367 + 71,943,390) \/ 856,076,200 \u00d7 100 = 463,501,757 \/ 856,076,200 \u00d7 100 = 54.1%. This means ~54 dependants per 100 working-age persons.'\n },\n {\n id:94,\n stem:'Which one of the following statements regarding Rabies Immunoglobulin is NOT true?',\n correct:'It can be administered till 15 days after the first dose of anti-rabies vaccine',\n options:['It should be administered only once as soon as possible after the initiation of post-exposure prophylaxis','It should be administered all into or around the wound sites','There is no scientific ground for performing a skin test prior to administering equine immunoglobulin','It can be administered till 15 days after the first dose of anti-rabies vaccine'],\n exp:\"WHO guidelines state RIG should be given on Day 0 (simultaneously with first vaccine dose) or as soon as possible, but NOT later than 7 days after the first vaccine dose \u2014 not 15 days. After 7 days, the body's own antibody response from the vaccine renders RIG unnecessary and potentially counterproductive.\"\n },\n {\n id:95,\n stem:'All of the following are true about Bedaquiline (BDQ) EXCEPT:',\n correct:'It is a bacteriostatic drug',\n options:['It specifically targets mycobacterial ATP synthase','It is a bacteriostatic drug','It has extended half-life','It has high volume of tissue distribution'],\n exp:'Bedaquiline is a diarylquinoline that specifically inhibits mycobacterial ATP synthase \u2014 it is BACTERICIDAL (not bacteriostatic). This distinguishes it from most other anti-TB drugs in its mechanism. It has an extremely long half-life (~5.5 months for terminal phase) and high volume of distribution, accumulating in tissues.'\n },\n {\n id:96,\n stem:'Visual inspection based screening test with 5% acetic acid is used for the screening of which one of the following cancers?',\n correct:'Cervix cancer',\n options:['Lung cancer','Cervix cancer','Oral cancer','Breast cancer'],\n exp:'VIA (Visual Inspection with Acetic Acid) is used for cervical cancer screening \u2014 acetic acid causes acetowhitening of dysplastic\/neoplastic cervical epithelium, visible to the naked eye. It is a low-cost, low-technology alternative to Pap smear suitable for low-resource settings. WHO recommends it as a primary screening tool in LMICs.'\n },\n {\n id:97,\n stem:'Predictive accuracy of a screening test depends on the following EXCEPT:',\n correct:'Disease incidence',\n options:['Disease prevalence','Disease incidence','Sensitivity of screening test','Specificity of screening test'],\n exp:\"Predictive accuracy (PPV and NPV) of a screening test depends on: (1) disease PREVALENCE in the population being screened, (2) sensitivity of the test, and (3) specificity of the test. Disease INCIDENCE (new cases over time) is not a direct determinant of PPV\/NPV \u2014 prevalence (proportion with disease at a point in time) is what matters in Bayes' theorem.\"\n },\n {\n id:98,\n stem:'How much zinc supplement is recommended by WHO and UNICEF for infants less than 6 months of age after an episode of acute diarrhoea?',\n correct:'10 mg per day for 10\u201314 days',\n options:['20 mg per day for 10\u201314 days','10 mg per day for 10\u201314 days','5 mg per day for 7 days','6 mg per day for 7 days'],\n exp:'WHO\/UNICEF joint statement (2004): Zinc supplementation for acute diarrhoea \u2014 infants <6 months: 10 mg\/day for 10\u201314 days; children \u22656 months: 20 mg\/day for 10\u201314 days. Zinc reduces stool output, duration of diarrhoea, and risk of recurrence over the following 2\u20133 months.'\n },\n {\n id:99,\n stem:'Which one of the following statements regarding sequential administration of IPV and OPV is NOT correct?',\n correct:'Intestinal mucosal immunity is lost due to IPV administration',\n options:['It will be cost effective in developing countries for polio prevention','The combined schedules of IPV and OPV appear to reduce or prevent Vaccine Associated Paralytic Polio (VAPP)','Intestinal mucosal immunity is lost due to IPV administration','IPV and OPV together may optimise both the humoral and mucosal immunogenicity of polio vaccine'],\n exp:\"IPV does NOT cause loss of intestinal mucosal immunity \u2014 it simply does not generate it in the first place (it produces humoral\/serum immunity only). The statement that mucosal immunity is 'lost due to IPV' is incorrect. Sequential IPV\u2192OPV schedules reduce VAPP risk, are cost-effective, and together provide both humoral (IPV) and mucosal (OPV) immunity.\"\n },\n {\n id:100,\n stem:'What is the recommended dose regimen of Vitamin A for the treatment of early stages of Xerophthalmia?',\n correct:'2 lac IU on two successive days',\n options:['Single massive dose of 2 lac International Units (IU)','2 lac IU on two successive days','2 doses of 1 lac IU in two successive days','2 doses of 1 lac IU at a gap of one week'],\n exp:'WHO protocol for Xerophthalmia treatment: Day 1 \u2014 200,000 IU (2 lac IU) orally; Day 2 \u2014 200,000 IU; Day 14 (or at discharge) \u2014 200,000 IU. For early stages (night blindness, conjunctival xerosis), the first two doses (Day 1 and Day 2) are the primary treatment = 2 lac IU on two successive days. Infants under 6 months receive half the dose.'\n },\n {\n id:101,\n stem:'Which is the most specific causative agent of Rabies?',\n correct:'Lyssavirus serotype 1',\n options:['Lyssavirus serotype 1','Lyssavirus serotype 2','Lyssavirus serotype 3','Lyssavirus serotype 4'],\n exp:'Classical rabies virus is Lyssavirus genotype\/serotype 1 \u2014 responsible for the vast majority of human rabies cases worldwide. Serotypes 2, 3, and 4 (Lagos bat virus, Mokola virus, Duvenhage virus) are related but rare and geographically restricted African lyssaviruses. All current anti-rabies vaccines are based on serotype 1.'\n },\n {\n id:102,\n stem:'Which one of the following is the antibiotic of choice for the prevention of Rheumatic heart disease?',\n correct:'Benzathine Benzyl Penicillin',\n options:['Benzathine Benzyl Penicillin','Procaine Penicillin','Doxycycline','Ciprofloxacin'],\n exp:'Benzathine Benzyl Penicillin (long-acting penicillin G) given IM every 3\u20134 weeks is the drug of choice for secondary prophylaxis of Rheumatic Heart Disease \u2014 it maintains adequate penicillin levels to prevent Group A Streptococcal pharyngitis and recurrent rheumatic fever. Duration depends on age, carditis severity, and access to healthcare.'\n },\n {\n id:103,\n stem:'All of the following are global targets for WHO Global Action Plan (2013\u20132020) for Prevention and Control of NCDs EXCEPT:',\n correct:'A 10% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases',\n options:['A 10% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases','A 10% relative reduction in prevalence of insufficient physical activity','A 10% relative reduction in mean population intake of salt\/sodium','At least 10% relative reduction in the harmful use of alcohol'],\n exp:\"The WHO NCD Global Action Plan 2013\u20132020 target for premature mortality was a 25% relative reduction (not 10%) in premature deaths from the four major NCDs by 2025 \u2014 sometimes called the '25 by 25' target. The 10% figure for physical inactivity, salt intake, and harmful alcohol use are correct targets. The premature mortality target of 10% is therefore wrong.\"\n },\n {\n id:104,\n stem:'Under the Employees State Insurance (ESI) Scheme, extended sickness benefit is provided in which of the following infectious diseases?\\n1. Tuberculosis\\n2. Leprosy\\n3. Chronic empyema',\n correct:'1 and 2 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'ESI Extended Sickness Benefit covers 34 specified long-term diseases including tuberculosis and leprosy (along with malignancy, mental illness, cardiac disease, renal failure, epilepsy, and others). Chronic empyema is not among the listed diseases eligible for ESI extended sickness benefit, which provides up to 2 years of cash benefit.'\n },\n {\n id:105,\n stem:'In the context of NCD prevention and control in India, the extent of relative reduction in household use of solid fuels as a primary source of energy for cooking by 2025 is targeted at:',\n correct:'40%',\n options:['30%','40%','50%','60%'],\n exp:\"India's National Action Plan for NCDs includes a target of 40% relative reduction in household solid fuel use by 2025 \u2014 addressing indoor air pollution as a major risk factor for COPD, respiratory infections, and cardiovascular disease, particularly in rural women. This is one of India's specific NCD targets beyond WHO's global plan.\"\n },\n {\n id:106,\n stem:'Consider the following criteria which may indicate elimination of lymphatic filariasis in a community:\\n1. When lymphatic filariasis ceases to be a public health problem in the community\\n2. When the number of microfilaria carriers declines to 1.5% within the community\\n3. When children born in the community after the initiation of elimination programme are free from circulating antigenaemia\\nWhich of the criteria stated above hold true?',\n correct:'1 and 3 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'WHO criteria for LF elimination: (1) it ceases to be a public health problem AND (2) microfilaria prevalence falls to <1% (not 1.5% \u2014 statement 2 uses wrong threshold). (3) Children born after the programme are free from circulating antigenaemia confirms interruption of transmission. Statements 1 and 3 are correct; statement 2 has the wrong threshold.'\n },\n {\n id:107,\n stem:'Hold-over time of cold chain equipment depends on all of the following factors EXCEPT:',\n correct:'Types of vaccines kept',\n options:['Ambient temperature','Quantity of vaccines kept','Types of vaccines kept','Condition of icepack lining'],\n exp:\"Hold-over time (how long equipment maintains adequate temperature after power failure) depends on: ambient temperature (higher = shorter hold-over), insulation quality (icepack lining condition), and quantity\/mass of frozen icepacks inside (more mass = longer). The TYPE of vaccine stored doesn't affect the physical thermal properties of the equipment \u2014 all vaccines require 2\u20138\u00b0C regardless of type.\"\n },\n {\n id:108,\n stem:'Which of the following statements regarding Physical Quality of Life Index (PQLI) are correct?\\n1. It consolidates infant mortality, life expectancy at age one, and literacy\\n2. It does not measure economic growth but measures the result of economic policies\\n3. For each component, the performance of individual countries is placed on a scale of 0\u2013100',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'All three statements about PQLI (developed by Morris David Morris, 1979) are correct: (1) it combines infant mortality rate, life expectancy at age 1 (not birth), and basic literacy rate; (2) it measures quality of life outcomes rather than economic inputs (unlike GNP); (3) each component is scored 0\u2013100 and averaged to give a composite PQLI score.'\n },\n {\n id:109,\n stem:'Disability-adjusted life years (DALYs) include:',\n correct:'Both YLL and YLD',\n options:['Years of lost life (YLL)','Years lost to disability (YLD)','Both YLL and YLD','Neither YLL nor YLD'],\n exp:'DALY = YLL (Years of Life Lost due to premature death) + YLD (Years Lived with Disability). DALYs quantify the total burden of disease \u2014 both mortality (YLL) and morbidity (YLD). One DALY = one year of healthy life lost. Originally developed by Murray and Lopez for the Global Burden of Disease study (1993).'\n },\n {\n id:110,\n stem:'Which of the following are health care delivery indicators?\\n1. Population per trained birth attendant\\n2. Population per health\/sub centre\\n3. Doctor-nurse ratio',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Health care delivery (coverage) indicators measure the availability and access to health services. All three are standard indicators: population per trained birth attendant and population per health\/sub-centre measure facility coverage; doctor-nurse ratio reflects human resource availability and the composition of the healthcare workforce. All are used in health system assessment.'\n },\n {\n id:111,\n stem:'Which of the following key action areas are incorporated in the Ottawa Charter?\\n1. Building healthy public policy\\n2. Strengthening community action for health\\n3. Reorienting health services',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'The Ottawa Charter for Health Promotion (1986) identifies five action areas: (1) Build healthy public policy, (2) Create supportive environments, (3) Strengthen community action, (4) Develop personal skills, (5) Reorient health services. All three listed options are explicitly in the Charter \u2014 all correct.'\n },\n {\n id:112,\n stem:'Under Chapter XXI of the 10th revision of ICD (ICD-10), lifestyle-related problems fall under which of the following code range?',\n correct:'Z 72.0 \u2013 Z 72.5',\n options:['U 50.0 \u2013 U 50.5','U 10.0 \u2013 U 10.5','Z 72.0 \u2013 Z 72.5','Z 10.0 \u2013 Z 10.5'],\n exp:'ICD-10 Chapter XXI (Z00\u2013Z99): Factors influencing health status and contact with health services. Z72 = Problems related to lifestyle, including: Z72.0 (tobacco use), Z72.1 (alcohol use), Z72.2 (drug use), Z72.3 (lack of physical exercise), Z72.4 (inappropriate diet\/eating habits), Z72.5 (high-risk sexual behaviour). U codes are for special purposes\/COVID-19.'\n },\n {\n id:113,\n stem:'Which of the following diseases are spread by airborne transmission?\\n1. Influenza\\n2. Chicken pox\\n3. Q-fever\\n4. Psittacosis',\n correct:'1, 2, 3 and 4',\n options:['1 and 3 only','1 and 4 only','3 and 4 only','1, 2, 3 and 4'],\n exp:'All four are transmitted by airborne route: Influenza (aerosol droplet nuclei), Chickenpox\/Varicella (airborne \u2014 travels long distances, hence highly infectious), Q-fever\/Coxiella burnetii (inhalation of contaminated dust\/aerosols from animal products), Psittacosis\/Chlamydia psittaci (inhalation of dried bird excreta\/secretions). All four qualify.'\n },\n {\n id:114,\n stem:'DASH diet plan is advocated in the control of which one of the following diseases?',\n correct:'Hypertension',\n options:['Cancer','Chronic Obstructive Pulmonary Disease','Hypertension','Rheumatic heart disease'],\n exp:'DASH (Dietary Approaches to Stop Hypertension) diet emphasises fruits, vegetables, whole grains, low-fat dairy, and reduced sodium and saturated fats. Clinical trials show it reduces systolic BP by 8\u201314 mmHg. It is specifically designed for hypertension prevention and management, though its overall healthy pattern also benefits cardiovascular health.'\n },\n {\n id:115,\n stem:'Endemic ascites occurs due to:',\n correct:'Naturally occurring toxin',\n options:['Naturally occurring toxin','Bacterial toxin','Fungal toxin','Viral toxin'],\n exp:'Endemic ascites (hepatic veno-occlusive disease \/ Budd-Chiari-like syndrome) in certain regions (e.g., India \u2014 Sarguja, Rajasthan) is caused by pyrrolizidine alkaloids \u2014 naturally occurring plant toxins found in Crotalaria and Heliotropium species contaminating cereal crops. These alkaloids cause hepatic sinusoidal obstruction.'\n },\n {\n id:116,\n stem:'The presence of which of the following bacteria in drinking water is an important confirmatory evidence of recent faecal pollution of water?',\n correct:'E. coli',\n options:['E. coli','Streptococci','Clostridium','Klebsiella'],\n exp:\"E. coli (specifically thermotolerant\/faecal coliforms) is the WHO-recommended indicator of recent faecal contamination of drinking water. Its presence confirms faecal pollution because it survives only briefly outside the gut. Clostridium perfringens indicates past faecal contamination. Streptococci and Klebsiella are less specific indicators.\"\n },\n {\n id:117,\n stem:'With regard to the Goals, Milestones and Targets for the WHO Global Technical Strategy for Malaria (2016\u20132030), consider the following statements:\\n1. Compared to 2015, target is to reduce malaria mortality rates globally by at least 90% by 2030\\n2. Compared to 2015, target is to reduce malaria case incidence by 90% by 2030\\n3. Eliminate malaria from at least 35 countries where malaria was transmitted in 2015, by 2030',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'WHO Global Technical Strategy for Malaria 2016\u20132030 targets by 2030 (compared to 2015 baseline): (1) \u226590% reduction in malaria mortality rates \u2713, (2) \u226590% reduction in malaria case incidence \u2713, (3) elimination in at least 35 countries that had ongoing malaria transmission in 2015 \u2713. All three statements are correct.'\n },\n {\n id:118,\n stem:'Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?',\n correct:'LNG-20 (Mirena)',\n options:['Cu T-380A','ML-Cu 375','Progestasert','LNG-20 (Mirena)'],\n exp:'LNG-20 (Levonorgestrel IUS, Mirena) releases 20 mcg\/day of levonorgestrel locally \u2014 it has a failure rate of ~0.2\/100 woman-years, significantly reduces menstrual blood loss (treats menorrhagia), and reduces ectopic pregnancy risk by suppressing ovulation and thickening cervical mucus. CuT-380A has a failure rate of ~0.6\u20130.8\/100.'\n },\n {\n id:119,\n stem:'The incidence of diarrhoea is highest among infants in the age group of 6\u201311 months due to all of the following reasons EXCEPT:',\n correct:'Eruption of teeth',\n options:['Declining level of maternal antibodies','Introduction of foods which may be contaminated','Eruption of teeth','Direct contact with human or animal faeces'],\n exp:'Diarrhoea peaks at 6\u201311 months due to: waning maternal antibody protection, introduction of complementary foods (contamination risk), increased exploratory oral behaviour (hand-to-mouth contact with faeces). Teething\/eruption of teeth is a commonly believed but scientifically unsupported cause of diarrhoea \u2014 it does not cause true diarrhoeal illness.'\n },\n {\n id:120,\n stem:'In the context of \"Anti-Malaria Month Campaign\", consider the following statements:\\n1. It is observed every year in the month of June\\n2. It is planned during the Monsoon season\\n3. It aims to enhance the level of community awareness and participation',\n correct:'1 and 3',\n options:['1 and 2','2 and 3','3 only','1 and 3'],\n exp:\"India's Anti-Malaria Month is observed every June \u2014 statement 1 correct. June marks the PRE-monsoon\/early monsoon period (not the peak monsoon season) \u2014 the campaign is timed to mobilise communities BEFORE mosquito breeding peaks, not during monsoon \u2014 statement 2 is inaccurate. Statement 3 (community awareness and participation) is a primary objective \u2014 correct. Statements 1 and 3 are true.\"\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[a[i],a[j]]=[a[j],a[i]];}\n return a;\n }\n function esc(s){return s.replace(\/&\/g,'&').replace(\/<\/g,'<').replace(\/>\/g,'>').replace(\/\"\/g,'"')}\n\n const LETTERS=['A','B','C','D'];\n let userAnswers={}, answered=0, shuffledOpts={};\n let timerRunning=false, timerRemaining=TIMER_SECS, timerInterval=null, graceInterval=null;\n let quizSubmitted=false;\n\n function fmtTime(s){\n const m=Math.floor(s\/60),sec=s%60;\n return String(m).padStart(2,'0')+':'+String(sec).padStart(2,'0');\n }\n\n function startTimer(){\n if(timerRunning||quizSubmitted)return;\n timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 '+fmtTime(timerRemaining);\n btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n 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Submitting in 10 Submit Now Combined Medical Services Examination 2020Paper II \u00b7 Part 3 Preventive & Social Medicine \u00b7 Community Medicine Questions 81 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba Retry 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-36553","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 Paper-2 Part-3 - 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\/13\/cms-2020-paper-2-part-3\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2020 Paper-2 Part-3 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2020 Paper II \u2013 Part 3 (Q81\u2013Q120) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time’s Up! 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var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s,color 0.2s}\n#cms20p2c .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){\n #cms20p2c .cq-header h1{font-size:1.15rem}\n #cms20p2c .cq-qtext{font-size:0.88rem}\n #cms20p2c .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms20p2c\">\n\n <div class=\"cq-sentinel\" id=\"cms20p2c-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms20p2c-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms20p2c-timer-item\">\u23f1 <strong id=\"cms20p2c-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p2c-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p2c-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p2c-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p2c-sn\">0<\/strong> \/ <strong id=\"cms20p2c-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p2c-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-grace\" id=\"cms20p2c-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time’s Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms20p2c-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms20p2c-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper II \u00b7 Part 3<\/h1>\n <p>Preventive & Social Medicine \u00b7 Community Medicine<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 81 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms20p2c-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p2c-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p2c-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p2c-score\">\n <div class=\"cq-score-ring\" id=\"cms20p2c-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p2c-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=\"cms20p2c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p2c-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p2c-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p2c-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p2c-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p2c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms20p2c', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60;\n const GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:81,\n stem:'Which of the following represent the properties of an ideal disinfectant?\\n1. It is broad spectrum\\n2. It is fast acting\\n3. It is non-toxic',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'An ideal disinfectant should be broad-spectrum (effective against bacteria, viruses, fungi, spores), fast-acting, non-toxic and non-irritant to tissues, stable, non-corrosive, affordable, and with no unpleasant odour. All three listed properties are correct \u2014 the answer is all three.'\n },\n {\n id:82,\n stem:'Which of the following measures can help reduce the risk of systemic hypertension?\\n1. Reduction in dietary intake of common salt\\n2. Controlling weight for age\\n3. Increasing potassium-rich foods in the diet',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'All three are evidence-based lifestyle modifications for hypertension prevention and control: (1) sodium restriction lowers BP by ~5 mmHg systolic, (2) weight reduction is one of the most effective interventions (~1 mmHg per kg lost), (3) potassium-rich diet (fruits, vegetables) counters sodium retention and promotes vasodilation.'\n },\n {\n id:83,\n stem:'Keeping biological determinants in perspective, consider the following statements:\\n1. Presence of a normal karyotype is the first requisite for human health\\n2. Genetic screening can play an important role in prevention of a wide spectrum of diseases\\n3. If an individual is allowed to live in healthy relationship with the environment, the person\\'s genetic potentialities can transform into phenotypic realities\\nWhich of the above statements is\/are correct?',\n correct:'1, 2 and 3',\n options:['1 and 2 only','1 and 3 only','1, 2 and 3','2 and 3 only'],\n exp:'All three statements are correct. Normal karyotype is fundamental to biological health. Genetic screening (neonatal, carrier, prenatal) prevents a wide range of hereditary and metabolic diseases. Gene-environment interaction underpins the concept that genetic potential is realised only under favourable environmental conditions \u2014 central to public health genetics.'\n },\n {\n id:84,\n stem:'NITI Aayog has the following roles EXCEPT:',\n correct:'It focuses on the development of \"Referral Service Complex\"',\n options:['It provides critical directional and strategic input in the development process','It provides relevant technical advice with focus on technology upgradation','It focuses on capacity building','It focuses on the development of \"Referral Service Complex\"'],\n exp:'\"Referral Service Complex\" is a health infrastructure concept under the National Rural Health Mission (NRHM) \/ NHM framework \u2014 not a NITI Aayog mandate. NITI Aayog (National Institution for Transforming India) functions as a policy think tank: strategic direction, technical advice, capacity building, cooperative federalism, and monitoring of government programmes.'\n },\n {\n id:85,\n stem:'Poor hand hygiene of a mess worker in a university college mess led to Hepatitis A cases in the hostel inmates. What type of epidemic will this exposure present with?\\n1. Propagated\\n2. Common source \u2014 continuous exposure\\n3. Common source \u2014 point exposure',\n correct:'2 only',\n options:['1 and 2','1 and 3','1 only','2 only'],\n exp:\"A single food handler continuously contaminating meals over a period = common source, continuous exposure epidemic. Cases accumulate gradually as long as the source persists, producing a plateau rather than a sharp peak on the epidemic curve. Point source = single event (one meal); propagated = person-to-person chain. Here the worker's ongoing poor hygiene = continuous common source.\"\n },\n {\n id:86,\n stem:'What is the specificity of sputum microscopy in detection of Pulmonary Tuberculosis (PTB) as per the information given below?\\n\\nPTB Present \/ PTB Absent \/ Total\\nPositive: 270 \/ 20 \/ 290\\nNegative: 30 \/ 180 \/ 210\\nTotal: 300 \/ 200 \/ 500',\n correct:'90%',\n options:['10%','36%','90%','94%'],\n exp:'Specificity = True Negatives \/ (True Negatives + False Positives) = TN \/ (TN + FP) = 180 \/ (180 + 20) = 180 \/ 200 = 0.90 = 90%. Sensitivity = 270\/300 = 90%. PPV = 270\/290 = 93%. NPV = 180\/210 = 86%.'\n },\n {\n id:87,\n stem:'In a cohort of 500 women attending antenatal clinic, 70% had ultrasonography (USG). Of women who had USG, 70 delivered LBW babies; whereas of women who did not undergo USG, 50 delivered LBW babies. The incidence of LBW babies among women who had USG is:',\n correct:'20%',\n options:['10%','15%','20%','25%'],\n exp:'70% of 500 = 350 women had USG. Of these, 70 delivered LBW babies. Incidence = 70\/350 = 0.20 = 20%. (Note: 30% = 150 women had no USG; 50 LBW among them = 50\/150 = 33% \u2014 higher incidence in non-USG group, suggesting selection bias or confounding.)'\n },\n {\n id:88,\n stem:'Major source of vitamin K1 is:',\n correct:'Fresh dark green vegetables',\n options:['Fresh dark green vegetables','Exposure of body to sunlight','Citrus fruits','Foods rich in polyunsaturated fatty acids'],\n exp:'Vitamin K1 (phylloquinone) is found primarily in green leafy and dark green vegetables \u2014 spinach, kale, broccoli, cabbage. Sunlight is the source for vitamin D, not K. Citrus fruits provide vitamin C. Vitamin K2 (menaquinone) is produced by gut bacteria and found in fermented foods.'\n },\n {\n id:89,\n stem:'Which one of the following is NOT a function of Epidemiology?',\n correct:'Making clinical diagnosis',\n options:['To study historically the rise and fall of disease in the population','Searching for the causes and risk factors','Identifying syndromes','Making clinical diagnosis'],\n exp:\"Making clinical diagnosis is a function of clinical medicine \u2014 not epidemiology. The functions of epidemiology (MacMahon and Pugh) include: describing disease distribution, identifying causes and risk factors, studying natural history, evaluating interventions, identifying syndromes, and providing the scientific basis for preventive and curative health services.\"\n },\n {\n id:90,\n stem:'Which one of the following is NOT a contagious disease?',\n correct:'Malaria',\n options:['Malaria','Scabies','Trachoma','Leprosy'],\n exp:\"Contagious diseases are those transmitted by direct contact from person to person. Scabies (direct skin contact), trachoma (contact with eye secretions), and leprosy (droplet\/contact) are all contagious. Malaria is transmitted via the bite of an infected Anopheles mosquito \u2014 it is a vector-borne disease, NOT contagious (does not spread person-to-person directly).\"\n },\n {\n id:91,\n stem:'In primary immune response, how much more antigenic dose is required to induce IgG antibodies as against the induction of IgM antibodies?',\n correct:'100 times more',\n options:['10 times more','25 times more','50 times more','100 times more'],\n exp:'In the primary immune response, IgM is induced at low antigen doses. IgG production requires class switching, which needs T-cell help and higher antigen doses \u2014 approximately 100 times more antigen than needed to induce IgM. This is relevant to vaccine design and the rationale for adjuvants and booster doses.'\n },\n {\n id:92,\n stem:'Pentavalent vaccine provides protection against which of the following diseases?',\n correct:'Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib',\n options:['Diphtheria, Pertussis, Tuberculosis, Measles and Hepatitis B','Diphtheria, Pertussis, Measles, Hepatitis B and Hib','Diphtheria, Pertussis, Tetanus, Hepatitis B and Rubella','Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib'],\n exp:\"Pentavalent vaccine (introduced under UIP in India) = DPT + Hepatitis B + Hib (Haemophilus influenzae type b) \u2014 5 antigens in one injection. It replaced the separate DPT and HepB vaccines. Given at 6, 10, and 14 weeks of age.\"\n },\n {\n id:93,\n stem:'Consider the following data for a country:\\nPopulation 0\u201314 years: 391,558,367\\nPopulation 15\u201364 years: 856,076,200\\nPopulation above 65 years: 71,943,390\\nWhat shall be the dependency ratio of this country?',\n correct:'54.1%',\n options:['42.4%','54.1%','66.2%','78.6%'],\n exp:'Dependency ratio = (Population 0\u201314 + Population 65+) \/ Population 15\u201364 \u00d7 100 = (391,558,367 + 71,943,390) \/ 856,076,200 \u00d7 100 = 463,501,757 \/ 856,076,200 \u00d7 100 = 54.1%. This means ~54 dependants per 100 working-age persons.'\n },\n {\n id:94,\n stem:'Which one of the following statements regarding Rabies Immunoglobulin is NOT true?',\n correct:'It can be administered till 15 days after the first dose of anti-rabies vaccine',\n options:['It should be administered only once as soon as possible after the initiation of post-exposure prophylaxis','It should be administered all into or around the wound sites','There is no scientific ground for performing a skin test prior to administering equine immunoglobulin','It can be administered till 15 days after the first dose of anti-rabies vaccine'],\n exp:\"WHO guidelines state RIG should be given on Day 0 (simultaneously with first vaccine dose) or as soon as possible, but NOT later than 7 days after the first vaccine dose \u2014 not 15 days. After 7 days, the body's own antibody response from the vaccine renders RIG unnecessary and potentially counterproductive.\"\n },\n {\n id:95,\n stem:'All of the following are true about Bedaquiline (BDQ) EXCEPT:',\n correct:'It is a bacteriostatic drug',\n options:['It specifically targets mycobacterial ATP synthase','It is a bacteriostatic drug','It has extended half-life','It has high volume of tissue distribution'],\n exp:'Bedaquiline is a diarylquinoline that specifically inhibits mycobacterial ATP synthase \u2014 it is BACTERICIDAL (not bacteriostatic). This distinguishes it from most other anti-TB drugs in its mechanism. It has an extremely long half-life (~5.5 months for terminal phase) and high volume of distribution, accumulating in tissues.'\n },\n {\n id:96,\n stem:'Visual inspection based screening test with 5% acetic acid is used for the screening of which one of the following cancers?',\n correct:'Cervix cancer',\n options:['Lung cancer','Cervix cancer','Oral cancer','Breast cancer'],\n exp:'VIA (Visual Inspection with Acetic Acid) is used for cervical cancer screening \u2014 acetic acid causes acetowhitening of dysplastic\/neoplastic cervical epithelium, visible to the naked eye. It is a low-cost, low-technology alternative to Pap smear suitable for low-resource settings. WHO recommends it as a primary screening tool in LMICs.'\n },\n {\n id:97,\n stem:'Predictive accuracy of a screening test depends on the following EXCEPT:',\n correct:'Disease incidence',\n options:['Disease prevalence','Disease incidence','Sensitivity of screening test','Specificity of screening test'],\n exp:\"Predictive accuracy (PPV and NPV) of a screening test depends on: (1) disease PREVALENCE in the population being screened, (2) sensitivity of the test, and (3) specificity of the test. Disease INCIDENCE (new cases over time) is not a direct determinant of PPV\/NPV \u2014 prevalence (proportion with disease at a point in time) is what matters in Bayes' theorem.\"\n },\n {\n id:98,\n stem:'How much zinc supplement is recommended by WHO and UNICEF for infants less than 6 months of age after an episode of acute diarrhoea?',\n correct:'10 mg per day for 10\u201314 days',\n options:['20 mg per day for 10\u201314 days','10 mg per day for 10\u201314 days','5 mg per day for 7 days','6 mg per day for 7 days'],\n exp:'WHO\/UNICEF joint statement (2004): Zinc supplementation for acute diarrhoea \u2014 infants <6 months: 10 mg\/day for 10\u201314 days; children \u22656 months: 20 mg\/day for 10\u201314 days. Zinc reduces stool output, duration of diarrhoea, and risk of recurrence over the following 2\u20133 months.'\n },\n {\n id:99,\n stem:'Which one of the following statements regarding sequential administration of IPV and OPV is NOT correct?',\n correct:'Intestinal mucosal immunity is lost due to IPV administration',\n options:['It will be cost effective in developing countries for polio prevention','The combined schedules of IPV and OPV appear to reduce or prevent Vaccine Associated Paralytic Polio (VAPP)','Intestinal mucosal immunity is lost due to IPV administration','IPV and OPV together may optimise both the humoral and mucosal immunogenicity of polio vaccine'],\n exp:\"IPV does NOT cause loss of intestinal mucosal immunity \u2014 it simply does not generate it in the first place (it produces humoral\/serum immunity only). The statement that mucosal immunity is 'lost due to IPV' is incorrect. Sequential IPV\u2192OPV schedules reduce VAPP risk, are cost-effective, and together provide both humoral (IPV) and mucosal (OPV) immunity.\"\n },\n {\n id:100,\n stem:'What is the recommended dose regimen of Vitamin A for the treatment of early stages of Xerophthalmia?',\n correct:'2 lac IU on two successive days',\n options:['Single massive dose of 2 lac International Units (IU)','2 lac IU on two successive days','2 doses of 1 lac IU in two successive days','2 doses of 1 lac IU at a gap of one week'],\n exp:'WHO protocol for Xerophthalmia treatment: Day 1 \u2014 200,000 IU (2 lac IU) orally; Day 2 \u2014 200,000 IU; Day 14 (or at discharge) \u2014 200,000 IU. For early stages (night blindness, conjunctival xerosis), the first two doses (Day 1 and Day 2) are the primary treatment = 2 lac IU on two successive days. Infants under 6 months receive half the dose.'\n },\n {\n id:101,\n stem:'Which is the most specific causative agent of Rabies?',\n correct:'Lyssavirus serotype 1',\n options:['Lyssavirus serotype 1','Lyssavirus serotype 2','Lyssavirus serotype 3','Lyssavirus serotype 4'],\n exp:'Classical rabies virus is Lyssavirus genotype\/serotype 1 \u2014 responsible for the vast majority of human rabies cases worldwide. Serotypes 2, 3, and 4 (Lagos bat virus, Mokola virus, Duvenhage virus) are related but rare and geographically restricted African lyssaviruses. All current anti-rabies vaccines are based on serotype 1.'\n },\n {\n id:102,\n stem:'Which one of the following is the antibiotic of choice for the prevention of Rheumatic heart disease?',\n correct:'Benzathine Benzyl Penicillin',\n options:['Benzathine Benzyl Penicillin','Procaine Penicillin','Doxycycline','Ciprofloxacin'],\n exp:'Benzathine Benzyl Penicillin (long-acting penicillin G) given IM every 3\u20134 weeks is the drug of choice for secondary prophylaxis of Rheumatic Heart Disease \u2014 it maintains adequate penicillin levels to prevent Group A Streptococcal pharyngitis and recurrent rheumatic fever. Duration depends on age, carditis severity, and access to healthcare.'\n },\n {\n id:103,\n stem:'All of the following are global targets for WHO Global Action Plan (2013\u20132020) for Prevention and Control of NCDs EXCEPT:',\n correct:'A 10% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases',\n options:['A 10% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases','A 10% relative reduction in prevalence of insufficient physical activity','A 10% relative reduction in mean population intake of salt\/sodium','At least 10% relative reduction in the harmful use of alcohol'],\n exp:\"The WHO NCD Global Action Plan 2013\u20132020 target for premature mortality was a 25% relative reduction (not 10%) in premature deaths from the four major NCDs by 2025 \u2014 sometimes called the '25 by 25' target. The 10% figure for physical inactivity, salt intake, and harmful alcohol use are correct targets. The premature mortality target of 10% is therefore wrong.\"\n },\n {\n id:104,\n stem:'Under the Employees State Insurance (ESI) Scheme, extended sickness benefit is provided in which of the following infectious diseases?\\n1. Tuberculosis\\n2. Leprosy\\n3. Chronic empyema',\n correct:'1 and 2 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'ESI Extended Sickness Benefit covers 34 specified long-term diseases including tuberculosis and leprosy (along with malignancy, mental illness, cardiac disease, renal failure, epilepsy, and others). Chronic empyema is not among the listed diseases eligible for ESI extended sickness benefit, which provides up to 2 years of cash benefit.'\n },\n {\n id:105,\n stem:'In the context of NCD prevention and control in India, the extent of relative reduction in household use of solid fuels as a primary source of energy for cooking by 2025 is targeted at:',\n correct:'40%',\n options:['30%','40%','50%','60%'],\n exp:\"India's National Action Plan for NCDs includes a target of 40% relative reduction in household solid fuel use by 2025 \u2014 addressing indoor air pollution as a major risk factor for COPD, respiratory infections, and cardiovascular disease, particularly in rural women. This is one of India's specific NCD targets beyond WHO's global plan.\"\n },\n {\n id:106,\n stem:'Consider the following criteria which may indicate elimination of lymphatic filariasis in a community:\\n1. When lymphatic filariasis ceases to be a public health problem in the community\\n2. When the number of microfilaria carriers declines to 1.5% within the community\\n3. When children born in the community after the initiation of elimination programme are free from circulating antigenaemia\\nWhich of the criteria stated above hold true?',\n correct:'1 and 3 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'WHO criteria for LF elimination: (1) it ceases to be a public health problem AND (2) microfilaria prevalence falls to <1% (not 1.5% \u2014 statement 2 uses wrong threshold). (3) Children born after the programme are free from circulating antigenaemia confirms interruption of transmission. Statements 1 and 3 are correct; statement 2 has the wrong threshold.'\n },\n {\n id:107,\n stem:'Hold-over time of cold chain equipment depends on all of the following factors EXCEPT:',\n correct:'Types of vaccines kept',\n options:['Ambient temperature','Quantity of vaccines kept','Types of vaccines kept','Condition of icepack lining'],\n exp:\"Hold-over time (how long equipment maintains adequate temperature after power failure) depends on: ambient temperature (higher = shorter hold-over), insulation quality (icepack lining condition), and quantity\/mass of frozen icepacks inside (more mass = longer). The TYPE of vaccine stored doesn't affect the physical thermal properties of the equipment \u2014 all vaccines require 2\u20138\u00b0C regardless of type.\"\n },\n {\n id:108,\n stem:'Which of the following statements regarding Physical Quality of Life Index (PQLI) are correct?\\n1. It consolidates infant mortality, life expectancy at age one, and literacy\\n2. It does not measure economic growth but measures the result of economic policies\\n3. For each component, the performance of individual countries is placed on a scale of 0\u2013100',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'All three statements about PQLI (developed by Morris David Morris, 1979) are correct: (1) it combines infant mortality rate, life expectancy at age 1 (not birth), and basic literacy rate; (2) it measures quality of life outcomes rather than economic inputs (unlike GNP); (3) each component is scored 0\u2013100 and averaged to give a composite PQLI score.'\n },\n {\n id:109,\n stem:'Disability-adjusted life years (DALYs) include:',\n correct:'Both YLL and YLD',\n options:['Years of lost life (YLL)','Years lost to disability (YLD)','Both YLL and YLD','Neither YLL nor YLD'],\n exp:'DALY = YLL (Years of Life Lost due to premature death) + YLD (Years Lived with Disability). DALYs quantify the total burden of disease \u2014 both mortality (YLL) and morbidity (YLD). One DALY = one year of healthy life lost. Originally developed by Murray and Lopez for the Global Burden of Disease study (1993).'\n },\n {\n id:110,\n stem:'Which of the following are health care delivery indicators?\\n1. Population per trained birth attendant\\n2. Population per health\/sub centre\\n3. Doctor-nurse ratio',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Health care delivery (coverage) indicators measure the availability and access to health services. All three are standard indicators: population per trained birth attendant and population per health\/sub-centre measure facility coverage; doctor-nurse ratio reflects human resource availability and the composition of the healthcare workforce. All are used in health system assessment.'\n },\n {\n id:111,\n stem:'Which of the following key action areas are incorporated in the Ottawa Charter?\\n1. Building healthy public policy\\n2. Strengthening community action for health\\n3. Reorienting health services',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'The Ottawa Charter for Health Promotion (1986) identifies five action areas: (1) Build healthy public policy, (2) Create supportive environments, (3) Strengthen community action, (4) Develop personal skills, (5) Reorient health services. All three listed options are explicitly in the Charter \u2014 all correct.'\n },\n {\n id:112,\n stem:'Under Chapter XXI of the 10th revision of ICD (ICD-10), lifestyle-related problems fall under which of the following code range?',\n correct:'Z 72.0 \u2013 Z 72.5',\n options:['U 50.0 \u2013 U 50.5','U 10.0 \u2013 U 10.5','Z 72.0 \u2013 Z 72.5','Z 10.0 \u2013 Z 10.5'],\n exp:'ICD-10 Chapter XXI (Z00\u2013Z99): Factors influencing health status and contact with health services. Z72 = Problems related to lifestyle, including: Z72.0 (tobacco use), Z72.1 (alcohol use), Z72.2 (drug use), Z72.3 (lack of physical exercise), Z72.4 (inappropriate diet\/eating habits), Z72.5 (high-risk sexual behaviour). U codes are for special purposes\/COVID-19.'\n },\n {\n id:113,\n stem:'Which of the following diseases are spread by airborne transmission?\\n1. Influenza\\n2. Chicken pox\\n3. Q-fever\\n4. Psittacosis',\n correct:'1, 2, 3 and 4',\n options:['1 and 3 only','1 and 4 only','3 and 4 only','1, 2, 3 and 4'],\n exp:'All four are transmitted by airborne route: Influenza (aerosol droplet nuclei), Chickenpox\/Varicella (airborne \u2014 travels long distances, hence highly infectious), Q-fever\/Coxiella burnetii (inhalation of contaminated dust\/aerosols from animal products), Psittacosis\/Chlamydia psittaci (inhalation of dried bird excreta\/secretions). All four qualify.'\n },\n {\n id:114,\n stem:'DASH diet plan is advocated in the control of which one of the following diseases?',\n correct:'Hypertension',\n options:['Cancer','Chronic Obstructive Pulmonary Disease','Hypertension','Rheumatic heart disease'],\n exp:'DASH (Dietary Approaches to Stop Hypertension) diet emphasises fruits, vegetables, whole grains, low-fat dairy, and reduced sodium and saturated fats. Clinical trials show it reduces systolic BP by 8\u201314 mmHg. It is specifically designed for hypertension prevention and management, though its overall healthy pattern also benefits cardiovascular health.'\n },\n {\n id:115,\n stem:'Endemic ascites occurs due to:',\n correct:'Naturally occurring toxin',\n options:['Naturally occurring toxin','Bacterial toxin','Fungal toxin','Viral toxin'],\n exp:'Endemic ascites (hepatic veno-occlusive disease \/ Budd-Chiari-like syndrome) in certain regions (e.g., India \u2014 Sarguja, Rajasthan) is caused by pyrrolizidine alkaloids \u2014 naturally occurring plant toxins found in Crotalaria and Heliotropium species contaminating cereal crops. These alkaloids cause hepatic sinusoidal obstruction.'\n },\n {\n id:116,\n stem:'The presence of which of the following bacteria in drinking water is an important confirmatory evidence of recent faecal pollution of water?',\n correct:'E. coli',\n options:['E. coli','Streptococci','Clostridium','Klebsiella'],\n exp:\"E. coli (specifically thermotolerant\/faecal coliforms) is the WHO-recommended indicator of recent faecal contamination of drinking water. Its presence confirms faecal pollution because it survives only briefly outside the gut. Clostridium perfringens indicates past faecal contamination. Streptococci and Klebsiella are less specific indicators.\"\n },\n {\n id:117,\n stem:'With regard to the Goals, Milestones and Targets for the WHO Global Technical Strategy for Malaria (2016\u20132030), consider the following statements:\\n1. Compared to 2015, target is to reduce malaria mortality rates globally by at least 90% by 2030\\n2. Compared to 2015, target is to reduce malaria case incidence by 90% by 2030\\n3. Eliminate malaria from at least 35 countries where malaria was transmitted in 2015, by 2030',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'WHO Global Technical Strategy for Malaria 2016\u20132030 targets by 2030 (compared to 2015 baseline): (1) \u226590% reduction in malaria mortality rates \u2713, (2) \u226590% reduction in malaria case incidence \u2713, (3) elimination in at least 35 countries that had ongoing malaria transmission in 2015 \u2713. All three statements are correct.'\n },\n {\n id:118,\n stem:'Which one of the following IUDs is associated with a low pregnancy rate (0.2 per 100), less number of ectopic pregnancies and lower menstrual blood loss?',\n correct:'LNG-20 (Mirena)',\n options:['Cu T-380A','ML-Cu 375','Progestasert','LNG-20 (Mirena)'],\n exp:'LNG-20 (Levonorgestrel IUS, Mirena) releases 20 mcg\/day of levonorgestrel locally \u2014 it has a failure rate of ~0.2\/100 woman-years, significantly reduces menstrual blood loss (treats menorrhagia), and reduces ectopic pregnancy risk by suppressing ovulation and thickening cervical mucus. CuT-380A has a failure rate of ~0.6\u20130.8\/100.'\n },\n {\n id:119,\n stem:'The incidence of diarrhoea is highest among infants in the age group of 6\u201311 months due to all of the following reasons EXCEPT:',\n correct:'Eruption of teeth',\n options:['Declining level of maternal antibodies','Introduction of foods which may be contaminated','Eruption of teeth','Direct contact with human or animal faeces'],\n exp:'Diarrhoea peaks at 6\u201311 months due to: waning maternal antibody protection, introduction of complementary foods (contamination risk), increased exploratory oral behaviour (hand-to-mouth contact with faeces). Teething\/eruption of teeth is a commonly believed but scientifically unsupported cause of diarrhoea \u2014 it does not cause true diarrhoeal illness.'\n },\n {\n id:120,\n stem:'In the context of \"Anti-Malaria Month Campaign\", consider the following statements:\\n1. It is observed every year in the month of June\\n2. It is planned during the Monsoon season\\n3. It aims to enhance the level of community awareness and participation',\n correct:'1 and 3',\n options:['1 and 2','2 and 3','3 only','1 and 3'],\n exp:\"India's Anti-Malaria Month is observed every June \u2014 statement 1 correct. June marks the PRE-monsoon\/early monsoon period (not the peak monsoon season) \u2014 the campaign is timed to mobilise communities BEFORE mosquito breeding peaks, not during monsoon \u2014 statement 2 is inaccurate. Statement 3 (community awareness and participation) is a primary objective \u2014 correct. 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Submitting in 10 Submit Now Combined Medical Services Examination 2020Paper II \u00b7 Part 3 Preventive & Social Medicine \u00b7 Community Medicine Questions 81 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba Retry 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-36553","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 Paper-2 Part-3 - 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\/13\/cms-2020-paper-2-part-3\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2020 Paper-2 Part-3 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2020 Paper II \u2013 Part 3 (Q81\u2013Q120) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time’s Up! 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