CMS 2021 Paper I \u2013 Part 2 (Q31\u2013Q60)<\/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: cms21p1b \u2500\u2500 *\/\n#cms21p1b *,#cms21p1b *::before,#cms21p1b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms21p1b{\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#cms21p1b .cq-sentinel{height:1px}\n#cms21p1b .cq-statusbar{\n 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id=\"cms21p1b\">\n\n <div class=\"cq-sentinel\" id=\"cms21p1b-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms21p1b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms21p1b-timer-item\">\u23f1 <strong id=\"cms21p1b-timer-display\">30:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms21p1b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms21p1b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms21p1b-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms21p1b-sn\">0<\/strong> \/ <strong id=\"cms21p1b-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms21p1b-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-grace\" id=\"cms21p1b-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=\"cms21p1b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms21p1b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2021<br>Paper I \u00b7 Part 2<\/h1>\n <p>Nephrology \u00b7 Neurology \u00b7 Haematology \u00b7 Endocrinology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 31 \u2013 60<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms21p1b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms21p1b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms21p1b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms21p1b-score\">\n <div class=\"cq-score-ring\" id=\"cms21p1b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms21p1b-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=\"cms21p1b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms21p1b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms21p1b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms21p1b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms21p1b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms21p1b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms21p1b', TOTAL=30, MAX=TOTAL*4;\n const TIMER_SECS=30*60;\n const GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:31,\n stem:'Consider the following statements regarding Coeliac disease:\\n1. There is a strong association with HLA-DQ2\/DQ8\\n2. There is intolerance to gluten found in wheat, rye, barley and oats\\n3. In the elderly, the disease presents with symptoms ranging from florid malabsorption to oral ulceration, dyspepsia and bloating\\n4. In suspected patients, small bowel biopsy is contraindicated\\nWhich of the above statements are correct?',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','2 and 3 only','1 and 2 only','1, 3 and 4'],\n exp:'Statements 1, 2, and 3 are correct. Statement 4 is false \u2014 small bowel biopsy is the GOLD STANDARD for diagnosing coeliac disease (showing villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes) and is NOT contraindicated. HLA-DQ2 is present in ~90% of coeliac patients.'\n },\n {\n id:32,\n stem:'Asymptomatic bacteriuria is defined as the presence of more than:',\n correct:'10^5 organisms\/mL in the urine of apparently healthy asymptomatic patients',\n options:['10^5 organisms\/mL in the urine of apparently healthy asymptomatic patients','10^4 organisms\/mL in the urine of apparently healthy asymptomatic patients','10^3 organisms\/mL in the urine of apparently healthy asymptomatic patients','10^2 organisms\/mL in the urine of apparently healthy asymptomatic patients'],\n exp:'Asymptomatic bacteriuria is defined as two consecutive midstream urine cultures yielding more than 10^5 colony-forming units (CFU) per mL of the same organism in asymptomatic patients. Treatment is only recommended in pregnancy, before urological procedures, or in renal transplant recipients.'\n },\n {\n id:33,\n stem:'Renal transplant offers the best chance of long-term survival in ESRD and is cost-effective. Which one of the following is NOT a contraindication to renal transplantation?',\n correct:'Diabetes mellitus',\n options:['Active malignancy','Children less than one year','Adults more than 75 years','Diabetes mellitus'],\n exp:'Diabetes mellitus is NOT a contraindication to renal transplant \u2014 in fact, diabetics often benefit most from transplantation, and simultaneous pancreas-kidney transplant can be considered. Contraindications include active malignancy (risk of immunosuppression-driven progression), age extremes (under 1 year \u2014 technical challenges), and severe comorbidity reducing life expectancy.'\n },\n {\n id:34,\n stem:'Which of the following are the mechanisms for anaemia in Chronic Kidney Disease?\\n1. Deficiency of erythropoietin\\n2. Folate and Vitamin B12 deficiency\\n3. Toxic effects of uraemia on bone marrow\\n4. Reduced utilization of dietary iron',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'Anaemia in CKD results from: (1) reduced EPO production by damaged kidneys (primary cause), (2) folate and B12 deficiency (due to poor intake, dialysis losses), (3) uraemic toxins suppressing bone marrow erythropoiesis. Statement 4 is false \u2014 it is impaired iron MOBILISATION from stores (functional iron deficiency) that occurs, not reduced dietary iron utilisation per se. Statements 1, 2, and 3 are correct.'\n },\n {\n id:35,\n stem:'The leading cause of Chronic Kidney Disease (CKD) globally is:',\n correct:'Diabetic nephropathy',\n options:['Diabetic nephropathy','Glomerulonephritis','Hypertension-associated CKD','Polycystic kidney disease'],\n exp:'Diabetic nephropathy (diabetic kidney disease) is the single leading cause of CKD and ESRD globally, accounting for ~40% of all new cases of dialysis in developed countries. The epidemic of type 2 diabetes has driven this rise. Hypertension is second. Glomerulonephritis remains more common in some developing countries.'\n },\n {\n id:36,\n stem:\"The presence of Beevor's sign on neurological examination is characteristic of spinal cord lesion at which one of the following levels?\",\n correct:'T9 - T10',\n options:['T3 - T4','T7 - T8','T9 - T10','None of the above'],\n exp:\"Beevor's sign: when the patient attempts to flex the neck, the umbilicus moves upward (cranially). This occurs because the lower rectus abdominis (innervated below T10) is weak while the upper rectus (above T10) is intact. It indicates a spinal cord lesion at T9\u2013T10 level, classically seen in facioscapulohumeral muscular dystrophy and thoracic cord lesions.\"\n },\n {\n id:37,\n stem:'Which one of the following statements is correct regarding lower motor neuron type of lesion?',\n correct:'Plantar reflex shows flexor response.',\n options:['Fasciculation is absent.','Deep tendon reflexes are increased.','Clonus is present.','Plantar reflex shows flexor response.'],\n exp:'LMN lesion features: flaccid weakness, muscle wasting, fasciculations (NOT absent), DECREASED or absent deep tendon reflexes, no clonus, and a FLEXOR plantar response (or absent). The extensor plantar (Babinski) response indicates UMN lesion. Only statement (d) is correct \u2014 plantar reflex is flexor (or absent) in LMN lesions.'\n },\n {\n id:38,\n stem:'Which one of the following is the single strongest risk factor for dementia?',\n correct:'Increasing age',\n options:['Increasing age','Alcoholism','Positive family history','Systemic illness'],\n exp:\"Increasing age is the single most powerful risk factor for dementia. The prevalence roughly doubles every 5 years after age 65, reaching ~30\u201340% in those above 85 years. While family history (genetics), vascular risk factors, and alcohol all contribute, none surpasses age as the dominant determinant.\"\n },\n {\n id:39,\n stem:\"Massive retinal haemorrhage with 'blood and thunder' appearance and vision loss is caused by which of the following?\",\n correct:'Central retinal vein occlusion',\n options:['Central retinal artery occlusion','Central retinal vein occlusion','Hypertensive retinopathy','Anterior optic neuropathy'],\n exp:\"Central Retinal Vein Occlusion (CRVO) produces the classic 'blood and thunder' fundus: massive flame-shaped haemorrhages in all four quadrants, disc swelling, dilated tortuous veins, and cotton wool spots. CRAO causes sudden painless vision loss with pale retina and cherry red spot \u2014 no haemorrhages. CRVO = haemorrhagic; CRAO = ischaemic pale appearance.\"\n },\n {\n id:40,\n stem:'Visual hallucination is characteristic of which type of dementia?',\n correct:'Diffuse Lewy body dementia',\n options:['Diffuse Lewy body dementia','Frontotemporal dementia','Alzheimer\\'s dementia','Vascular dementia'],\n exp:'Recurrent, well-formed visual hallucinations (typically of people or animals) are one of the core clinical features of Dementia with Lewy Bodies (DLB) \u2014 along with fluctuating cognition, Parkinsonism, and REM sleep behaviour disorder. Hallucinations are not characteristic of Alzheimer\\'s, FTD, or vascular dementia in the early stages.'\n },\n {\n id:41,\n stem:'A 37-year-old mother of two children has bilateral headache that worsens with emotional stress; pain is less severe in the early part of the day but becomes more severe in the evening; there is tenderness over the skull vault. Both children are not doing well in school. What is the most likely diagnosis?',\n correct:'Tension type headache',\n options:['Cluster headache','Tension type headache','Trigeminal neuralgia','Migraine'],\n exp:'Bilateral headache worsening with stress, worse in the evening (after accumulation of daily tension), with scalp tenderness, and a psychosocial stressor (children struggling in school) is classic for tension-type headache. Cluster headache is unilateral, periorbital, with autonomic features. Migraine is typically unilateral, pulsating, with nausea\/photophobia.'\n },\n {\n id:42,\n stem:'Which of the following are the causes of polyneuropathy?\\n1. HIV\\n2. Alcohol\\n3. Phenytoin\\n4. Rifampicin',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'HIV causes distal symmetric polyneuropathy (direct viral effect and antiretroviral toxicity). Alcohol causes peripheral neuropathy through direct toxicity and nutritional deficiency (thiamine). Phenytoin causes peripheral neuropathy with chronic use. Rifampicin is NOT a recognised cause of polyneuropathy \u2014 Isoniazid (which depletes pyridoxine) causes INH neuropathy, not rifampicin. Statements 1, 2, and 3 are correct.'\n },\n {\n id:43,\n stem:'Consider the following statements regarding Intracerebral Haemorrhage (ICH):\\n1. It accounts for 35% of all strokes\\n2. Most common site of hypertensive ICH is cerebral cortex\\n3. Use of cocaine and methamphetamine is a frequent cause of stroke in young age\\n4. Hypertensive ICH usually results from spontaneous rupture of small penetrating artery deep in brain\\nWhich of the above statements are correct?',\n correct:'3 and 4',\n options:['1 and 2','2 and 3','3 and 4','1 and 4'],\n exp:'Statement 1 is false \u2014 ICH accounts for ~10\u201315% of all strokes (not 35%; ischaemic stroke = ~85%). Statement 2 is false \u2014 most common sites of hypertensive ICH are the putamen\/basal ganglia, thalamus, cerebellum, and pons (deep penetrating artery territories), NOT the cortex. Statements 3 (sympathomimetic drugs cause ICH in young) and 4 (Charcot-Bouchard microaneurysm rupture) are correct.'\n },\n {\n id:44,\n stem:'A 21-year-old young lady presents with unilateral facial weakness. She is unable to close her eye on the affected side and there are vesicles in her ear. She is suffering from:',\n correct:'7th Cranial Nerve Palsy',\n options:['8th Cranial Nerve Palsy','3rd Cranial Nerve Palsy','5th Cranial Nerve Palsy','7th Cranial Nerve Palsy'],\n exp:\"Unilateral LMN facial palsy (unable to close eye = weakness of orbicularis oculi) with herpetic vesicles in the external auditory canal (Ramsey Hunt syndrome) = VZV reactivation affecting the geniculate ganglion of the 7th (facial) cranial nerve. This is Herpes Zoster Oticus. Treatment: acyclovir + corticosteroids.\"\n },\n {\n id:45,\n stem:'Lesion of dominant parietal lobe causes which of the following?\\n1. Dysphasia\\n2. Acalculia\\n3. Dyslexia\\n4. Contralateral neglect',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:\"Dominant (left) parietal lobe lesion causes Gerstmann's syndrome: acalculia, agraphia, finger agnosia, right-left disorientation \u2014 plus dysphasia and dyslexia (language-dominant side involvement). Contralateral neglect (hemineglect\/hemispatial neglect) is a feature of NON-DOMINANT (right) parietal lobe lesion. Statement 4 is false. Statements 1, 2, and 3 are correct.\"\n },\n {\n id:46,\n stem:'Which of the following are the clinical features of Neurofibromatosis-1?\\n1. Angiomas\\n2. Axillary freckles\\n3. Cutaneous schwannomas\\n4. Neurofibromas',\n correct:'2, 3 and 4',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'NF-1 (von Recklinghausen disease) features: cafe-au-lait spots (6 or more), axillary\/inguinal freckles (Crowe\\'s sign), Lisch nodules (iris hamartomas), neurofibromas (peripheral nerve sheath tumours), cutaneous schwannomas, optic gliomas, and skeletal dysplasia. Angiomas are NOT a recognised feature of NF-1 \u2014 they are associated with Sturge-Weber syndrome and hereditary haemorrhagic telangiectasia. Statements 2, 3, and 4 are correct.'\n },\n {\n id:47,\n stem:\"Which of the following are clinical features of Parkinson's disease?\\n1. Bradykinesia\\n2. Rigidity\\n3. Spastic gait\\n4. Mask-like face\",\n correct:'1, 2 and 4',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:\"Parkinson's disease features: bradykinesia (essential for diagnosis), cogwheel rigidity, resting tremor, postural instability, mask-like (hypomimic) face, micrographia, and festinating gait (shuffling, narrow base). Spastic gait indicates UMN\/pyramidal tract involvement \u2014 Parkinson's is a basal ganglia disorder with NO spasticity. Statement 3 is false. Statements 1, 2, and 4 are correct.\"\n },\n {\n id:48,\n stem:'Which one of the following statements is correct for an individual with blood group AB?',\n correct:'A and B antigens on RBC; no antibody in plasma.',\n options:['A antigen on RBC; Anti-B antibody in plasma.','A and B antigens on RBC; no antibody in plasma.','B antigen on RBC; Anti-A antibody in plasma.','No antigen on RBC; Anti-A and Anti-B antibodies in plasma.'],\n exp:'Blood group AB: both A and B antigens on the RBC surface, and NO antibodies in the plasma (universal recipient). This is explained by Landsteiner\\'s law \u2014 antibodies are not formed against self-antigens. Group O has no antigens but both Anti-A and Anti-B antibodies (universal donor for RBCs).'\n },\n {\n id:49,\n stem:'Which one of the following is unlikely to be associated with eosinophilia?',\n correct:'Tuberculosis',\n options:[\"Loeffler's syndrome\",'Toxocariasis','Trichinella spiralis','Tuberculosis'],\n exp:\"Eosinophilia is caused by: tissue-invasive parasites (Toxocara, Trichinella, filaria, schistosoma), allergic\/atopic disease, Loeffler's syndrome (transient pulmonary eosinophilia from larval migration), and drugs. Tuberculosis causes lymphocytosis in the CSF and mononuclear response \u2014 it is NOT associated with eosinophilia. TB actually tends to suppress eosinophilia.\"\n },\n {\n id:50,\n stem:'Which one of the following is a tumour marker for carcinoma of pancreas?',\n correct:'CA-19-9',\n options:['Alpha-fetoprotein','CA-125','Calcitonin','CA-19-9'],\n exp:'CA-19-9 (carbohydrate antigen 19-9) is the primary tumour marker for pancreatic adenocarcinoma \u2014 used for monitoring treatment response and detecting recurrence rather than screening. AFP = hepatocellular carcinoma \/ germ cell tumour. CA-125 = epithelial ovarian carcinoma. Calcitonin = medullary carcinoma of thyroid.'\n },\n {\n id:51,\n stem:'Which of the following statements regarding G6PD enzyme deficiency are correct?\\n1. It is an X-linked deficiency\\n2. Geographical distribution parallels the malaria belt\\n3. Consumption of fava beans is protective\\n4. Transfusion support may be life saving',\n correct:'1, 2 and 4',\n options:['1 and 3 only','1, 2 and 4','1 and 4 only','2, 3 and 4'],\n exp:'G6PD deficiency: (1) X-linked recessive \u2014 correct; (2) highest prevalence in malaria-endemic regions (partial protection against P. falciparum via oxidative stress in parasitised RBCs) \u2014 correct; (3) fava beans TRIGGER haemolysis, they are NOT protective \u2014 statement 3 is FALSE; (4) severe haemolytic crisis may require RBC transfusion \u2014 correct. Statements 1, 2, and 4 are correct.'\n },\n {\n id:52,\n stem:'Which of the following investigations indicate active haemolysis?\\n1. Increased reticulocyte count\\n2. Increased conjugated bilirubin\\n3. Increased urinary urobilinogen\\n4. Decreased haptoglobin',\n correct:'1, 3 and 4',\n options:['1, 2 and 3','1 and 4 only','1, 3 and 4','2 and 3 only'],\n exp:'Haemolysis markers: raised reticulocyte count (bone marrow compensatory response), raised UNCONJUGATED (not conjugated) bilirubin (from haem breakdown), raised urinary urobilinogen, decreased haptoglobin (scavenges free haemoglobin, rapidly consumed). Statement 2 is false \u2014 haemolysis raises unconjugated bilirubin, not conjugated. Statements 1, 3, and 4 are correct.'\n },\n {\n id:53,\n stem:'Which type of anaemia can be caused by the drug Dapsone?',\n correct:'Haemolytic anaemia',\n options:['Iron deficiency anaemia','Sideroblastic anaemia','Spur cell anaemia','Haemolytic anaemia'],\n exp:'Dapsone (used in leprosy, PCP prophylaxis, dermatitis herpetiformis) causes dose-dependent oxidative haemolytic anaemia and methaemoglobinaemia. It oxidises haemoglobin, forming Heinz bodies which damage the RBC membrane. This effect is more severe in G6PD-deficient individuals. All patients on dapsone should have baseline G6PD testing.'\n },\n {\n id:54,\n stem:'Which of the following are decreased during pregnancy?\\n1. Iron stores\\n2. Vitamin B12 levels\\n3. Folate levels\\n4. Coagulation factors',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2, 3 and 4'],\n exp:'During pregnancy: iron stores deplete (increased fetal demand + expanded plasma volume), Vitamin B12 levels fall (haemodilution + fetal transfer), folate levels fall (increased demand for fetal neural tube development \u2014 hence supplementation). Coagulation factors (I, VII, VIII, IX, X, XII, vWF) actually INCREASE in pregnancy \u2014 pregnancy is a hypercoagulable state. Statement 4 is false. Statements 1, 2, and 3 are correct.'\n },\n {\n id:55,\n stem:'Which one of the following drugs causes direct Xa inhibition?',\n correct:'Apixaban',\n options:['Tirofiban','Apixaban','Dabigatran','Prasugrel'],\n exp:'Direct oral anticoagulants (DOACs) by mechanism: Factor Xa inhibitors = apixaban, rivaroxaban, edoxaban, betrixaban (the \"-xabans\"). Direct thrombin (Factor IIa) inhibitor = dabigatran. Tirofiban = GpIIb\/IIIa inhibitor (antiplatelet). Prasugrel = P2Y12 ADP receptor antagonist (antiplatelet). Apixaban is therefore the direct Xa inhibitor.'\n },\n {\n id:56,\n stem:'A 20-year-old girl presents with heavy menstrual bleeding, petechiae on arms and blood blisters in mouth. CBC shows Hb 7 gm\/dL, TLC 8,700 cells\/uL and platelet count 6,000\/uL with large platelets on smear. Which is likely the best initial drug treatment?',\n correct:'High dose glucocorticoids',\n options:['High dose glucocorticoids','High dose glucocorticoids with IVIgG','High dose glucocorticoids with Rituximab','IVIgG with anti-Rho(D) therapy'],\n exp:'Severe ITP (platelet count below 10,000 with mucosal bleeding) in a young woman: first-line treatment is high-dose glucocorticoids (prednisolone 1 mg\/kg or dexamethasone 40 mg\/day for 4 days). IVIgG is added when rapid platelet rise is needed (surgery, life-threatening bleed). Rituximab and thrombopoietin receptor agonists are second-line after steroid failure.'\n },\n {\n id:57,\n stem:'A 30-year-old female vegetarian presents with malaise, breathlessness and paraesthesias. Investigations show Hb 6.2 gm\/dL, MCV 128 fL, platelet count 1,20,000\/cumm, blood smear showing macrocytosis and neutrophil hypersegmentation. What is the likely diagnosis?',\n correct:'Megaloblastic anaemia',\n options:['Iron deficiency anaemia','Myelophthisic anaemia','Megaloblastic anaemia','Aplastic anaemia'],\n exp:'The combination of macrocytic anaemia (MCV 128 fL), neutrophil hypersegmentation (5+ lobes), vegetarian diet (B12 deficiency risk), and neurological symptoms (paraesthesias from subacute combined degeneration) is diagnostic of megaloblastic anaemia due to B12\/folate deficiency. Aplastic anaemia shows pancytopenia with normocytic RBCs. IDA shows microcytic anaemia.'\n },\n {\n id:58,\n stem:'Which of the following is the most common dermatologic manifestation of Diabetes mellitus?',\n correct:'Xerosis',\n options:['Xerosis','Acanthosis nigricans','Lichen planus','Necrobiosis lipoidica'],\n exp:'Xerosis (dry skin) is the most common dermatological manifestation of diabetes mellitus, occurring in up to 70% of diabetic patients. It results from autonomic neuropathy causing decreased sweating and sebaceous secretion. Acanthosis nigricans indicates insulin resistance but is less common overall. Necrobiosis lipoidica diabeticorum is pathognomonic but rare (~0.3%).'\n },\n {\n id:59,\n stem:'Which one of the following conditions may result in hypoglycaemia?',\n correct:'Critical illness',\n options:['Critical illness','Cortisol therapy','Cushing\\'s disease','Metabolic syndrome'],\n exp:'Critical illness causes hypoglycaemia through: impaired gluconeogenesis (liver dysfunction), increased insulin sensitivity, reduced glycogen stores, and decreased counterregulatory hormone responses. Cortisol therapy, Cushing\\'s disease, and metabolic syndrome all cause HYPERGLYCAEMIA through insulin resistance and increased hepatic glucose output.'\n },\n {\n id:60,\n stem:'Use of which of the following drugs may result in osteoporosis?\\n1. Phenytoin\\n2. Lithium\\n3. Methotrexate\\n4. Azathioprine',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'Drug-induced osteoporosis: Phenytoin (induces CYP450 enzymes, accelerating vitamin D catabolism), Lithium (increases PTH secretion, affecting bone turnover), Methotrexate (inhibits osteoblast function, causes methotrexate osteopathy). Azathioprine is NOT a recognised cause of osteoporosis \u2014 it is an immunosuppressant with other toxicities (myelosuppression, hepatotoxicity). 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Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 2 Nephrology \u00b7 Neurology \u00b7 Haematology \u00b7 Endocrinology Questions 31 \u2013 60 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-36591","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2021 P1 Part-2 - 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\/16\/cms-2021-p1-part-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2021 P1 Part-2 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2021 Paper I \u2013 Part 2 (Q31\u2013Q60) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 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#cms21p1b .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){\n #cms21p1b .cq-header h1{font-size:1.15rem}\n #cms21p1b .cq-qtext{font-size:0.88rem}\n #cms21p1b .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms21p1b\">\n\n <div class=\"cq-sentinel\" id=\"cms21p1b-sentinel\"><\/div>\n\n <div class=\"cq-statusbar\" id=\"cms21p1b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms21p1b-timer-item\">\u23f1 <strong id=\"cms21p1b-timer-display\">30:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms21p1b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms21p1b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms21p1b-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms21p1b-sn\">0<\/strong> \/ <strong id=\"cms21p1b-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms21p1b-fill\"><\/div><\/div>\n <\/div>\n\n <div class=\"cq-grace\" id=\"cms21p1b-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=\"cms21p1b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms21p1b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2021<br>Paper I \u00b7 Part 2<\/h1>\n <p>Nephrology \u00b7 Neurology \u00b7 Haematology \u00b7 Endocrinology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 31 \u2013 60<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms21p1b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms21p1b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms21p1b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms21p1b-score\">\n <div class=\"cq-score-ring\" id=\"cms21p1b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms21p1b-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=\"cms21p1b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms21p1b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms21p1b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms21p1b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms21p1b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms21p1b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms21p1b', TOTAL=30, MAX=TOTAL*4;\n const TIMER_SECS=30*60;\n const GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:31,\n stem:'Consider the following statements regarding Coeliac disease:\\n1. There is a strong association with HLA-DQ2\/DQ8\\n2. There is intolerance to gluten found in wheat, rye, barley and oats\\n3. In the elderly, the disease presents with symptoms ranging from florid malabsorption to oral ulceration, dyspepsia and bloating\\n4. In suspected patients, small bowel biopsy is contraindicated\\nWhich of the above statements are correct?',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','2 and 3 only','1 and 2 only','1, 3 and 4'],\n exp:'Statements 1, 2, and 3 are correct. Statement 4 is false \u2014 small bowel biopsy is the GOLD STANDARD for diagnosing coeliac disease (showing villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes) and is NOT contraindicated. HLA-DQ2 is present in ~90% of coeliac patients.'\n },\n {\n id:32,\n stem:'Asymptomatic bacteriuria is defined as the presence of more than:',\n correct:'10^5 organisms\/mL in the urine of apparently healthy asymptomatic patients',\n options:['10^5 organisms\/mL in the urine of apparently healthy asymptomatic patients','10^4 organisms\/mL in the urine of apparently healthy asymptomatic patients','10^3 organisms\/mL in the urine of apparently healthy asymptomatic patients','10^2 organisms\/mL in the urine of apparently healthy asymptomatic patients'],\n exp:'Asymptomatic bacteriuria is defined as two consecutive midstream urine cultures yielding more than 10^5 colony-forming units (CFU) per mL of the same organism in asymptomatic patients. Treatment is only recommended in pregnancy, before urological procedures, or in renal transplant recipients.'\n },\n {\n id:33,\n stem:'Renal transplant offers the best chance of long-term survival in ESRD and is cost-effective. Which one of the following is NOT a contraindication to renal transplantation?',\n correct:'Diabetes mellitus',\n options:['Active malignancy','Children less than one year','Adults more than 75 years','Diabetes mellitus'],\n exp:'Diabetes mellitus is NOT a contraindication to renal transplant \u2014 in fact, diabetics often benefit most from transplantation, and simultaneous pancreas-kidney transplant can be considered. Contraindications include active malignancy (risk of immunosuppression-driven progression), age extremes (under 1 year \u2014 technical challenges), and severe comorbidity reducing life expectancy.'\n },\n {\n id:34,\n stem:'Which of the following are the mechanisms for anaemia in Chronic Kidney Disease?\\n1. Deficiency of erythropoietin\\n2. Folate and Vitamin B12 deficiency\\n3. Toxic effects of uraemia on bone marrow\\n4. Reduced utilization of dietary iron',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'Anaemia in CKD results from: (1) reduced EPO production by damaged kidneys (primary cause), (2) folate and B12 deficiency (due to poor intake, dialysis losses), (3) uraemic toxins suppressing bone marrow erythropoiesis. Statement 4 is false \u2014 it is impaired iron MOBILISATION from stores (functional iron deficiency) that occurs, not reduced dietary iron utilisation per se. Statements 1, 2, and 3 are correct.'\n },\n {\n id:35,\n stem:'The leading cause of Chronic Kidney Disease (CKD) globally is:',\n correct:'Diabetic nephropathy',\n options:['Diabetic nephropathy','Glomerulonephritis','Hypertension-associated CKD','Polycystic kidney disease'],\n exp:'Diabetic nephropathy (diabetic kidney disease) is the single leading cause of CKD and ESRD globally, accounting for ~40% of all new cases of dialysis in developed countries. The epidemic of type 2 diabetes has driven this rise. Hypertension is second. Glomerulonephritis remains more common in some developing countries.'\n },\n {\n id:36,\n stem:\"The presence of Beevor's sign on neurological examination is characteristic of spinal cord lesion at which one of the following levels?\",\n correct:'T9 - T10',\n options:['T3 - T4','T7 - T8','T9 - T10','None of the above'],\n exp:\"Beevor's sign: when the patient attempts to flex the neck, the umbilicus moves upward (cranially). This occurs because the lower rectus abdominis (innervated below T10) is weak while the upper rectus (above T10) is intact. It indicates a spinal cord lesion at T9\u2013T10 level, classically seen in facioscapulohumeral muscular dystrophy and thoracic cord lesions.\"\n },\n {\n id:37,\n stem:'Which one of the following statements is correct regarding lower motor neuron type of lesion?',\n correct:'Plantar reflex shows flexor response.',\n options:['Fasciculation is absent.','Deep tendon reflexes are increased.','Clonus is present.','Plantar reflex shows flexor response.'],\n exp:'LMN lesion features: flaccid weakness, muscle wasting, fasciculations (NOT absent), DECREASED or absent deep tendon reflexes, no clonus, and a FLEXOR plantar response (or absent). The extensor plantar (Babinski) response indicates UMN lesion. Only statement (d) is correct \u2014 plantar reflex is flexor (or absent) in LMN lesions.'\n },\n {\n id:38,\n stem:'Which one of the following is the single strongest risk factor for dementia?',\n correct:'Increasing age',\n options:['Increasing age','Alcoholism','Positive family history','Systemic illness'],\n exp:\"Increasing age is the single most powerful risk factor for dementia. The prevalence roughly doubles every 5 years after age 65, reaching ~30\u201340% in those above 85 years. While family history (genetics), vascular risk factors, and alcohol all contribute, none surpasses age as the dominant determinant.\"\n },\n {\n id:39,\n stem:\"Massive retinal haemorrhage with 'blood and thunder' appearance and vision loss is caused by which of the following?\",\n correct:'Central retinal vein occlusion',\n options:['Central retinal artery occlusion','Central retinal vein occlusion','Hypertensive retinopathy','Anterior optic neuropathy'],\n exp:\"Central Retinal Vein Occlusion (CRVO) produces the classic 'blood and thunder' fundus: massive flame-shaped haemorrhages in all four quadrants, disc swelling, dilated tortuous veins, and cotton wool spots. CRAO causes sudden painless vision loss with pale retina and cherry red spot \u2014 no haemorrhages. CRVO = haemorrhagic; CRAO = ischaemic pale appearance.\"\n },\n {\n id:40,\n stem:'Visual hallucination is characteristic of which type of dementia?',\n correct:'Diffuse Lewy body dementia',\n options:['Diffuse Lewy body dementia','Frontotemporal dementia','Alzheimer\\'s dementia','Vascular dementia'],\n exp:'Recurrent, well-formed visual hallucinations (typically of people or animals) are one of the core clinical features of Dementia with Lewy Bodies (DLB) \u2014 along with fluctuating cognition, Parkinsonism, and REM sleep behaviour disorder. Hallucinations are not characteristic of Alzheimer\\'s, FTD, or vascular dementia in the early stages.'\n },\n {\n id:41,\n stem:'A 37-year-old mother of two children has bilateral headache that worsens with emotional stress; pain is less severe in the early part of the day but becomes more severe in the evening; there is tenderness over the skull vault. Both children are not doing well in school. What is the most likely diagnosis?',\n correct:'Tension type headache',\n options:['Cluster headache','Tension type headache','Trigeminal neuralgia','Migraine'],\n exp:'Bilateral headache worsening with stress, worse in the evening (after accumulation of daily tension), with scalp tenderness, and a psychosocial stressor (children struggling in school) is classic for tension-type headache. Cluster headache is unilateral, periorbital, with autonomic features. Migraine is typically unilateral, pulsating, with nausea\/photophobia.'\n },\n {\n id:42,\n stem:'Which of the following are the causes of polyneuropathy?\\n1. HIV\\n2. Alcohol\\n3. Phenytoin\\n4. Rifampicin',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'HIV causes distal symmetric polyneuropathy (direct viral effect and antiretroviral toxicity). Alcohol causes peripheral neuropathy through direct toxicity and nutritional deficiency (thiamine). Phenytoin causes peripheral neuropathy with chronic use. Rifampicin is NOT a recognised cause of polyneuropathy \u2014 Isoniazid (which depletes pyridoxine) causes INH neuropathy, not rifampicin. Statements 1, 2, and 3 are correct.'\n },\n {\n id:43,\n stem:'Consider the following statements regarding Intracerebral Haemorrhage (ICH):\\n1. It accounts for 35% of all strokes\\n2. Most common site of hypertensive ICH is cerebral cortex\\n3. Use of cocaine and methamphetamine is a frequent cause of stroke in young age\\n4. Hypertensive ICH usually results from spontaneous rupture of small penetrating artery deep in brain\\nWhich of the above statements are correct?',\n correct:'3 and 4',\n options:['1 and 2','2 and 3','3 and 4','1 and 4'],\n exp:'Statement 1 is false \u2014 ICH accounts for ~10\u201315% of all strokes (not 35%; ischaemic stroke = ~85%). Statement 2 is false \u2014 most common sites of hypertensive ICH are the putamen\/basal ganglia, thalamus, cerebellum, and pons (deep penetrating artery territories), NOT the cortex. Statements 3 (sympathomimetic drugs cause ICH in young) and 4 (Charcot-Bouchard microaneurysm rupture) are correct.'\n },\n {\n id:44,\n stem:'A 21-year-old young lady presents with unilateral facial weakness. She is unable to close her eye on the affected side and there are vesicles in her ear. She is suffering from:',\n correct:'7th Cranial Nerve Palsy',\n options:['8th Cranial Nerve Palsy','3rd Cranial Nerve Palsy','5th Cranial Nerve Palsy','7th Cranial Nerve Palsy'],\n exp:\"Unilateral LMN facial palsy (unable to close eye = weakness of orbicularis oculi) with herpetic vesicles in the external auditory canal (Ramsey Hunt syndrome) = VZV reactivation affecting the geniculate ganglion of the 7th (facial) cranial nerve. This is Herpes Zoster Oticus. Treatment: acyclovir + corticosteroids.\"\n },\n {\n id:45,\n stem:'Lesion of dominant parietal lobe causes which of the following?\\n1. Dysphasia\\n2. Acalculia\\n3. Dyslexia\\n4. Contralateral neglect',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:\"Dominant (left) parietal lobe lesion causes Gerstmann's syndrome: acalculia, agraphia, finger agnosia, right-left disorientation \u2014 plus dysphasia and dyslexia (language-dominant side involvement). Contralateral neglect (hemineglect\/hemispatial neglect) is a feature of NON-DOMINANT (right) parietal lobe lesion. Statement 4 is false. Statements 1, 2, and 3 are correct.\"\n },\n {\n id:46,\n stem:'Which of the following are the clinical features of Neurofibromatosis-1?\\n1. Angiomas\\n2. Axillary freckles\\n3. Cutaneous schwannomas\\n4. Neurofibromas',\n correct:'2, 3 and 4',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'NF-1 (von Recklinghausen disease) features: cafe-au-lait spots (6 or more), axillary\/inguinal freckles (Crowe\\'s sign), Lisch nodules (iris hamartomas), neurofibromas (peripheral nerve sheath tumours), cutaneous schwannomas, optic gliomas, and skeletal dysplasia. Angiomas are NOT a recognised feature of NF-1 \u2014 they are associated with Sturge-Weber syndrome and hereditary haemorrhagic telangiectasia. Statements 2, 3, and 4 are correct.'\n },\n {\n id:47,\n stem:\"Which of the following are clinical features of Parkinson's disease?\\n1. Bradykinesia\\n2. Rigidity\\n3. Spastic gait\\n4. Mask-like face\",\n correct:'1, 2 and 4',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:\"Parkinson's disease features: bradykinesia (essential for diagnosis), cogwheel rigidity, resting tremor, postural instability, mask-like (hypomimic) face, micrographia, and festinating gait (shuffling, narrow base). Spastic gait indicates UMN\/pyramidal tract involvement \u2014 Parkinson's is a basal ganglia disorder with NO spasticity. Statement 3 is false. Statements 1, 2, and 4 are correct.\"\n },\n {\n id:48,\n stem:'Which one of the following statements is correct for an individual with blood group AB?',\n correct:'A and B antigens on RBC; no antibody in plasma.',\n options:['A antigen on RBC; Anti-B antibody in plasma.','A and B antigens on RBC; no antibody in plasma.','B antigen on RBC; Anti-A antibody in plasma.','No antigen on RBC; Anti-A and Anti-B antibodies in plasma.'],\n exp:'Blood group AB: both A and B antigens on the RBC surface, and NO antibodies in the plasma (universal recipient). This is explained by Landsteiner\\'s law \u2014 antibodies are not formed against self-antigens. Group O has no antigens but both Anti-A and Anti-B antibodies (universal donor for RBCs).'\n },\n {\n id:49,\n stem:'Which one of the following is unlikely to be associated with eosinophilia?',\n correct:'Tuberculosis',\n options:[\"Loeffler's syndrome\",'Toxocariasis','Trichinella spiralis','Tuberculosis'],\n exp:\"Eosinophilia is caused by: tissue-invasive parasites (Toxocara, Trichinella, filaria, schistosoma), allergic\/atopic disease, Loeffler's syndrome (transient pulmonary eosinophilia from larval migration), and drugs. Tuberculosis causes lymphocytosis in the CSF and mononuclear response \u2014 it is NOT associated with eosinophilia. TB actually tends to suppress eosinophilia.\"\n },\n {\n id:50,\n stem:'Which one of the following is a tumour marker for carcinoma of pancreas?',\n correct:'CA-19-9',\n options:['Alpha-fetoprotein','CA-125','Calcitonin','CA-19-9'],\n exp:'CA-19-9 (carbohydrate antigen 19-9) is the primary tumour marker for pancreatic adenocarcinoma \u2014 used for monitoring treatment response and detecting recurrence rather than screening. AFP = hepatocellular carcinoma \/ germ cell tumour. CA-125 = epithelial ovarian carcinoma. Calcitonin = medullary carcinoma of thyroid.'\n },\n {\n id:51,\n stem:'Which of the following statements regarding G6PD enzyme deficiency are correct?\\n1. It is an X-linked deficiency\\n2. Geographical distribution parallels the malaria belt\\n3. Consumption of fava beans is protective\\n4. Transfusion support may be life saving',\n correct:'1, 2 and 4',\n options:['1 and 3 only','1, 2 and 4','1 and 4 only','2, 3 and 4'],\n exp:'G6PD deficiency: (1) X-linked recessive \u2014 correct; (2) highest prevalence in malaria-endemic regions (partial protection against P. falciparum via oxidative stress in parasitised RBCs) \u2014 correct; (3) fava beans TRIGGER haemolysis, they are NOT protective \u2014 statement 3 is FALSE; (4) severe haemolytic crisis may require RBC transfusion \u2014 correct. Statements 1, 2, and 4 are correct.'\n },\n {\n id:52,\n stem:'Which of the following investigations indicate active haemolysis?\\n1. Increased reticulocyte count\\n2. Increased conjugated bilirubin\\n3. Increased urinary urobilinogen\\n4. Decreased haptoglobin',\n correct:'1, 3 and 4',\n options:['1, 2 and 3','1 and 4 only','1, 3 and 4','2 and 3 only'],\n exp:'Haemolysis markers: raised reticulocyte count (bone marrow compensatory response), raised UNCONJUGATED (not conjugated) bilirubin (from haem breakdown), raised urinary urobilinogen, decreased haptoglobin (scavenges free haemoglobin, rapidly consumed). Statement 2 is false \u2014 haemolysis raises unconjugated bilirubin, not conjugated. Statements 1, 3, and 4 are correct.'\n },\n {\n id:53,\n stem:'Which type of anaemia can be caused by the drug Dapsone?',\n correct:'Haemolytic anaemia',\n options:['Iron deficiency anaemia','Sideroblastic anaemia','Spur cell anaemia','Haemolytic anaemia'],\n exp:'Dapsone (used in leprosy, PCP prophylaxis, dermatitis herpetiformis) causes dose-dependent oxidative haemolytic anaemia and methaemoglobinaemia. It oxidises haemoglobin, forming Heinz bodies which damage the RBC membrane. This effect is more severe in G6PD-deficient individuals. All patients on dapsone should have baseline G6PD testing.'\n },\n {\n id:54,\n stem:'Which of the following are decreased during pregnancy?\\n1. Iron stores\\n2. Vitamin B12 levels\\n3. Folate levels\\n4. Coagulation factors',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2, 3 and 4'],\n exp:'During pregnancy: iron stores deplete (increased fetal demand + expanded plasma volume), Vitamin B12 levels fall (haemodilution + fetal transfer), folate levels fall (increased demand for fetal neural tube development \u2014 hence supplementation). Coagulation factors (I, VII, VIII, IX, X, XII, vWF) actually INCREASE in pregnancy \u2014 pregnancy is a hypercoagulable state. Statement 4 is false. Statements 1, 2, and 3 are correct.'\n },\n {\n id:55,\n stem:'Which one of the following drugs causes direct Xa inhibition?',\n correct:'Apixaban',\n options:['Tirofiban','Apixaban','Dabigatran','Prasugrel'],\n exp:'Direct oral anticoagulants (DOACs) by mechanism: Factor Xa inhibitors = apixaban, rivaroxaban, edoxaban, betrixaban (the \"-xabans\"). Direct thrombin (Factor IIa) inhibitor = dabigatran. Tirofiban = GpIIb\/IIIa inhibitor (antiplatelet). Prasugrel = P2Y12 ADP receptor antagonist (antiplatelet). Apixaban is therefore the direct Xa inhibitor.'\n },\n {\n id:56,\n stem:'A 20-year-old girl presents with heavy menstrual bleeding, petechiae on arms and blood blisters in mouth. CBC shows Hb 7 gm\/dL, TLC 8,700 cells\/uL and platelet count 6,000\/uL with large platelets on smear. Which is likely the best initial drug treatment?',\n correct:'High dose glucocorticoids',\n options:['High dose glucocorticoids','High dose glucocorticoids with IVIgG','High dose glucocorticoids with Rituximab','IVIgG with anti-Rho(D) therapy'],\n exp:'Severe ITP (platelet count below 10,000 with mucosal bleeding) in a young woman: first-line treatment is high-dose glucocorticoids (prednisolone 1 mg\/kg or dexamethasone 40 mg\/day for 4 days). IVIgG is added when rapid platelet rise is needed (surgery, life-threatening bleed). Rituximab and thrombopoietin receptor agonists are second-line after steroid failure.'\n },\n {\n id:57,\n stem:'A 30-year-old female vegetarian presents with malaise, breathlessness and paraesthesias. Investigations show Hb 6.2 gm\/dL, MCV 128 fL, platelet count 1,20,000\/cumm, blood smear showing macrocytosis and neutrophil hypersegmentation. What is the likely diagnosis?',\n correct:'Megaloblastic anaemia',\n options:['Iron deficiency anaemia','Myelophthisic anaemia','Megaloblastic anaemia','Aplastic anaemia'],\n exp:'The combination of macrocytic anaemia (MCV 128 fL), neutrophil hypersegmentation (5+ lobes), vegetarian diet (B12 deficiency risk), and neurological symptoms (paraesthesias from subacute combined degeneration) is diagnostic of megaloblastic anaemia due to B12\/folate deficiency. Aplastic anaemia shows pancytopenia with normocytic RBCs. IDA shows microcytic anaemia.'\n },\n {\n id:58,\n stem:'Which of the following is the most common dermatologic manifestation of Diabetes mellitus?',\n correct:'Xerosis',\n options:['Xerosis','Acanthosis nigricans','Lichen planus','Necrobiosis lipoidica'],\n exp:'Xerosis (dry skin) is the most common dermatological manifestation of diabetes mellitus, occurring in up to 70% of diabetic patients. It results from autonomic neuropathy causing decreased sweating and sebaceous secretion. Acanthosis nigricans indicates insulin resistance but is less common overall. Necrobiosis lipoidica diabeticorum is pathognomonic but rare (~0.3%).'\n },\n {\n id:59,\n stem:'Which one of the following conditions may result in hypoglycaemia?',\n correct:'Critical illness',\n options:['Critical illness','Cortisol therapy','Cushing\\'s disease','Metabolic syndrome'],\n exp:'Critical illness causes hypoglycaemia through: impaired gluconeogenesis (liver dysfunction), increased insulin sensitivity, reduced glycogen stores, and decreased counterregulatory hormone responses. Cortisol therapy, Cushing\\'s disease, and metabolic syndrome all cause HYPERGLYCAEMIA through insulin resistance and increased hepatic glucose output.'\n },\n {\n id:60,\n stem:'Use of which of the following drugs may result in osteoporosis?\\n1. Phenytoin\\n2. Lithium\\n3. Methotrexate\\n4. Azathioprine',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],\n exp:'Drug-induced osteoporosis: Phenytoin (induces CYP450 enzymes, accelerating vitamin D catabolism), Lithium (increases PTH secretion, affecting bone turnover), Methotrexate (inhibits osteoblast function, causes methotrexate osteopathy). Azathioprine is NOT a recognised cause of osteoporosis \u2014 it is an immunosuppressant with other toxicities (myelosuppression, hepatotoxicity). 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Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 2 Nephrology \u00b7 Neurology \u00b7 Haematology \u00b7 Endocrinology Questions 31 \u2013 60 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-36591","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2021 P1 Part-2 - 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\/16\/cms-2021-p1-part-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2021 P1 Part-2 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2021 Paper I \u2013 Part 2 (Q31\u2013Q60) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! 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