CMS 2021 Paper I \u2013 Part 3 (Q61\u2013Q90)<\/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: cms21p1c \u2500\u2500 *\/\n#cms21p1c *,#cms21p1c *::before,#cms21p1c *::after{box-sizing:border-box;margin:0;padding:0}\n#cms21p1c{\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#cms21p1c .cq-sentinel{height:1px}\n#cms21p1c 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var(--teal);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms21p1c .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#cms21p1c .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms21p1c .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms21p1c .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms21p1c .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms21p1c .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms21p1c .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms21p1c 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id=\"cms21p1c\">\n <div class=\"cq-sentinel\" id=\"cms21p1c-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms21p1c-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms21p1c-timer-item\">\u23f1 <strong id=\"cms21p1c-timer-display\">30:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms21p1c-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms21p1c-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms21p1c-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms21p1c-sn\">0<\/strong> \/ <strong id=\"cms21p1c-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms21p1c-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms21p1c-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms21p1c-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms21p1c-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2021<br>Paper I \u00b7 Part 3<\/h1>\n <p>Endocrinology \u00b7 Infectious Disease \u00b7 Rheumatology \u00b7 Genetics<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 61 \u2013 90<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms21p1c-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms21p1c-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms21p1c-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms21p1c-score\">\n <div class=\"cq-score-ring\" id=\"cms21p1c-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms21p1c-ring-pct\">0%<\/span><span class=\"cq-ring-sub\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms21p1c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms21p1c-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms21p1c-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms21p1c-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms21p1c-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms21p1c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms21p1c',TOTAL=30,MAX=TOTAL*4,TIMER_SECS=30*60,GRACE_SECS=10;\n const QUESTIONS=[\n {id:61,stem:'Which one of the following oral anti-diabetic drugs acts on renal proximal tubules?',correct:'SGLT-2 inhibitors',options:['Alpha glucosidase inhibitors','GLP-1 analogue','DPP-4 inhibitors','SGLT-2 inhibitors'],exp:'SGLT-2 (sodium-glucose co-transporter 2) inhibitors (e.g., dapagliflozin, empagliflozin, canagliflozin) act on the renal proximal tubule to block glucose reabsorption, causing glucosuria regardless of blood glucose levels. This lowers HbA1c and also has cardioprotective and renoprotective benefits demonstrated in major trials.'},\n {id:62,stem:'Which of the following are short acting insulin?\\n1. Aspart\\n2. Lispro\\n3. Glargine\\n4. Regular',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Short-acting insulins: Regular (soluble) insulin and rapid-acting analogues Aspart, Lispro, and Glulisine. Glargine is a long-acting basal insulin analogue with a flat 24-hour profile and no pronounced peak. Statement 3 is false. Statements 1, 2, and 4 are correct.'},\n {id:63,stem:'Hirsutism is seen in which of the following?\\n1. Polycystic ovarian syndrome\\n2. Congenital adrenal hyperplasia\\n3. Hypothyroidism\\n4. Ovarian tumour',correct:'1, 2 and 4',options:['1 and 2 only','1, 2 and 4','1, 3 and 4','2 and 4 only'],exp:'Hirsutism (androgen-dependent male-pattern hair growth in women) occurs in PCOS (elevated androgens), CAH (androgen excess from cortisol synthesis defect), and androgen-secreting ovarian tumours. Hypothyroidism causes dry, coarse hair and hair loss (not hirsutism). Statement 3 is false. Statements 1, 2, and 4 are correct.'},\n {id:64,stem:'Which of the following are correct regarding hypothyroidism?\\n1. It is more common in females\\n2. Autoimmunity is a rare aetiopathogenesis\\n3. In pregnancy, increased dose of levothyroxine is required\\n4. Suppressed TSH is a risk factor for osteoporosis',correct:'1, 3 and 4',options:['1, 2 and 3','1 and 4 only','1, 3 and 4','2, 3 and 4'],exp:'Statement 2 is false: autoimmune thyroiditis (Hashimoto) is the MOST COMMON cause of hypothyroidism in iodine-sufficient areas, not rare. Statements 1 (F:M ratio ~10:1), 3 (pregnancy increases T4 demand by 30\u201350%), and 4 (suppressed TSH from over-replacement causes accelerated bone loss) are all correct.'},\n {id:65,stem:'Which of the following are correct regarding Diabetes insipidus?\\n1. Polyuria and polydipsia are common symptoms\\n2. Urine is of low osmolality and specific gravity\\n3. Lithium is useful in treatment\\n4. It is potentially lethal if hypothalamic thirst centre is damaged',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'Statement 3 is false: Lithium CAUSES nephrogenic DI (blocks ADH action on collecting duct) \u2014 it does not treat it. DI is treated with desmopressin (central DI) or thiazides\/indomethacin (nephrogenic DI). Statements 1 (polyuria\/polydipsia), 2 (dilute urine), and 4 (if thirst mechanism is impaired, patients cannot compensate and develop fatal hypernatraemia) are correct.'},\n {id:66,stem:'A 42-year-old lady presents with tiredness, constipation, impaired hearing and weight gain despite poor appetite. Which of the following are relevant investigations in this case?\\n1. TSH level\\n2. Free T4 levels\\n3. Anti-TPO antibodies\\n4. Radionuclide scan of the thyroid',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'This presentation (tiredness, constipation, weight gain, hearing loss) is classic for hypothyroidism. Relevant investigations: TSH (most sensitive screening test), free T4 (severity), anti-TPO antibodies (confirms autoimmune aetiology, Hashimoto). Radionuclide scan is used for thyroid nodules, hyperthyroidism, or goitre \u2014 it is NOT required for diagnosing hypothyroidism. Statement 4 is not relevant here.'},\n {id:67,stem:'A patient presents with circulatory shock, nausea, vomiting and diarrhoea. Acute adrenal crisis is considered. Treatment is started. Which of the following are appropriate interventions?\\n1. IV normal saline\\n2. IV hydrocortisone 100 mg stat\\n3. IV 10% glucose\\n4. IV KCl as infusion',correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2, 3 and 4'],exp:'Adrenal crisis management: IV normal saline (volume resuscitation, correct hypotension), IV hydrocortisone 100 mg stat then 50\u2013100 mg 6-hourly (replaces cortisol), IV glucose (adrenal crisis causes hypoglycaemia). Statement 4 is wrong: adrenal crisis causes HYPERkalaemia (lack of aldosterone) \u2014 IV KCl would be dangerous. Statements 1, 2, and 3 are appropriate.'},\n {id:68,stem:'The most common acid-base disturbance in critically ill patients is:',correct:'Chronic metabolic acidosis',options:['Chronic respiratory acidosis','Chronic respiratory alkalosis','Chronic metabolic acidosis','Chronic metabolic alkalosis'],exp:'Metabolic acidosis is the most frequently observed acid-base disorder in critically ill patients \u2014 driven by lactic acidosis (from poor tissue perfusion\/sepsis), renal failure, ketoacidosis, and hyperchloraemia from IV saline infusions. Recognition and identification of the underlying cause (MUDPILES mnemonic) is essential for management.'},\n {id:69,stem:'Which of the following are the potentially reversible causes of weight gain?\\n1. Insulinoma\\n2. Cushing\\'s syndrome\\n3. Sulfonylureas\\n4. Beta-blockers',correct:'1, 2, 3 and 4',options:['1 and 2 only','3 and 4 only','2 and 3 only','1, 2, 3 and 4'],exp:'All four are potentially reversible causes of weight gain: Insulinoma (surgical cure \u2192 weight loss), Cushing\\'s syndrome (treating the cause reverses weight gain), Sulfonylureas (stimulate insulin secretion, increase appetite \u2014 can be switched), Beta-blockers (modest weight gain via reduced metabolic rate \u2014 can be switched). All four are correct.'},\n {id:70,stem:'Which of the following are the metabolic complications of parenteral nutrition?\\n1. Hyperglycaemia\\n2. Liver disease (cholestasis\/steatosis)\\n3. Fluid overload\\n4. Hyperphosphataemia',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','3 and 4 only','1 and 3 only'],exp:'Parenteral nutrition complications: hyperglycaemia (from glucose load), liver disease (cholestasis, steatohepatitis from TPN), fluid overload (excessive volume). Statement 4 is false: HYPOphosphataemia (refeeding syndrome) is the recognised complication, not hyperphosphataemia. Refeeding syndrome occurs as insulin drives phosphate intracellularly. Statements 1, 2, and 3 are correct.'},\n {id:71,stem:'Pseudomembranous colitis is associated with which one of the following microbes?',correct:'Clostridium difficile',options:['Entamoeba histolytica','Salmonella typhi','Escherichia coli','Clostridium difficile'],exp:'Pseudomembranous colitis is caused by Clostridium difficile (now Clostridioides difficile) toxins A and B, typically following antibiotic disruption of the colonic microbiome. Yellow-white pseudomembranes on colonoscopy are pathognomonic. Diagnosis by stool C. difficile toxin assay or PCR. Treatment: oral vancomycin or fidaxomicin.'},\n {id:72,stem:'The characteristic rash seen on the face in a case of Parvovirus B19 infection is called:',correct:'Slapped cheek rash',options:['Slapped cheek rash','Butterfly rash','Melasma-like rash','Christmas tree rash'],exp:\"Parvovirus B19 causes Erythema infectiosum (Fifth disease) in children, characterised by the 'slapped cheek' appearance \u2014 bright red erythema on both cheeks. This is followed by a lacy reticular rash on the trunk and limbs. In adults it causes arthropathy; in sickle cell\/haemolytic anaemia patients it causes aplastic crisis; in pregnancy it risks hydrops fetalis.\"},\n {id:73,stem:'Bartonella infection is an important cause of blood culture negative endocarditis. Clinical diseases caused by Bartonella species in humans include which of the following?\\n1. Cat scratch disease\\n2. Trench fever\\n3. Carrion\\'s disease\\n4. Anisakiasis',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Bartonella diseases: Cat scratch disease (B. henselae \u2014 via cat scratch\/flea), Trench fever (B. quintana \u2014 louse-borne, classically in WWI soldiers), Carrion's disease\/Oroya fever\/Verruga peruana (B. bacilliformis \u2014 sandfly-borne, Andean regions), and bacillary angiomatosis (B. henselae\/quintana in HIV). Anisakiasis is caused by Anisakis simplex (a marine nematode from raw fish) \u2014 NOT Bartonella. Statement 4 is false.\"},\n {id:74,stem:'The causative organism and the vector for scrub typhus are:',correct:'Orientia tsutsugamushi and Trombiculid mite',options:['Orientia tsutsugamushi and Louse','Rickettsia rickettsii and Trombiculid mite','Orientia tsutsugamushi and Trombiculid mite','Rickettsia prowazekii and Ixodes tick'],exp:\"Scrub typhus: caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi), transmitted by the larval stage (chigger) of Trombiculid mites (Leptotrombidium species). Characteristic eschar at bite site, fever, rash, and lymphadenopathy. Treatment: doxycycline. Rickettsia rickettsii = Rocky Mountain spotted fever (Dermacentor tick); R. prowazekii = epidemic typhus (louse).\"},\n {id:75,stem:'Which of the following are correct regarding tetanus?\\n1. Risus sardonicus may be seen\\n2. Endotoxin produced has affinity for sensory nerve endings\\n3. Lockjaw is painless\\n4. Hysteria can mimic tetanus',correct:'1, 3 and 4',options:['1, 2 and 3 only','2 and 4 only','1, 3 and 4','1, 2, 3 and 4'],exp:\"Statement 2 is false on two counts: tetanus produces an EXOTOXIN (tetanospasmin), not endotoxin, and it has affinity for MOTOR nerve endings and inhibitory interneurons (Renshaw cells) \u2014 not sensory endings. Risus sardonicus (sardonic smile from facial spasm) is characteristic. Lockjaw (trismus) is tonic rigidity \u2014 not the lancinating pain type; hysteria (conversion disorder) can clinically mimic tetanus. Statements 1, 3, and 4 are correct.\"},\n {id:76,stem:'A 25-year-old traveller from United Kingdom desires anti-malaria prophylaxis before travelling to India. He has history of seizures and depression. Which of the following drugs can be used?\\n1. Doxycycline\\n2. Atovaquone + Proguanil\\n3. Chloroquine + Proguanil\\n4. Mefloquine',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1 and 3 only','3 and 4 only'],exp:'Mefloquine (statement 4) is ABSOLUTELY CONTRAINDICATED in patients with seizure disorders or psychiatric conditions (depression, anxiety, psychosis) \u2014 it lowers seizure threshold and causes neuropsychiatric adverse effects. Doxycycline, Atovaquone+Proguanil (Malarone), and Chloroquine+Proguanil are safe options in this patient. Statements 1, 2, and 3 are correct.'},\n {id:77,stem:'Pulmonary stage (Loeffler\\'s syndrome) is seen in which of the following infections?\\n1. Ascaris lumbricoides\\n2. Strongyloides stercoralis\\n3. Onchocerca volvulus',correct:'1 and 2 only',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:\"Pulmonary larval migration (Loeffler's syndrome) occurs with helminths whose larvae migrate through the lungs: Ascaris lumbricoides (larvae ascend the airways after gut penetration), Strongyloides stercoralis (filariform larvae penetrate skin \u2192 lung \u2192 gut), hookworm (Ancylostoma\/Necator), and Toxocara. Onchocerca volvulus is transmitted by Simulium blackflies and causes river blindness \u2014 its larvae do NOT migrate through the lungs. Statements 1 and 2 are correct.\"},\n {id:78,stem:'Consider the following statements with regard to Amphotericin B:\\n1. It is a narrow spectrum antifungal agent\\n2. It can cause nephrotoxicity\\n3. It lacks an oral preparation\\n4. Its lipid formulations are less toxic',correct:'2, 3 and 4',options:['2 and 3 only','2, 3 and 4','1, 3 and 4','2 and 4 only'],exp:'Statement 1 is false: Amphotericin B is a BROAD-spectrum antifungal active against most pathogenic fungi (Candida, Aspergillus, Cryptococcus, Histoplasma, Mucor, etc.) and some parasites (Leishmania). Statements 2 (nephrotoxicity is the major dose-limiting adverse effect), 3 (no oral preparation \u2014 given only IV or intrathecally), and 4 (liposomal and lipid complex formulations have significantly reduced nephrotoxicity) are all correct.'},\n {id:79,stem:\"Which one of the following moulds causes mucormycosis, commonly known as 'black fungus'?\",correct:'Rhizopus',options:['Rhizopus','Aspergillus','Candida','Histoplasma'],exp:'Mucormycosis (black fungus) is caused by fungi of the order Mucorales, most commonly Rhizopus arrhizus (oryzae), followed by Mucor, Lichtheimia, and Cunninghamella. It is an angioinvasive infection causing thrombosis and infarction (hence the black necrotic appearance). Risk factors: diabetic ketoacidosis, immunosuppression, corticosteroid therapy (notably post-COVID).'},\n {id:80,stem:'Which of the following infections are caused by mosquito bite?\\n1. Malaria\\n2. Typhus\\n3. Filariasis\\n4. Dengue fever',correct:'1, 3 and 4',options:['1, 2 and 3','1 and 4 only','1, 3 and 4','2, 3 and 4'],exp:'Mosquito-borne: Malaria (Anopheles), Lymphatic filariasis (Culex \u2014 Wuchereria bancrofti), Dengue\/Zika\/Chikungunya (Aedes), Japanese encephalitis (Culex). Typhus is vector-borne but NOT by mosquito: epidemic typhus = body louse (Pediculus humanus), scrub typhus = chigger (Trombiculid mite), murine typhus = rat flea. Statement 2 is false. Statements 1, 3, and 4 are correct.'},\n {id:81,stem:'Which one of the following is a hallmark of marasmus?',correct:'Triceps skin fold below 3 mm',options:['Normal body mass index','Serum albumin below 2.8 g\/dL','Anergy','Triceps skin fold below 3 mm'],exp:'Marasmus is severe caloric deficiency with gross wasting of fat and muscle. The hallmark anthropometric finding is severe depletion of subcutaneous fat measured as triceps skinfold thickness below 3 mm. Serum albumin below 2.8 g\/dL is the hallmark of Kwashiorkor (protein deficiency with oedema). BMI is very low in marasmus (not normal). Anergy occurs in both.'},\n {id:82,stem:'Anti-Ribonucleoprotein antibody (Anti-RNP) is characteristically seen in which one of the following conditions?',correct:'Mixed connective tissue disorder',options:[\"Sjogren's syndrome\",'Diffuse systemic sclerosis','Sarcoidosis','Mixed connective tissue disorder'],exp:\"Anti-U1-RNP antibodies at high titre are the hallmark of Mixed Connective Tissue Disease (MCTD\/Sharp syndrome) \u2014 a condition with overlapping features of SLE, polymyositis, scleroderma, and rheumatoid arthritis. Anti-Ro\/La = Sjogren's syndrome. Anti-Scl-70 = diffuse systemic sclerosis. Sarcoidosis has no specific ANA pattern.\"},\n {id:83,stem:'Polyarteritis nodosa has peak incidence between the ages of:',correct:'40 - 50 years',options:['10 - 20 years','20 - 30 years','30 - 40 years','40 - 50 years'],exp:'Polyarteritis nodosa (PAN) is a necrotising vasculitis of medium-sized arteries. It peaks in the 5th decade (40\u201360 years) and is more common in males. It spares the lungs and is associated with Hepatitis B (in ~30% of classic PAN). It does NOT cause glomerulonephritis (unlike ANCA-associated vasculitides).'},\n {id:84,stem:'First-line drug treatment to reduce fractures in osteoporosis is:',correct:'Bisphosphonates',options:['Bisphosphonates','Denosumab','Teriparatide','Raloxifene'],exp:'Bisphosphonates (alendronate, risedronate, zoledronic acid) are the first-line pharmacological treatment for osteoporosis \u2014 they reduce vertebral fractures by ~50% and hip fractures by ~25\u201340% in clinical trials. Denosumab and teriparatide are second-line or specialist-initiated. Raloxifene reduces vertebral but NOT hip fractures.'},\n {id:85,stem:'Which of the following are tricyclic antidepressants?\\n1. Amitriptyline\\n2. Dosulepin\\n3. Paroxetine\\n4. Imipramine',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Tricyclic antidepressants (TCAs): amitriptyline, imipramine, clomipramine, dosulepin (dothiepin), doxepin, nortriptyline, trimipramine. Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) \u2014 NOT a TCA. Statement 3 is false. Statements 1, 2, and 4 are correct.'},\n {id:86,stem:'Recurrent bouts of binge eating are usually associated with:',correct:'Bulimia nervosa',options:['Bulimia nervosa','Anorexia nervosa','Post-partum depression','Personality disorder'],exp:'Bulimia nervosa is characterised by recurrent episodes of binge eating (consuming abnormally large amounts of food rapidly) followed by compensatory behaviours (purging, laxative use, excessive exercise). BMI is typically normal. Anorexia nervosa involves severe food restriction with very low BMI. The binge-purge cycle is the defining feature of bulimia.'},\n {id:87,stem:'During physical assessment of a 55-year-old male with low back pain, the quadriceps (knee) reflex was absent. Which of the following nerve roots is most likely to be affected?',correct:'L4',options:['L2','L5','L4','S1'],exp:'The knee jerk (patellar tendon) reflex is mediated primarily by L3\u2013L4. L4 is the dominant root for the quadriceps reflex. L5 mediates the tibialis posterior\/extensor digitorum reflexes. S1 mediates the ankle jerk (Achilles tendon) reflex. L2\u2013L3 contribute to the adductor reflex. Absent knee reflex = L4 lesion most likely.'},\n {id:88,stem:'Which of the following conditions are parts of inherited cancer syndrome?\\n1. Retinoblastoma\\n2. Li-Fraumeni syndrome\\n3. Xeroderma pigmentosum\\n4. Peutz-Jeghers syndrome',correct:'1, 2, 3 and 4',options:['1, 2, 3 and 4','1, 2 and 3 only','1 and 3 only','2 and 4 only'],exp:'All four are inherited cancer syndromes: Retinoblastoma (RB1 tumour suppressor gene, AD), Li-Fraumeni syndrome (TP53 germline mutation \u2014 sarcomas, breast, brain, adrenal cancers), Xeroderma pigmentosum (DNA nucleotide excision repair defect \u2014 extreme UV sensitivity, skin cancers), Peutz-Jeghers syndrome (STK11\/LKB1 mutation \u2014 hamartomatous polyps + GI\/breast\/pancreatic cancers). All four are correct.'},\n {id:89,stem:'Which of the following are the diseases associated with DNA repeat sequences?\\n1. Huntington\\'s disease\\n2. Myotonic dystrophy\\n3. Friedreich\\'s ataxia\\n4. Klinefelter syndrome',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Trinucleotide\/nucleotide repeat expansion diseases: Huntington (CAG repeat in HTT), Myotonic dystrophy type 1 (CTG repeat in DMPK), Friedreich\\'s ataxia (GAA repeat in FXN\/frataxin), Fragile X syndrome (CGG repeat), SBMA, DRPLA. Klinefelter syndrome (47,XXY) is a chromosomal aneuploidy \u2014 NOT a repeat sequence disorder. Statement 4 is false. Statements 1, 2, and 3 are correct.'},\n {id:90,stem:'Cardiac outflow tract defect, thymic hypoplasia, cleft palate and hypocalcaemia are clinical features of which gene disorder?',correct:'DiGeorge syndrome',options:['Angelman syndrome','Williams syndrome','Smith-Magenis syndrome','DiGeorge syndrome'],exp:\"DiGeorge syndrome (22q11.2 deletion syndrome \/ CATCH-22): Cardiac defects (conotruncal \u2014 ToF, truncus arteriosus, interrupted aortic arch), Abnormal facies, Thymic hypoplasia (T-cell immunodeficiency), Cleft palate, Hypocalcaemia (hypoparathyroidism from absent parathyroids). It is the most common microdeletion syndrome. Williams syndrome = 7q11 deletion (supravalvular aortic stenosis, elfin facies, hypercalcaemia).\"}\n ];\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,quizSubmitted=false;\n\n function shuffle(arr){const a=arr.slice();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]];}return a;}\n function fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return(m<10?'0':'')+m+':'+(sec<10?'0':'')+sec;}\n\n function startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 '+fmtTime(timerRemaining);btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n timerRemaining--;\n const disp=fmtTime(timerRemaining);\n 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Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 3 Endocrinology \u00b7 Infectious Disease \u00b7 Rheumatology \u00b7 Genetics Questions 61 \u2013 90 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-36593","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2021 P1 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\/16\/cms-2021-p1-part-3\/\" \/>\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-3 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2021 Paper I \u2013 Part 3 (Q61\u2013Q90) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! 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class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms21p1c-sn\">0<\/strong> \/ <strong id=\"cms21p1c-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms21p1c-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms21p1c-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms21p1c-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms21p1c-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2021<br>Paper I \u00b7 Part 3<\/h1>\n <p>Endocrinology \u00b7 Infectious Disease \u00b7 Rheumatology \u00b7 Genetics<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 61 \u2013 90<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms21p1c-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms21p1c-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms21p1c-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms21p1c-score\">\n <div class=\"cq-score-ring\" id=\"cms21p1c-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms21p1c-ring-pct\">0%<\/span><span class=\"cq-ring-sub\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms21p1c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms21p1c-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms21p1c-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms21p1c-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms21p1c-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms21p1c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms21p1c',TOTAL=30,MAX=TOTAL*4,TIMER_SECS=30*60,GRACE_SECS=10;\n const QUESTIONS=[\n {id:61,stem:'Which one of the following oral anti-diabetic drugs acts on renal proximal tubules?',correct:'SGLT-2 inhibitors',options:['Alpha glucosidase inhibitors','GLP-1 analogue','DPP-4 inhibitors','SGLT-2 inhibitors'],exp:'SGLT-2 (sodium-glucose co-transporter 2) inhibitors (e.g., dapagliflozin, empagliflozin, canagliflozin) act on the renal proximal tubule to block glucose reabsorption, causing glucosuria regardless of blood glucose levels. This lowers HbA1c and also has cardioprotective and renoprotective benefits demonstrated in major trials.'},\n {id:62,stem:'Which of the following are short acting insulin?\\n1. Aspart\\n2. Lispro\\n3. Glargine\\n4. Regular',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Short-acting insulins: Regular (soluble) insulin and rapid-acting analogues Aspart, Lispro, and Glulisine. Glargine is a long-acting basal insulin analogue with a flat 24-hour profile and no pronounced peak. Statement 3 is false. Statements 1, 2, and 4 are correct.'},\n {id:63,stem:'Hirsutism is seen in which of the following?\\n1. Polycystic ovarian syndrome\\n2. Congenital adrenal hyperplasia\\n3. Hypothyroidism\\n4. Ovarian tumour',correct:'1, 2 and 4',options:['1 and 2 only','1, 2 and 4','1, 3 and 4','2 and 4 only'],exp:'Hirsutism (androgen-dependent male-pattern hair growth in women) occurs in PCOS (elevated androgens), CAH (androgen excess from cortisol synthesis defect), and androgen-secreting ovarian tumours. Hypothyroidism causes dry, coarse hair and hair loss (not hirsutism). Statement 3 is false. Statements 1, 2, and 4 are correct.'},\n {id:64,stem:'Which of the following are correct regarding hypothyroidism?\\n1. It is more common in females\\n2. Autoimmunity is a rare aetiopathogenesis\\n3. In pregnancy, increased dose of levothyroxine is required\\n4. Suppressed TSH is a risk factor for osteoporosis',correct:'1, 3 and 4',options:['1, 2 and 3','1 and 4 only','1, 3 and 4','2, 3 and 4'],exp:'Statement 2 is false: autoimmune thyroiditis (Hashimoto) is the MOST COMMON cause of hypothyroidism in iodine-sufficient areas, not rare. Statements 1 (F:M ratio ~10:1), 3 (pregnancy increases T4 demand by 30\u201350%), and 4 (suppressed TSH from over-replacement causes accelerated bone loss) are all correct.'},\n {id:65,stem:'Which of the following are correct regarding Diabetes insipidus?\\n1. Polyuria and polydipsia are common symptoms\\n2. Urine is of low osmolality and specific gravity\\n3. Lithium is useful in treatment\\n4. It is potentially lethal if hypothalamic thirst centre is damaged',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'Statement 3 is false: Lithium CAUSES nephrogenic DI (blocks ADH action on collecting duct) \u2014 it does not treat it. DI is treated with desmopressin (central DI) or thiazides\/indomethacin (nephrogenic DI). Statements 1 (polyuria\/polydipsia), 2 (dilute urine), and 4 (if thirst mechanism is impaired, patients cannot compensate and develop fatal hypernatraemia) are correct.'},\n {id:66,stem:'A 42-year-old lady presents with tiredness, constipation, impaired hearing and weight gain despite poor appetite. Which of the following are relevant investigations in this case?\\n1. TSH level\\n2. Free T4 levels\\n3. Anti-TPO antibodies\\n4. Radionuclide scan of the thyroid',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'This presentation (tiredness, constipation, weight gain, hearing loss) is classic for hypothyroidism. Relevant investigations: TSH (most sensitive screening test), free T4 (severity), anti-TPO antibodies (confirms autoimmune aetiology, Hashimoto). Radionuclide scan is used for thyroid nodules, hyperthyroidism, or goitre \u2014 it is NOT required for diagnosing hypothyroidism. Statement 4 is not relevant here.'},\n {id:67,stem:'A patient presents with circulatory shock, nausea, vomiting and diarrhoea. Acute adrenal crisis is considered. Treatment is started. Which of the following are appropriate interventions?\\n1. IV normal saline\\n2. IV hydrocortisone 100 mg stat\\n3. IV 10% glucose\\n4. IV KCl as infusion',correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2, 3 and 4'],exp:'Adrenal crisis management: IV normal saline (volume resuscitation, correct hypotension), IV hydrocortisone 100 mg stat then 50\u2013100 mg 6-hourly (replaces cortisol), IV glucose (adrenal crisis causes hypoglycaemia). Statement 4 is wrong: adrenal crisis causes HYPERkalaemia (lack of aldosterone) \u2014 IV KCl would be dangerous. Statements 1, 2, and 3 are appropriate.'},\n {id:68,stem:'The most common acid-base disturbance in critically ill patients is:',correct:'Chronic metabolic acidosis',options:['Chronic respiratory acidosis','Chronic respiratory alkalosis','Chronic metabolic acidosis','Chronic metabolic alkalosis'],exp:'Metabolic acidosis is the most frequently observed acid-base disorder in critically ill patients \u2014 driven by lactic acidosis (from poor tissue perfusion\/sepsis), renal failure, ketoacidosis, and hyperchloraemia from IV saline infusions. Recognition and identification of the underlying cause (MUDPILES mnemonic) is essential for management.'},\n {id:69,stem:'Which of the following are the potentially reversible causes of weight gain?\\n1. Insulinoma\\n2. Cushing\\'s syndrome\\n3. Sulfonylureas\\n4. Beta-blockers',correct:'1, 2, 3 and 4',options:['1 and 2 only','3 and 4 only','2 and 3 only','1, 2, 3 and 4'],exp:'All four are potentially reversible causes of weight gain: Insulinoma (surgical cure \u2192 weight loss), Cushing\\'s syndrome (treating the cause reverses weight gain), Sulfonylureas (stimulate insulin secretion, increase appetite \u2014 can be switched), Beta-blockers (modest weight gain via reduced metabolic rate \u2014 can be switched). All four are correct.'},\n {id:70,stem:'Which of the following are the metabolic complications of parenteral nutrition?\\n1. Hyperglycaemia\\n2. Liver disease (cholestasis\/steatosis)\\n3. Fluid overload\\n4. Hyperphosphataemia',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','3 and 4 only','1 and 3 only'],exp:'Parenteral nutrition complications: hyperglycaemia (from glucose load), liver disease (cholestasis, steatohepatitis from TPN), fluid overload (excessive volume). Statement 4 is false: HYPOphosphataemia (refeeding syndrome) is the recognised complication, not hyperphosphataemia. Refeeding syndrome occurs as insulin drives phosphate intracellularly. Statements 1, 2, and 3 are correct.'},\n {id:71,stem:'Pseudomembranous colitis is associated with which one of the following microbes?',correct:'Clostridium difficile',options:['Entamoeba histolytica','Salmonella typhi','Escherichia coli','Clostridium difficile'],exp:'Pseudomembranous colitis is caused by Clostridium difficile (now Clostridioides difficile) toxins A and B, typically following antibiotic disruption of the colonic microbiome. Yellow-white pseudomembranes on colonoscopy are pathognomonic. Diagnosis by stool C. difficile toxin assay or PCR. Treatment: oral vancomycin or fidaxomicin.'},\n {id:72,stem:'The characteristic rash seen on the face in a case of Parvovirus B19 infection is called:',correct:'Slapped cheek rash',options:['Slapped cheek rash','Butterfly rash','Melasma-like rash','Christmas tree rash'],exp:\"Parvovirus B19 causes Erythema infectiosum (Fifth disease) in children, characterised by the 'slapped cheek' appearance \u2014 bright red erythema on both cheeks. This is followed by a lacy reticular rash on the trunk and limbs. In adults it causes arthropathy; in sickle cell\/haemolytic anaemia patients it causes aplastic crisis; in pregnancy it risks hydrops fetalis.\"},\n {id:73,stem:'Bartonella infection is an important cause of blood culture negative endocarditis. Clinical diseases caused by Bartonella species in humans include which of the following?\\n1. Cat scratch disease\\n2. Trench fever\\n3. Carrion\\'s disease\\n4. Anisakiasis',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Bartonella diseases: Cat scratch disease (B. henselae \u2014 via cat scratch\/flea), Trench fever (B. quintana \u2014 louse-borne, classically in WWI soldiers), Carrion's disease\/Oroya fever\/Verruga peruana (B. bacilliformis \u2014 sandfly-borne, Andean regions), and bacillary angiomatosis (B. henselae\/quintana in HIV). Anisakiasis is caused by Anisakis simplex (a marine nematode from raw fish) \u2014 NOT Bartonella. Statement 4 is false.\"},\n {id:74,stem:'The causative organism and the vector for scrub typhus are:',correct:'Orientia tsutsugamushi and Trombiculid mite',options:['Orientia tsutsugamushi and Louse','Rickettsia rickettsii and Trombiculid mite','Orientia tsutsugamushi and Trombiculid mite','Rickettsia prowazekii and Ixodes tick'],exp:\"Scrub typhus: caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi), transmitted by the larval stage (chigger) of Trombiculid mites (Leptotrombidium species). Characteristic eschar at bite site, fever, rash, and lymphadenopathy. Treatment: doxycycline. Rickettsia rickettsii = Rocky Mountain spotted fever (Dermacentor tick); R. prowazekii = epidemic typhus (louse).\"},\n {id:75,stem:'Which of the following are correct regarding tetanus?\\n1. Risus sardonicus may be seen\\n2. Endotoxin produced has affinity for sensory nerve endings\\n3. Lockjaw is painless\\n4. Hysteria can mimic tetanus',correct:'1, 3 and 4',options:['1, 2 and 3 only','2 and 4 only','1, 3 and 4','1, 2, 3 and 4'],exp:\"Statement 2 is false on two counts: tetanus produces an EXOTOXIN (tetanospasmin), not endotoxin, and it has affinity for MOTOR nerve endings and inhibitory interneurons (Renshaw cells) \u2014 not sensory endings. Risus sardonicus (sardonic smile from facial spasm) is characteristic. Lockjaw (trismus) is tonic rigidity \u2014 not the lancinating pain type; hysteria (conversion disorder) can clinically mimic tetanus. Statements 1, 3, and 4 are correct.\"},\n {id:76,stem:'A 25-year-old traveller from United Kingdom desires anti-malaria prophylaxis before travelling to India. He has history of seizures and depression. Which of the following drugs can be used?\\n1. Doxycycline\\n2. Atovaquone + Proguanil\\n3. Chloroquine + Proguanil\\n4. Mefloquine',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1 and 3 only','3 and 4 only'],exp:'Mefloquine (statement 4) is ABSOLUTELY CONTRAINDICATED in patients with seizure disorders or psychiatric conditions (depression, anxiety, psychosis) \u2014 it lowers seizure threshold and causes neuropsychiatric adverse effects. Doxycycline, Atovaquone+Proguanil (Malarone), and Chloroquine+Proguanil are safe options in this patient. Statements 1, 2, and 3 are correct.'},\n {id:77,stem:'Pulmonary stage (Loeffler\\'s syndrome) is seen in which of the following infections?\\n1. Ascaris lumbricoides\\n2. Strongyloides stercoralis\\n3. Onchocerca volvulus',correct:'1 and 2 only',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:\"Pulmonary larval migration (Loeffler's syndrome) occurs with helminths whose larvae migrate through the lungs: Ascaris lumbricoides (larvae ascend the airways after gut penetration), Strongyloides stercoralis (filariform larvae penetrate skin \u2192 lung \u2192 gut), hookworm (Ancylostoma\/Necator), and Toxocara. Onchocerca volvulus is transmitted by Simulium blackflies and causes river blindness \u2014 its larvae do NOT migrate through the lungs. Statements 1 and 2 are correct.\"},\n {id:78,stem:'Consider the following statements with regard to Amphotericin B:\\n1. It is a narrow spectrum antifungal agent\\n2. It can cause nephrotoxicity\\n3. It lacks an oral preparation\\n4. Its lipid formulations are less toxic',correct:'2, 3 and 4',options:['2 and 3 only','2, 3 and 4','1, 3 and 4','2 and 4 only'],exp:'Statement 1 is false: Amphotericin B is a BROAD-spectrum antifungal active against most pathogenic fungi (Candida, Aspergillus, Cryptococcus, Histoplasma, Mucor, etc.) and some parasites (Leishmania). Statements 2 (nephrotoxicity is the major dose-limiting adverse effect), 3 (no oral preparation \u2014 given only IV or intrathecally), and 4 (liposomal and lipid complex formulations have significantly reduced nephrotoxicity) are all correct.'},\n {id:79,stem:\"Which one of the following moulds causes mucormycosis, commonly known as 'black fungus'?\",correct:'Rhizopus',options:['Rhizopus','Aspergillus','Candida','Histoplasma'],exp:'Mucormycosis (black fungus) is caused by fungi of the order Mucorales, most commonly Rhizopus arrhizus (oryzae), followed by Mucor, Lichtheimia, and Cunninghamella. It is an angioinvasive infection causing thrombosis and infarction (hence the black necrotic appearance). Risk factors: diabetic ketoacidosis, immunosuppression, corticosteroid therapy (notably post-COVID).'},\n {id:80,stem:'Which of the following infections are caused by mosquito bite?\\n1. Malaria\\n2. Typhus\\n3. Filariasis\\n4. Dengue fever',correct:'1, 3 and 4',options:['1, 2 and 3','1 and 4 only','1, 3 and 4','2, 3 and 4'],exp:'Mosquito-borne: Malaria (Anopheles), Lymphatic filariasis (Culex \u2014 Wuchereria bancrofti), Dengue\/Zika\/Chikungunya (Aedes), Japanese encephalitis (Culex). Typhus is vector-borne but NOT by mosquito: epidemic typhus = body louse (Pediculus humanus), scrub typhus = chigger (Trombiculid mite), murine typhus = rat flea. Statement 2 is false. Statements 1, 3, and 4 are correct.'},\n {id:81,stem:'Which one of the following is a hallmark of marasmus?',correct:'Triceps skin fold below 3 mm',options:['Normal body mass index','Serum albumin below 2.8 g\/dL','Anergy','Triceps skin fold below 3 mm'],exp:'Marasmus is severe caloric deficiency with gross wasting of fat and muscle. The hallmark anthropometric finding is severe depletion of subcutaneous fat measured as triceps skinfold thickness below 3 mm. Serum albumin below 2.8 g\/dL is the hallmark of Kwashiorkor (protein deficiency with oedema). BMI is very low in marasmus (not normal). Anergy occurs in both.'},\n {id:82,stem:'Anti-Ribonucleoprotein antibody (Anti-RNP) is characteristically seen in which one of the following conditions?',correct:'Mixed connective tissue disorder',options:[\"Sjogren's syndrome\",'Diffuse systemic sclerosis','Sarcoidosis','Mixed connective tissue disorder'],exp:\"Anti-U1-RNP antibodies at high titre are the hallmark of Mixed Connective Tissue Disease (MCTD\/Sharp syndrome) \u2014 a condition with overlapping features of SLE, polymyositis, scleroderma, and rheumatoid arthritis. Anti-Ro\/La = Sjogren's syndrome. Anti-Scl-70 = diffuse systemic sclerosis. Sarcoidosis has no specific ANA pattern.\"},\n {id:83,stem:'Polyarteritis nodosa has peak incidence between the ages of:',correct:'40 - 50 years',options:['10 - 20 years','20 - 30 years','30 - 40 years','40 - 50 years'],exp:'Polyarteritis nodosa (PAN) is a necrotising vasculitis of medium-sized arteries. It peaks in the 5th decade (40\u201360 years) and is more common in males. It spares the lungs and is associated with Hepatitis B (in ~30% of classic PAN). It does NOT cause glomerulonephritis (unlike ANCA-associated vasculitides).'},\n {id:84,stem:'First-line drug treatment to reduce fractures in osteoporosis is:',correct:'Bisphosphonates',options:['Bisphosphonates','Denosumab','Teriparatide','Raloxifene'],exp:'Bisphosphonates (alendronate, risedronate, zoledronic acid) are the first-line pharmacological treatment for osteoporosis \u2014 they reduce vertebral fractures by ~50% and hip fractures by ~25\u201340% in clinical trials. Denosumab and teriparatide are second-line or specialist-initiated. Raloxifene reduces vertebral but NOT hip fractures.'},\n {id:85,stem:'Which of the following are tricyclic antidepressants?\\n1. Amitriptyline\\n2. Dosulepin\\n3. Paroxetine\\n4. Imipramine',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Tricyclic antidepressants (TCAs): amitriptyline, imipramine, clomipramine, dosulepin (dothiepin), doxepin, nortriptyline, trimipramine. Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) \u2014 NOT a TCA. Statement 3 is false. Statements 1, 2, and 4 are correct.'},\n {id:86,stem:'Recurrent bouts of binge eating are usually associated with:',correct:'Bulimia nervosa',options:['Bulimia nervosa','Anorexia nervosa','Post-partum depression','Personality disorder'],exp:'Bulimia nervosa is characterised by recurrent episodes of binge eating (consuming abnormally large amounts of food rapidly) followed by compensatory behaviours (purging, laxative use, excessive exercise). BMI is typically normal. Anorexia nervosa involves severe food restriction with very low BMI. The binge-purge cycle is the defining feature of bulimia.'},\n {id:87,stem:'During physical assessment of a 55-year-old male with low back pain, the quadriceps (knee) reflex was absent. Which of the following nerve roots is most likely to be affected?',correct:'L4',options:['L2','L5','L4','S1'],exp:'The knee jerk (patellar tendon) reflex is mediated primarily by L3\u2013L4. L4 is the dominant root for the quadriceps reflex. L5 mediates the tibialis posterior\/extensor digitorum reflexes. S1 mediates the ankle jerk (Achilles tendon) reflex. L2\u2013L3 contribute to the adductor reflex. Absent knee reflex = L4 lesion most likely.'},\n {id:88,stem:'Which of the following conditions are parts of inherited cancer syndrome?\\n1. Retinoblastoma\\n2. Li-Fraumeni syndrome\\n3. Xeroderma pigmentosum\\n4. Peutz-Jeghers syndrome',correct:'1, 2, 3 and 4',options:['1, 2, 3 and 4','1, 2 and 3 only','1 and 3 only','2 and 4 only'],exp:'All four are inherited cancer syndromes: Retinoblastoma (RB1 tumour suppressor gene, AD), Li-Fraumeni syndrome (TP53 germline mutation \u2014 sarcomas, breast, brain, adrenal cancers), Xeroderma pigmentosum (DNA nucleotide excision repair defect \u2014 extreme UV sensitivity, skin cancers), Peutz-Jeghers syndrome (STK11\/LKB1 mutation \u2014 hamartomatous polyps + GI\/breast\/pancreatic cancers). All four are correct.'},\n {id:89,stem:'Which of the following are the diseases associated with DNA repeat sequences?\\n1. Huntington\\'s disease\\n2. Myotonic dystrophy\\n3. Friedreich\\'s ataxia\\n4. Klinefelter syndrome',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Trinucleotide\/nucleotide repeat expansion diseases: Huntington (CAG repeat in HTT), Myotonic dystrophy type 1 (CTG repeat in DMPK), Friedreich\\'s ataxia (GAA repeat in FXN\/frataxin), Fragile X syndrome (CGG repeat), SBMA, DRPLA. Klinefelter syndrome (47,XXY) is a chromosomal aneuploidy \u2014 NOT a repeat sequence disorder. Statement 4 is false. Statements 1, 2, and 3 are correct.'},\n {id:90,stem:'Cardiac outflow tract defect, thymic hypoplasia, cleft palate and hypocalcaemia are clinical features of which gene disorder?',correct:'DiGeorge syndrome',options:['Angelman syndrome','Williams syndrome','Smith-Magenis syndrome','DiGeorge syndrome'],exp:\"DiGeorge syndrome (22q11.2 deletion syndrome \/ CATCH-22): Cardiac defects (conotruncal \u2014 ToF, truncus arteriosus, interrupted aortic arch), Abnormal facies, Thymic hypoplasia (T-cell immunodeficiency), Cleft palate, Hypocalcaemia (hypoparathyroidism from absent parathyroids). It is the most common microdeletion syndrome. Williams syndrome = 7q11 deletion (supravalvular aortic stenosis, elfin facies, hypercalcaemia).\"}\n ];\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,quizSubmitted=false;\n\n function shuffle(arr){const a=arr.slice();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]];}return a;}\n function fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return(m<10?'0':'')+m+':'+(sec<10?'0':'')+sec;}\n\n function startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 '+fmtTime(timerRemaining);btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n timerRemaining--;\n const disp=fmtTime(timerRemaining);\n 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Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 3 Endocrinology \u00b7 Infectious Disease \u00b7 Rheumatology \u00b7 Genetics Questions 61 \u2013 90 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-36593","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2021 P1 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\/16\/cms-2021-p1-part-3\/\" \/>\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-3 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2021 Paper I \u2013 Part 3 (Q61\u2013Q90) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! 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