CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms21p1d \u2500\u2500 *\/\n#cms21p1d *,#cms21p1d *::before,#cms21p1d *::after{box-sizing:border-box;margin:0;padding:0}\n#cms21p1d{\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#cms21p1d .cq-sentinel{height:1px}\n#cms21p1d .cq-statusbar{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px solid var(--ter);box-shadow:0 2px 12px rgba(0,0,0,0.11);opacity:0;pointer-events:none;transform:translateY(-110%);transition:opacity 0.22s ease,transform 0.22s ease}\n#cms21p1d .cq-statusbar.visible{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms21p1d .cq-sb-stats{display:flex;align-items:center;padding:0.38rem 0.7rem;font-size:0.73rem;color:var(--ink-soft)}\n#cms21p1d .cq-sb-item{display:flex;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1}\n#cms21p1d .cq-sb-item:last-child{border-right:none}\n#cms21p1d .cq-sb-item strong{color:var(--ink);font-size:0.8rem;font-weight:700}\n#cms21p1d .cq-sb-sep{flex:1}\n#cms21p1d .cq-sb-progress{height:4px;background:var(--line);overflow:hidden}\n#cms21p1d .cq-sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width 0.4s ease}\n#cms21p1d .cq-timer-item{display:none;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1;font-size:0.73rem}\n#cms21p1d .cq-timer-item.active{display:flex}\n#cms21p1d .cq-timer-item strong{font-size:0.8rem;font-weight:700;color:var(--teal);font-variant-numeric:tabular-nums}\n#cms21p1d .cq-timer-item.warning strong{color:var(--wrong)}\n#cms21p1d .cq-grace{display:none;position:fixed;top:0;right:0;bottom:0;left:0;z-index:999999;background:rgba(0,0,0,0.55);align-items:center;justify-content:center}\n#cms21p1d .cq-grace.show{display:flex}\n#cms21p1d .cq-grace-box{background:var(--white);border-radius:12px;border-top:5px solid var(--wrong);padding:32px 28px;text-align:center;max-width:320px;width:90%;box-shadow:0 8px 40px rgba(0,0,0,0.25)}\n#cms21p1d .cq-grace-box h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wrong);margin-bottom:10px}\n#cms21p1d .cq-grace-box p{font-size:0.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms21p1d .cq-grace-count{font-family:'Playfair Display',serif;font-size:2.8rem;font-weight:700;color:var(--wrong);line-height:1;margin-bottom:18px}\n#cms21p1d .cq-grace-btn{background:var(--wrong);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s}\n#cms21p1d .cq-grace-btn:hover{background:#c62828}\n#cms21p1d .cq-header{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center}\n#cms21p1d .cq-header h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;letter-spacing:0.01em;line-height:1.3}\n#cms21p1d .cq-header p{font-size:0.85rem;opacity:0.85;margin-top:6px;font-style:italic}\n#cms21p1d .cq-meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms21p1d .cq-badge{background:rgba(255,255,255,0.15);border:1px solid rgba(255,255,255,0.3);border-radius:20px;padding:4px 14px;font-size:0.78rem;letter-spacing:0.03em}\n#cms21p1d .cq-timer-btn{background:transparent;border:1.5px solid rgba(255,255,255,0.7);color:var(--white);border-radius:20px;padding:4px 14px;font-family:'Source Serif 4',serif;font-size:0.78rem;cursor:pointer;letter-spacing:0.03em;transition:background 0.2s;display:flex;align-items:center;gap:6px}\n#cms21p1d .cq-timer-btn:hover{background:rgba(255,255,255,0.15)}\n#cms21p1d .cq-timer-btn.running{background:rgba(255,255,255,0.2);border-color:var(--white)}\n#cms21p1d .cq-body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms21p1d .cq-card{background:var(--white);border:1px solid var(--line);border-radius:var(--radius);margin:24px 0;overflow:hidden;transition:box-shadow 0.2s}\n#cms21p1d .cq-card:hover{box-shadow:0 2px 12px rgba(192,96,58,0.1)}\n#cms21p1d .cq-qhead{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start}\n#cms21p1d .cq-qnum{flex-shrink:0;width:26px;height:26px;border-radius:50%;background:var(--ter);color:#fff;font-size:0.72rem;font-weight:700;display:flex;align-items:center;justify-content:center;margin-top:2px;transition:background 0.2s}\n#cms21p1d .cq-qnum.ans-c{background:var(--correct-border)}\n#cms21p1d .cq-qnum.ans-w{background:var(--wrong-border)}\n#cms21p1d .cq-qtext{font-size:0.93rem;color:var(--ink);line-height:1.65}\n#cms21p1d .cq-options{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms21p1d .cq-opt{display:flex;align-items:flex-start;gap:10px;padding:10px 14px;border:1.5px solid var(--line);border-radius:8px;cursor:pointer;transition:border-color 0.15s,background 0.15s;background:var(--white);-webkit-tap-highlight-color:transparent}\n#cms21p1d .cq-opt:hover:not(.cq-locked){border-color:var(--teal);background:var(--teal-pale)}\n#cms21p1d .cq-opt-letter{flex-shrink:0;width:20px;height:20px;border-radius:50%;border:1.5px solid var(--line);display:flex;align-items:center;justify-content:center;font-size:0.65rem;font-weight:700;color:var(--ink-soft);transition:all 0.15s;margin-top:1px}\n#cms21p1d .cq-opt-text{font-size:0.89rem;color:var(--ink-mid);line-height:1.55}\n#cms21p1d .cq-opt.cq-correct{border-color:var(--correct-border);background:var(--correct-bg);cursor:default}\n#cms21p1d .cq-opt.cq-correct .cq-opt-letter{background:var(--correct-border);border-color:var(--correct-border);color:#fff}\n#cms21p1d .cq-opt.cq-correct .cq-opt-text{color:var(--correct);font-weight:600}\n#cms21p1d .cq-opt.cq-wrong{border-color:var(--wrong-border);background:var(--wrong-bg);cursor:default}\n#cms21p1d .cq-opt.cq-wrong .cq-opt-letter{background:var(--wrong-border);border-color:var(--wrong-border);color:#fff}\n#cms21p1d .cq-opt.cq-wrong .cq-opt-text{color:var(--wrong)}\n#cms21p1d .cq-opt.cq-dimmed{opacity:0.42;cursor:default}\n#cms21p1d .cq-opt.cq-locked{cursor:default}\n#cms21p1d .cq-explanation{display:none;background:var(--teal-pale);border-top:1px solid #b2d8d3;padding:10px 18px 12px;font-size:0.82rem;color:#1a4f49;line-height:1.62}\n#cms21p1d .cq-exp-label{font-size:0.7rem;font-weight:700;letter-spacing:0.08em;text-transform:uppercase;color:var(--teal);margin-bottom:4px}\n#cms21p1d .cq-submit-wrap{text-align:center;padding:28px 16px 8px}\n#cms21p1d .cq-btn{background:var(--teal);color:var(--white);border:none;border-radius:8px;padding:13px 36px;font-family:'Playfair Display',serif;font-size:1rem;font-weight:700;cursor:pointer;letter-spacing:0.02em;transition:background 0.2s,transform 0.1s}\n#cms21p1d .cq-btn:hover{background:var(--teal-light)}\n#cms21p1d .cq-btn:active{transform:scale(0.98)}\n#cms21p1d .cq-score{display:none;background:var(--white);border:2px solid var(--teal);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms21p1d .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#cms21p1d .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms21p1d .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms21p1d .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms21p1d .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms21p1d .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms21p1d .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms21p1d .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms21p1d .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms21p1d .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms21p1d .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms21p1d .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms21p1d .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms21p1d .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid 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#cms21p1d .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms21p1d .cq-header h1{font-size:1.15rem}#cms21p1d .cq-qtext{font-size:0.88rem}#cms21p1d .cq-opt-text{font-size:0.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms21p1d\">\n <div class=\"cq-sentinel\" id=\"cms21p1d-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms21p1d-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms21p1d-timer-item\">\u23f1 <strong id=\"cms21p1d-timer-display\">30:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms21p1d-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms21p1d-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms21p1d-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms21p1d-sn\">0<\/strong> \/ <strong id=\"cms21p1d-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms21p1d-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms21p1d-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms21p1d-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms21p1d-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 4<\/h1>\n <p>Emergency Medicine \u00b7 Paediatrics<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 91 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms21p1d-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms21p1d-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms21p1d-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms21p1d-score\">\n <div class=\"cq-score-ring\" id=\"cms21p1d-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms21p1d-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=\"cms21p1d-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms21p1d-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms21p1d-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms21p1d-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms21p1d-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms21p1d-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms21p1d',TOTAL=30,MAX=TOTAL*4,TIMER_SECS=30*60,GRACE_SECS=10;\n const QUESTIONS=[\n {id:91,stem:'Early hypotension in venomous snakebite is due to which of the following?',correct:'Pooling of blood in the pulmonary and splanchnic circulation',options:['Pooling of blood in the pulmonary and splanchnic circulation','Systemic bleeding','Haemolysis','Loss of intravascular volume into soft tissues'],exp:'Early hypotension in viper envenomation results from direct vasodilatory effects of venom components (bradykinin-potentiating peptides, phospholipases) causing pooling of blood in the pulmonary and splanchnic vasculature \u2014 distributive shock. Late hypotension may be due to haemorrhage or myocardial toxicity. Systemic bleeding and haemolysis tend to cause later, more insidious haemodynamic compromise.'},\n {id:92,stem:'Gastric aspiration and lavage is contraindicated in which of the following poisonings?\\n1. Strong acids\\n2. Alkalis\\n3. Petroleum distillates\\n4. Ethanol',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Gastric lavage is contraindicated in: strong acids and alkalis (corrosive injury to oesophagus\/stomach would be worsened by repeated passage of tube and lavage), petroleum distillates\/hydrocarbons (high aspiration risk with low viscosity fluids \u2014 causes severe chemical pneumonitis). Ethanol poisoning is NOT a contraindication \u2014 gastric lavage\/aspiration may be used if presentation is very early. Statements 1, 2, and 3 are correct.'},\n {id:93,stem:'Acetylcysteine is an antidote for which poisoning?',correct:'Paracetamol',options:['Salicylates','Paracetamol','Tricyclic antidepressants','Benzodiazepines'],exp:'N-acetylcysteine (NAC) is the specific antidote for paracetamol (acetaminophen) overdose. It replenishes hepatic glutathione stores, which detoxify the toxic metabolite NAPQI (N-acetyl-p-benzoquinone imine) that causes centrilobular hepatic necrosis. Given within 8\u201310 hours of ingestion it is highly effective. Flumazenil = benzodiazepines; naloxone = opioids; sodium bicarbonate = TCA.'},\n {id:94,stem:'Which one of the following is NOT a constituent of treatment of severe hyperkalaemia?',correct:'Beta-2 adrenoceptor antagonist',options:['IV calcium gluconate (10 mL of 10%)','Beta-2 adrenoceptor antagonist','Dialysis','IV sodium bicarbonate'],exp:'Treatment of severe hyperkalaemia: IV calcium gluconate (membrane stabilisation), IV sodium bicarbonate (shifts K into cells in acidosis), IV insulin + dextrose (drives K intracellularly), IV salbutamol (beta-2 AGONIST \u2014 also drives K into cells), dialysis (definitive removal). Beta-2 adrenoceptor ANTAGONISTS (beta-blockers) would worsen hyperkalaemia by blocking the cellular uptake mechanism \u2014 they are NOT a treatment.'},\n {id:95,stem:'Kyasanur Forest Disease is endemic to:',correct:'South-West India',options:['West Africa','South America','South-West India','Balkans'],exp:'Kyasanur Forest Disease (KFD) is a tick-borne viral haemorrhagic fever caused by Kyasanur Forest Disease virus (a Flavivirus), transmitted by Haemaphysalis spinigera ticks. It is endemic to the Kyasanur forests of Karnataka (South-West India) and has recently spread to adjacent districts of Goa and Kerala. Monkeys act as amplifying hosts.'},\n {id:96,stem:'Which one of the following is NOT a usual cause of Type-2 respiratory failure?',correct:'Pulmonary embolism',options:['Guillain-Barr\u00e9 syndrome','Upper airway obstruction','Pulmonary embolism','Flail chest'],exp:'Type 2 (hypercapnic) respiratory failure is caused by inadequate ventilation \u2014 neuromuscular (GBS, MND, myasthenia), chest wall (flail chest, kyphoscoliosis), upper airway obstruction, COPD, severe asthma, obesity hypoventilation. Pulmonary embolism causes Type 1 (hypoxaemic) respiratory failure by V\/Q mismatch and increased dead space \u2014 PaCO2 is typically low or normal. PE is NOT a cause of Type 2 failure.'},\n {id:97,stem:'A 10-year-old girl is diagnosed with dengue fever. She has abdominal pain and persistent vomiting. Examination reveals normal blood pressure but haematocrit is increased. Which of the following is the most appropriate initial fluid management?',correct:'Ringer lactate at 5 mL\/kg\/hour',options:['Ringer lactate at 3 mL\/kg\/hour','Ringer lactate at 5 mL\/kg\/hour','Ringer lactate at 7 mL\/kg\/hour','Ringer lactate at 10 mL\/kg\/hour'],exp:'This child has dengue with warning signs (abdominal pain, persistent vomiting, rising haematocrit) but haemodynamically stable (normal BP) \u2014 WHO Group B. Initial fluid management: Ringer lactate or NS at 5\u20137 mL\/kg\/hour for 1\u20132 hours, then reassess. If stable, reduce to 3\u20135 mL\/kg\/hour. Starting rate of 5 mL\/kg\/hour is appropriate for Group B dengue.'},\n {id:98,stem:'A child presents with headache and vomiting in the emergency room following a fall from the bed. Which one of the following treatment modalities is NOT recommended in the emergency room?',correct:'Therapeutic lumbar puncture',options:['Intravenous mannitol administration','Administration of hypertonic (3%) solution','Elevate the head end by 30 degrees','Therapeutic lumbar puncture'],exp:'In a child with head injury and features of raised intracranial pressure (headache, vomiting), therapeutic lumbar puncture is ABSOLUTELY CONTRAINDICATED \u2014 it risks fatal transtentorial herniation (coning) by decompressing the lumbar subarachnoid space while the intracranial pressure remains elevated. Mannitol, hypertonic saline, and 30-degree head elevation are all accepted management for raised ICP.'},\n {id:99,stem:'The recommended ratio for chest compression to breaths administered by a single rescuer during resuscitation of a child in cardiac arrest is:',correct:'30 : 2',options:['15 : 2','30 : 2','14 : 1','7 : 1'],exp:'Per AHA\/ILCOR PALS guidelines: single rescuer performing CPR on a child uses 30:2 ratio (same as adult BLS). The 15:2 ratio is used by TWO healthcare provider rescuers in paediatric CPR (to allow more compressions with a lower ratio). Neonatal CPR uses 3:1. A single bystander should use 30:2 regardless of patient age.'},\n {id:100,stem:'A 4-year-old comatose child is assessed by the Modified Glasgow Coma Scale. Which is the correct interpretation of E2V3M2?',correct:'Eye opening to pain, cries to pain and extension to pain',options:['Eye opening to speech, makes incomprehensible sounds and abnormal flexion','Eye opening to speech, inappropriate words and abnormal flexion','Eye opening to pain, moans to pain and abnormal flexion','Eye opening to pain, cries to pain and extension to pain'],exp:'Modified GCS for children: E2 = eye opening to pain (E1=none, E2=pain, E3=speech, E4=spontaneous). In the modified paediatric verbal scale: V3 = cries to pain (age-appropriate equivalent of inappropriate words). M2 = abnormal extension\/decerebrate posturing (M1=none, M2=extension, M3=flexion, M4=withdrawal, M5=localises, M6=obeys). E2V3M2 = eye to pain, cries to pain, extension to pain.'},\n {id:101,stem:'What will a baby with mild hypothermia feel like, when touched by the back of the hand of an examiner?',correct:'The abdomen will be warm, but the hands and feet will be cold.',options:['The entire body will feel cold.','The abdomen and feet will be warm, but hands will be cold.','The abdomen will be warm, but the hands and feet will be cold.','The abdomen, feet and hands will all feel cold.'],exp:'WHO classification of neonatal hypothermia: Mild (36.0\u201336.4\u00b0C) = cold stress \u2014 abdomen\/trunk warm but hands and feet feel cold. Moderate (32.0\u201335.9\u00b0C) = entire body cold. Severe below 32\u00b0C = entire body very cold with features of shock. In mild hypothermia, peripheral vasoconstriction preserves core temperature, so the abdomen is warm while extremities are cold.'},\n {id:102,stem:'Which of the following manifestations is\/are seen in hypocalcaemia?',correct:'Dilated cardiomyopathy',options:['Nausea and vomiting','Dilated cardiomyopathy','Polyuria','Polydipsia'],exp:'Hypocalcaemia causes: neuromuscular excitability (tetany, Chvostek\/Trousseau signs, seizures), prolonged QT interval, dilated cardiomyopathy (chronic severe hypocalcaemia), laryngospasm, and cataracts. Nausea\/vomiting, polyuria, and polydipsia are features of HYPERcalcaemia. Dilated cardiomyopathy from hypocalcaemia is reversible with calcium repletion.'},\n {id:103,stem:'A 6-week-old infant presents with unconjugated hyperbilirubinaemia. Which of the following could be a likely diagnosis?',correct:'Congenital hypothyroidism',options:['Dubin Johnson syndrome','Galactosemia','Rotor syndrome','Congenital hypothyroidism'],exp:'Unconjugated hyperbilirubinaemia at 6 weeks suggests prolonged physiological jaundice or pathological causes: congenital hypothyroidism (impairs hepatic UDP-glucuronosyltransferase activity and gut motility reducing bilirubin excretion), haemolytic disorders, breast milk jaundice. Dubin-Johnson, Rotor syndrome, and galactosemia all cause CONJUGATED (direct) hyperbilirubinaemia due to hepatocellular or excretory defects.'},\n {id:104,stem:'A mother with polyhydramnios gives birth to a term newborn who develops choking and cyanosis on feeding soon after birth. There is excessive drooling and frothing from the mouth. Most likely diagnosis is:',correct:'Tracheoesophageal fistula',options:['Anorectal malformation','Diaphragmatic hernia','Arnold Chiari malformation','Tracheoesophageal fistula'],exp:'The classic triad of TOF\/OA (tracheoesophageal fistula with oesophageal atresia): maternal polyhydramnios (fetus cannot swallow amniotic fluid), early choking\/cyanosis with first feed (fluid\/milk enters the blind-ending oesophageal pouch and overflows into airway), and excessive drooling\/frothing (inability to swallow secretions). Confirmed by failure to pass nasogastric tube beyond 10\u201312 cm.'},\n {id:105,stem:'An infant has just started to watch his mother intently when she talks to him. He has not yet started smiling back. What is the approximate age of the child?',correct:'4 weeks',options:['4 weeks','6 weeks','8 weeks','12 weeks'],exp:'Visual fixation on a face and intense watching begins at around 4 weeks. Social smile (smiling in response to a face\/voice) begins at ~6 weeks. Since this infant is watching intently but has NOT yet started smiling, the developmental age is approximately 4 weeks \u2014 just before the social smile milestone.'},\n {id:106,stem:'A child demonstrates a mature pincer grasp and is able to build a tower of maximum 6 blocks and can make vertical and circular strokes with pencil. His developmental age is around:',correct:'24 months',options:['12 months','18 months','24 months','36 months'],exp:'Developmental milestones: mature pincer grasp = 12 months. Tower of 6 blocks = 24 months. Vertical stroke copy = 24 months. Circular stroke\/scribble = 24 months. At 18 months: tower of 3\u20134 blocks, scribbles. At 36 months: tower of 9\u201310 blocks, copies a circle. The combination of 6-block tower with vertical and circular strokes places this child at 24 months.'},\n {id:107,stem:'A typically developing girl is able to creep upstairs and builds a tower of 2 blocks. Which of the following skills should she also display?',correct:'Scribbling',options:['Scribbling','Running','Speaking at least 10 words','Exploring drawers'],exp:'Creeping upstairs = 15 months. Tower of 2 blocks = 15 months. At 15 months: first words (3\u20135 words), casts objects, scribbles with a crayon. Running begins at ~18 months. Speaking 10 words = ~18 months. Exploring drawers and cupboards = ~18 months. The skill appropriate for 15 months here is scribbling.'},\n {id:108,stem:'A child can ride a tricycle, hop on one foot but cannot skip. He uses alternate feet while going downstairs. Which one of the following motor skills should he be able to perform at this developmental level?',correct:'Copy a cross',options:['Copy a triangle','Copy a cross','Build a gate with blocks','Copy a rectangle'],exp:'Tricycle riding = 3 years. Hopping on one foot = 4 years. Alternate feet downstairs = 4 years. Cannot skip = not yet 5\u20136 years. Developmental age ~4 years. At 4 years: copies a cross (+), builds steps with blocks (not gate \u2014 gate is 4.5 years), can draw a person with 4+ parts. Copy a triangle = 5 years. Copy a rectangle = 4.5 years. Copying a cross is the appropriate 4-year milestone.'},\n {id:109,stem:'Which one of the following skills is a normally developing 2-year-old child unable to perform?',correct:'Copying a circle',options:['Unscrewing a lid','Turning a door knob','Building a vertical tower of 6 blocks','Copying a circle'],exp:'At 24 months: tower of 6 blocks (correct), turns door knobs, unscrews lids, turns pages singly, scribbles. Copying a CIRCLE (round shape) is a 36-month (3-year) milestone. At 2 years the child scribbles but cannot yet copy a geometric shape. A 2-year-old cannot copy a circle \u2014 this is the correct EXCEPT answer.'},\n {id:110,stem:'Which one of the following statements is age-appropriate for a normally developing 4-month-old infant?',correct:'The infant can bring his hands to the midline.',options:['The infant can bring his hands to the midline.','The infant has still not attained partial head control.','The infant has started to reach out with one hand.','The infant has started making monosyllable sounds like da or pa.'],exp:'At 4 months: brings hands to midline (midline hand play), holds head steady in sitting, rolls from prone to supine, smiles socially, coos and laughs. Partial head control starts at 3 months (not still absent at 4 months). Reaching with one hand = 5\u20136 months. Monosyllable babbling (da, pa) = 6\u20139 months. The correct age-appropriate statement is bringing hands to midline.'},\n {id:111,stem:'Which one of the following is used to estimate the surface area of burn injuries in children less than 15 years of age?',correct:'Lund and Browder chart',options:['Berkow body surface area chart','Rule of Nines','Lund and Browder chart','Parkland formula'],exp:'The Lund and Browder chart is used for estimating burn surface area in children because it accounts for the age-related changes in body proportions (relatively larger head, smaller limbs in infants). The Rule of Nines is for adults only. The Parkland formula is for calculating fluid resuscitation volumes (not for estimating burn area). Berkow chart is also age-adjusted and used by some but Lund-Browder is the standard.'},\n {id:112,stem:'A 4-year-old boy presents with ingestion of many tablets of salicylate. Which one of the following complications is he likely to develop?',correct:'Metabolic acidosis',options:['Hyperkalaemia','Rhabdomyolysis','Prolonged QRS complex in ECG','Metabolic acidosis'],exp:'Salicylate (aspirin) poisoning causes: early respiratory alkalosis (direct stimulation of respiratory centre), followed by metabolic acidosis (uncoupling of oxidative phosphorylation, lactic acid, ketoacids). In children, metabolic acidosis tends to predominate early. Hypokalaemia (not hyperkalaemia) occurs. Prolonged QRS = TCA overdose. Rhabdomyolysis = statins, extreme exertion.'},\n {id:113,stem:'A 3-year-old boy presents with parental concerns regarding delayed development, especially speech. On observation, the clinician notes decreased eye contact, inattentiveness, unresponsive to being called and toe walking. What is the most likely diagnosis?',correct:'Autism Spectrum Disorder',options:['Attention Deficit Hyperactivity Disorder','Autism Spectrum Disorder','Cerebral Palsy','Social Communication Disorder'],exp:'The triad of: (1) decreased eye contact and social reciprocity deficits, (2) language\/communication delay, and (3) restricted\/repetitive behaviours (toe walking) in a toddler is diagnostic of Autism Spectrum Disorder (DSM-5). Unresponsiveness to being called is a red flag. ADHD does not involve social communication deficits. Toe walking alone occurs in CP and idiopathic toe walking.'},\n {id:114,stem:'Atomoxetine is prescribed to children with Autism Spectrum Disorder to control symptoms of:',correct:'Hyperactivity',options:['Anxiety','Sleep disturbances','Hyperactivity','Repetitive behaviour'],exp:'Atomoxetine (a selective noradrenaline reuptake inhibitor, SNRI) is used in ASD to manage ADHD-like symptoms, particularly hyperactivity and inattention. In ASD: anxiety = SSRIs (fluoxetine); sleep disturbances = melatonin; repetitive\/stereotyped behaviours = SSRIs or risperidone; hyperactivity\/inattention = methylphenidate or atomoxetine.'},\n {id:115,stem:'Fractional inactivated intradermal poliovirus vaccine is given at which ages in the National Immunization Schedule?',correct:'6 weeks and 14 weeks',options:['6 weeks and 10 weeks','6 weeks and 14 weeks','10 weeks and 14 weeks','6 weeks, 10 weeks and 14 weeks'],exp:'India introduced fractional IPV (fIPV) given intradermally (1\/5th the intramuscular dose \u2014 0.1 mL ID) at 6 weeks and 14 weeks under the Universal Immunization Programme. This is in addition to OPV given at birth, 6, 10, and 14 weeks. The fractional ID dose achieves comparable seroconversion to full IM dose at reduced cost.'},\n {id:116,stem:'Protective efficacy of Varicella vaccine when used for post-exposure prophylaxis (given within 72 hours of contact) is approximately:',correct:'90%',options:['60%','70%','80%','90%'],exp:'Varicella vaccine given within 72 hours of exposure to a varicella case provides approximately 90% protection against disease (and near-complete protection against severe disease). Efficacy decreases to ~70% if given within 120 hours. Post-exposure prophylaxis with varicella vaccine is recommended for susceptible immunocompetent contacts as it is more effective and safer than waiting for natural infection.'},\n {id:117,stem:'A 10-year-old child presents with difficulty in word recognition, word decoding abilities, difficulty in spelling with normal listening comprehension. The most likely diagnosis is:',correct:'Dyslexia',options:['Dyslexia','Autism spectrum disorder','Rett syndrome','Attention deficit hyperactivity disorder'],exp:'Dyslexia (specific reading disorder) is characterised by unexpected difficulty in reading and spelling despite adequate intelligence, education, and intact listening comprehension. The deficit is in phonological processing \u2014 decoding written symbols. Normal listening comprehension distinguishes dyslexia from language\/intellectual disorders. It is the most common specific learning disorder.'},\n {id:118,stem:'Which of the following is the best strategy to use in the management of temper tantrums in a 3-year-old boy?',correct:\"'Time out'\",options:['Giving in to the demands','Physical punishment','Scolding',\"'Time out'\"],exp:\"Time out (brief supervised isolation \u2014 typically 1 minute per year of age in a safe, boring location) is the recommended evidence-based behavioural management for temper tantrums. It extinguishes the behaviour by removing the audience\/reinforcer. Giving in reinforces the tantrum. Physical punishment and scolding are harmful and counterproductive at this developmental stage.\"},\n {id:119,stem:'Which one of the following is the correct schedule for home visits by an ASHA for facility-born newborn babies?',correct:'On 3, 7, 14, 21, 28 and 42 days of life',options:['On 1, 3, 7, 14, 21 and 28 days of life','On 3, 7, 14, 21, 28 and 42 days of life','On 3, 7, 10, 14, 21 and 28 days of life','On 7, 14, 21, 28, 35 and 42 days of life'],exp:\"Under India's Home-Based Newborn Care (HBNC) programme, ASHA makes 6 home visits for facility-born babies at: days 3, 7, 14, 21, 28, and 42. For home-born babies, there are 7 visits including day 1 as well. The 42nd day visit coincides with immunisation at 6 weeks. This schedule was revised from the earlier 6-visit schedule.\"},\n {id:120,stem:'Which one of the following diseases is covered under Rashtriya Bal Swasthya Karyakram (RBSK)?',correct:'Rheumatic heart disease',options:['Rheumatic heart disease','Community acquired pneumonia','Systemic onset juvenile idiopathic arthritis','Nephrotic syndrome'],exp:\"RBSK (Rashtriya Bal Swasthya Karyakram) screens children from birth to 18 years for 39 conditions under the 4 D's: Defects at birth, Diseases, Deficiencies, and Development delays\/disabilities. Rheumatic heart disease IS one of the listed diseases under screening. Community-acquired pneumonia, sJIA, and nephrotic syndrome are not specifically listed as RBSK screening conditions.\"}\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 document.getElementById(NS+'-timer-display').textContent=disp;\n document.getElementById(NS+'-timer-btn').textContent='\u23f1 '+disp;\n if(timerRemaining<=300)document.getElementById(NS+'-timer-item').classList.add('warning');\n if(timerRemaining<=0){clearInterval(timerInterval);timerInterval=null;triggerGrace();}\n },1000);\n }\n function stopTimer(){if(timerInterval){clearInterval(timerInterval);timerInterval=null;}timerRunning=false;}\n function triggerGrace(){\n if(quizSubmitted)return;let count=GRACE_SECS;\n document.getElementById(NS+'-grace-count').textContent=count;\n document.getElementById(NS+'-grace').classList.add('show');\n graceInterval=setInterval(function(){count--;document.getElementById(NS+'-grace-count').textContent=count;if(count<=0){clearInterval(graceInterval);graceInterval=null;dismissGrace();showScore();}},1000);\n }\n function dismissGrace(){document.getElementById(NS+'-grace').classList.remove('show');if(graceInterval){clearInterval(graceInterval);graceInterval=null;}}\n\n function updateStats(){\n const c=Object.values(userAnswers).filter(function(v){return v==='correct';}).length;\n const w=Object.values(userAnswers).filter(function(v){return v==='wrong';}).length;\n const net=(c*4)-w;\n document.getElementById(NS+'-sc').textContent=c;\n document.getElementById(NS+'-sw').textContent=w;\n document.getElementById(NS+'-sr').textContent=TOTAL-answered;\n document.getElementById(NS+'-sn').textContent=net>=0?'+'+net:net;\n document.getElementById(NS+'-sm').textContent=MAX;\n document.getElementById(NS+'-fill').style.width=(answered\/TOTAL*100)+'%';\n }\n\n function pick(qid,oi){\n if(userAnswers[qid]!==undefined||quizSubmitted)return;\n const q=QUESTIONS.find(function(x){return x.id===qid;});\n const opts=shuffledOpts[qid],correct=opts[oi]===q.correct;\n userAnswers[qid]=correct?'correct':'wrong';answered++;\n opts.forEach(function(o,i){\n const el=document.getElementById(NS+'-o'+qid+'-'+i);\n if(o===q.correct)el.classList.add('cq-correct','cq-locked');\n else if(i===oi)el.classList.add('cq-wrong','cq-locked');\n else el.classList.add('cq-dimmed','cq-locked');\n });\n document.getElementById(NS+'-n'+qid).classList.add(correct?'ans-c':'ans-w');\n document.getElementById(NS+'-exp'+qid).style.display='block';\n updateStats();\n }\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n container.innerHTML='';userAnswers={};answered=0;shuffledOpts={};\n quizSubmitted=false;timerRunning=false;timerRemaining=TIMER_SECS;\n stopTimer();dismissGrace();\n document.getElementById(NS+'-score').style.display='none';\n document.getElementById(NS+'-timer-item').classList.remove('active','warning');\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 Start Timed Mode';btn.classList.remove('running');\n document.getElementById(NS+'-timer-display').textContent=fmtTime(TIMER_SECS);\n updateStats();\n QUESTIONS.forEach(function(q){\n const opts=shuffle(q.options);shuffledOpts[q.id]=opts;\n const card=document.createElement('div');card.className='cq-card';\n card.innerHTML='<div class=\"cq-qhead\"><div class=\"cq-qnum\" id=\"'+NS+'-n'+q.id+'\">'+q.id+'<\/div><div class=\"cq-qtext\">'+q.stem.replace(\/\\n\/g,'<br>')+'<\/div><\/div>'+\n '<div class=\"cq-options\" id=\"'+NS+'-opts'+q.id+'\">'+\n opts.map(function(o,i){return '<div class=\"cq-opt\" id=\"'+NS+'-o'+q.id+'-'+i+'\" role=\"button\" tabindex=\"0\"><span class=\"cq-opt-letter\">'+LETTERS[i]+'<\/span><span class=\"cq-opt-text\">'+o+'<\/span><\/div>';}).join('')+\n '<\/div><div class=\"cq-explanation\" id=\"'+NS+'-exp'+q.id+'\"><div class=\"cq-exp-label\">Explanation<\/div>'+q.exp+'<\/div>';\n container.appendChild(card);\n opts.forEach(function(_,i){document.getElementById(NS+'-o'+q.id+'-'+i).addEventListener('click',function(){pick(q.id,i);});});\n });\n }\n\n function showScore(){\n if(quizSubmitted)return;quizSubmitted=true;stopTimer();\n document.getElementById(NS+'-timer-btn').textContent='\u23f1 Submitted';\n document.getElementById(NS+'-timer-btn').classList.remove('running');\n const c=Object.values(userAnswers).filter(function(v){return v==='correct';}).length;\n const w=Object.values(userAnswers).filter(function(v){return v==='wrong';}).length;\n const s=TOTAL-answered,net=(c*4)-w,pct=Math.max(0,Math.round((net\/MAX)*100)),disp=Math.min(100,Math.max(0,pct));\n document.getElementById(NS+'-ring').style.background='conic-gradient(var(--teal) '+disp+'%,var(--line) 0%)';\n document.getElementById(NS+'-ring-pct').textContent=pct+'%';\n document.getElementById(NS+'-net-line').textContent='Net Score: '+net+' \/ '+MAX;\n document.getElementById(NS+'-verdict').textContent=pct>=80?'Excellent \u2014 well above the qualifying threshold.':pct>=60?'Good attempt \u2014 consolidate the weaker areas.':pct>=40?'Fair \u2014 systematic revision of these topics is recommended.':'Needs significant revision across these topics.';\n document.getElementById(NS+'-ct-c').textContent='\u2705 '+c+' Correct';\n document.getElementById(NS+'-ct-w').textContent='\u274c '+w+' Wrong';\n document.getElementById(NS+'-ct-s').textContent='\u23ed '+s+' Skipped';\n const sc=document.getElementById(NS+'-score');sc.style.display='block';sc.scrollIntoView({behavior:'smooth',block:'center'});\n }\n\n function init(){\n document.getElementById(NS+'-grace-now').addEventListener('click',function(){dismissGrace();showScore();});\n document.getElementById(NS+'-timer-btn').addEventListener('click',function(){if(!timerRunning&&!quizSubmitted)startTimer();});\n document.getElementById(NS+'-submit').addEventListener('click',showScore);\n document.getElementById(NS+'-retry').addEventListener('click',function(){build();window.scrollTo({top:0,behavior:'smooth'});});\n new IntersectionObserver(function(entries){\n document.getElementById(NS+'-statusbar').classList.toggle('visible',!entries[0].isIntersecting);\n },{threshold:0}).observe(document.getElementById(NS+'-sentinel'));\n build();updateStats();\n }\n\n if(document.readyState==='loading'){document.addEventListener('DOMContentLoaded',init);}else{init();}\n})();\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 4 Emergency Medicine \u00b7 Paediatrics Questions 91 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36596","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2021 P1 Part-4 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/\" \/>\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-4 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 4 Emergency Medicine \u00b7 Paediatrics Questions 91 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry Quiz\" \/>\n<meta property=\"og:url\" content=\"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/\" \/>\n<meta property=\"og:site_name\" content=\"atsixty\" \/>\n<meta property=\"article:published_time\" content=\"2026-04-16T02:45:48+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-19T12:34:07+00:00\" \/>\n<meta name=\"author\" content=\"Avi\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Avi\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\"},\"author\":{\"name\":\"Avi\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"headline\":\"CMS 2021 P1 Part-4\",\"datePublished\":\"2026-04-16T02:45:48+00:00\",\"dateModified\":\"2026-04-19T12:34:07+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\"},\"wordCount\":53,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"articleSection\":[\"CMS\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\",\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\",\"name\":\"CMS 2021 P1 Part-4 - atsixty\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\"},\"datePublished\":\"2026-04-16T02:45:48+00:00\",\"dateModified\":\"2026-04-19T12:34:07+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/atsixty.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CMS 2021 P1 Part-4\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\",\"url\":\"https:\\\/\\\/atsixty.com\\\/\",\"name\":\"At Sixty\",\"description\":\"The Option Taken\",\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/atsixty.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\",\"name\":\"Avi\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"url\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"contentUrl\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"width\":200,\"height\":200,\"caption\":\"Avi\"},\"logo\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\"},\"sameAs\":[\"https:\\\/\\\/atsixty.com\"],\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/author\\\/avinaux\\\/\"}]}<\/script>\n","yoast_head_json":{"title":"CMS 2021 P1 Part-4 - atsixty","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","og_locale":"en_US","og_type":"article","og_title":"CMS 2021 P1 Part-4 - atsixty","og_description":"CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 4 Emergency Medicine \u00b7 Paediatrics Questions 91 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry Quiz","og_url":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","og_site_name":"atsixty","article_published_time":"2026-04-16T02:45:48+00:00","article_modified_time":"2026-04-19T12:34:07+00:00","author":"Avi","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Avi","Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"CMS 2021 P1 Part-4","datePublished":"2026-04-16T02:45:48+00:00","dateModified":"2026-04-19T12:34:07+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/"},"wordCount":53,"commentCount":0,"publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"articleSection":["CMS"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","url":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","name":"CMS 2021 P1 Part-4 - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-04-16T02:45:48+00:00","dateModified":"2026-04-19T12:34:07+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"CMS 2021 P1 Part-4"}]},{"@type":"WebSite","@id":"https:\/\/atsixty.com\/#website","url":"https:\/\/atsixty.com\/","name":"At Sixty","description":"The Option Taken","publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/atsixty.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d","name":"Avi","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","url":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","contentUrl":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","width":200,"height":200,"caption":"Avi"},"logo":{"@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png"},"sameAs":["https:\/\/atsixty.com"],"url":"https:\/\/atsixty.com\/index.php\/author\/avinaux\/"}]}},"_links":{"self":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36596","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/comments?post=36596"}],"version-history":[{"count":2,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36596\/revisions"}],"predecessor-version":[{"id":36625,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36596\/revisions\/36625"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

{"id":36596,"date":"2026-04-16T08:15:48","date_gmt":"2026-04-16T02:45:48","guid":{"rendered":"https:\/\/atsixty.com\/?p=36596"},"modified":"2026-04-19T18:04:07","modified_gmt":"2026-04-19T12:34:07","slug":"cms-2021-p1-part-4","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","title":{"rendered":"CMS 2021 P1 Part-4"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms21p1d \u2500\u2500 *\/\n#cms21p1d *,#cms21p1d *::before,#cms21p1d *::after{box-sizing:border-box;margin:0;padding:0}\n#cms21p1d{\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#cms21p1d .cq-sentinel{height:1px}\n#cms21p1d .cq-statusbar{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px solid var(--ter);box-shadow:0 2px 12px rgba(0,0,0,0.11);opacity:0;pointer-events:none;transform:translateY(-110%);transition:opacity 0.22s ease,transform 0.22s ease}\n#cms21p1d .cq-statusbar.visible{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms21p1d .cq-sb-stats{display:flex;align-items:center;padding:0.38rem 0.7rem;font-size:0.73rem;color:var(--ink-soft)}\n#cms21p1d .cq-sb-item{display:flex;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1}\n#cms21p1d .cq-sb-item:last-child{border-right:none}\n#cms21p1d .cq-sb-item strong{color:var(--ink);font-size:0.8rem;font-weight:700}\n#cms21p1d .cq-sb-sep{flex:1}\n#cms21p1d .cq-sb-progress{height:4px;background:var(--line);overflow:hidden}\n#cms21p1d .cq-sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width 0.4s ease}\n#cms21p1d .cq-timer-item{display:none;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1;font-size:0.73rem}\n#cms21p1d .cq-timer-item.active{display:flex}\n#cms21p1d .cq-timer-item strong{font-size:0.8rem;font-weight:700;color:var(--teal);font-variant-numeric:tabular-nums}\n#cms21p1d .cq-timer-item.warning strong{color:var(--wrong)}\n#cms21p1d .cq-grace{display:none;position:fixed;top:0;right:0;bottom:0;left:0;z-index:999999;background:rgba(0,0,0,0.55);align-items:center;justify-content:center}\n#cms21p1d .cq-grace.show{display:flex}\n#cms21p1d .cq-grace-box{background:var(--white);border-radius:12px;border-top:5px solid var(--wrong);padding:32px 28px;text-align:center;max-width:320px;width:90%;box-shadow:0 8px 40px rgba(0,0,0,0.25)}\n#cms21p1d .cq-grace-box h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wrong);margin-bottom:10px}\n#cms21p1d .cq-grace-box p{font-size:0.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms21p1d .cq-grace-count{font-family:'Playfair Display',serif;font-size:2.8rem;font-weight:700;color:var(--wrong);line-height:1;margin-bottom:18px}\n#cms21p1d .cq-grace-btn{background:var(--wrong);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s}\n#cms21p1d .cq-grace-btn:hover{background:#c62828}\n#cms21p1d .cq-header{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center}\n#cms21p1d .cq-header h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;letter-spacing:0.01em;line-height:1.3}\n#cms21p1d .cq-header p{font-size:0.85rem;opacity:0.85;margin-top:6px;font-style:italic}\n#cms21p1d .cq-meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms21p1d .cq-badge{background:rgba(255,255,255,0.15);border:1px solid rgba(255,255,255,0.3);border-radius:20px;padding:4px 14px;font-size:0.78rem;letter-spacing:0.03em}\n#cms21p1d .cq-timer-btn{background:transparent;border:1.5px solid rgba(255,255,255,0.7);color:var(--white);border-radius:20px;padding:4px 14px;font-family:'Source Serif 4',serif;font-size:0.78rem;cursor:pointer;letter-spacing:0.03em;transition:background 0.2s;display:flex;align-items:center;gap:6px}\n#cms21p1d .cq-timer-btn:hover{background:rgba(255,255,255,0.15)}\n#cms21p1d .cq-timer-btn.running{background:rgba(255,255,255,0.2);border-color:var(--white)}\n#cms21p1d .cq-body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms21p1d .cq-card{background:var(--white);border:1px solid var(--line);border-radius:var(--radius);margin:24px 0;overflow:hidden;transition:box-shadow 0.2s}\n#cms21p1d .cq-card:hover{box-shadow:0 2px 12px rgba(192,96,58,0.1)}\n#cms21p1d .cq-qhead{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start}\n#cms21p1d .cq-qnum{flex-shrink:0;width:26px;height:26px;border-radius:50%;background:var(--ter);color:#fff;font-size:0.72rem;font-weight:700;display:flex;align-items:center;justify-content:center;margin-top:2px;transition:background 0.2s}\n#cms21p1d .cq-qnum.ans-c{background:var(--correct-border)}\n#cms21p1d .cq-qnum.ans-w{background:var(--wrong-border)}\n#cms21p1d .cq-qtext{font-size:0.93rem;color:var(--ink);line-height:1.65}\n#cms21p1d .cq-options{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms21p1d .cq-opt{display:flex;align-items:flex-start;gap:10px;padding:10px 14px;border:1.5px solid var(--line);border-radius:8px;cursor:pointer;transition:border-color 0.15s,background 0.15s;background:var(--white);-webkit-tap-highlight-color:transparent}\n#cms21p1d .cq-opt:hover:not(.cq-locked){border-color:var(--teal);background:var(--teal-pale)}\n#cms21p1d .cq-opt-letter{flex-shrink:0;width:20px;height:20px;border-radius:50%;border:1.5px solid var(--line);display:flex;align-items:center;justify-content:center;font-size:0.65rem;font-weight:700;color:var(--ink-soft);transition:all 0.15s;margin-top:1px}\n#cms21p1d .cq-opt-text{font-size:0.89rem;color:var(--ink-mid);line-height:1.55}\n#cms21p1d .cq-opt.cq-correct{border-color:var(--correct-border);background:var(--correct-bg);cursor:default}\n#cms21p1d .cq-opt.cq-correct .cq-opt-letter{background:var(--correct-border);border-color:var(--correct-border);color:#fff}\n#cms21p1d .cq-opt.cq-correct .cq-opt-text{color:var(--correct);font-weight:600}\n#cms21p1d .cq-opt.cq-wrong{border-color:var(--wrong-border);background:var(--wrong-bg);cursor:default}\n#cms21p1d .cq-opt.cq-wrong .cq-opt-letter{background:var(--wrong-border);border-color:var(--wrong-border);color:#fff}\n#cms21p1d .cq-opt.cq-wrong .cq-opt-text{color:var(--wrong)}\n#cms21p1d .cq-opt.cq-dimmed{opacity:0.42;cursor:default}\n#cms21p1d .cq-opt.cq-locked{cursor:default}\n#cms21p1d .cq-explanation{display:none;background:var(--teal-pale);border-top:1px solid #b2d8d3;padding:10px 18px 12px;font-size:0.82rem;color:#1a4f49;line-height:1.62}\n#cms21p1d .cq-exp-label{font-size:0.7rem;font-weight:700;letter-spacing:0.08em;text-transform:uppercase;color:var(--teal);margin-bottom:4px}\n#cms21p1d .cq-submit-wrap{text-align:center;padding:28px 16px 8px}\n#cms21p1d .cq-btn{background:var(--teal);color:var(--white);border:none;border-radius:8px;padding:13px 36px;font-family:'Playfair Display',serif;font-size:1rem;font-weight:700;cursor:pointer;letter-spacing:0.02em;transition:background 0.2s,transform 0.1s}\n#cms21p1d .cq-btn:hover{background:var(--teal-light)}\n#cms21p1d .cq-btn:active{transform:scale(0.98)}\n#cms21p1d .cq-score{display:none;background:var(--white);border:2px solid var(--teal);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms21p1d .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#cms21p1d .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms21p1d .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms21p1d .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms21p1d .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms21p1d .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms21p1d .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms21p1d .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms21p1d .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms21p1d .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms21p1d .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms21p1d .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms21p1d .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms21p1d .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid 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#cms21p1d .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms21p1d .cq-header h1{font-size:1.15rem}#cms21p1d .cq-qtext{font-size:0.88rem}#cms21p1d .cq-opt-text{font-size:0.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms21p1d\">\n <div class=\"cq-sentinel\" id=\"cms21p1d-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms21p1d-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms21p1d-timer-item\">\u23f1 <strong id=\"cms21p1d-timer-display\">30:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms21p1d-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms21p1d-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms21p1d-sr\">30<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms21p1d-sn\">0<\/strong> \/ <strong id=\"cms21p1d-sm\">120<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms21p1d-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms21p1d-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms21p1d-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms21p1d-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 4<\/h1>\n <p>Emergency Medicine \u00b7 Paediatrics<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 91 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms21p1d-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms21p1d-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms21p1d-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms21p1d-score\">\n <div class=\"cq-score-ring\" id=\"cms21p1d-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms21p1d-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=\"cms21p1d-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms21p1d-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms21p1d-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms21p1d-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms21p1d-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms21p1d-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms21p1d',TOTAL=30,MAX=TOTAL*4,TIMER_SECS=30*60,GRACE_SECS=10;\n const QUESTIONS=[\n {id:91,stem:'Early hypotension in venomous snakebite is due to which of the following?',correct:'Pooling of blood in the pulmonary and splanchnic circulation',options:['Pooling of blood in the pulmonary and splanchnic circulation','Systemic bleeding','Haemolysis','Loss of intravascular volume into soft tissues'],exp:'Early hypotension in viper envenomation results from direct vasodilatory effects of venom components (bradykinin-potentiating peptides, phospholipases) causing pooling of blood in the pulmonary and splanchnic vasculature \u2014 distributive shock. Late hypotension may be due to haemorrhage or myocardial toxicity. Systemic bleeding and haemolysis tend to cause later, more insidious haemodynamic compromise.'},\n {id:92,stem:'Gastric aspiration and lavage is contraindicated in which of the following poisonings?\\n1. Strong acids\\n2. Alkalis\\n3. Petroleum distillates\\n4. Ethanol',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Gastric lavage is contraindicated in: strong acids and alkalis (corrosive injury to oesophagus\/stomach would be worsened by repeated passage of tube and lavage), petroleum distillates\/hydrocarbons (high aspiration risk with low viscosity fluids \u2014 causes severe chemical pneumonitis). Ethanol poisoning is NOT a contraindication \u2014 gastric lavage\/aspiration may be used if presentation is very early. Statements 1, 2, and 3 are correct.'},\n {id:93,stem:'Acetylcysteine is an antidote for which poisoning?',correct:'Paracetamol',options:['Salicylates','Paracetamol','Tricyclic antidepressants','Benzodiazepines'],exp:'N-acetylcysteine (NAC) is the specific antidote for paracetamol (acetaminophen) overdose. It replenishes hepatic glutathione stores, which detoxify the toxic metabolite NAPQI (N-acetyl-p-benzoquinone imine) that causes centrilobular hepatic necrosis. Given within 8\u201310 hours of ingestion it is highly effective. Flumazenil = benzodiazepines; naloxone = opioids; sodium bicarbonate = TCA.'},\n {id:94,stem:'Which one of the following is NOT a constituent of treatment of severe hyperkalaemia?',correct:'Beta-2 adrenoceptor antagonist',options:['IV calcium gluconate (10 mL of 10%)','Beta-2 adrenoceptor antagonist','Dialysis','IV sodium bicarbonate'],exp:'Treatment of severe hyperkalaemia: IV calcium gluconate (membrane stabilisation), IV sodium bicarbonate (shifts K into cells in acidosis), IV insulin + dextrose (drives K intracellularly), IV salbutamol (beta-2 AGONIST \u2014 also drives K into cells), dialysis (definitive removal). Beta-2 adrenoceptor ANTAGONISTS (beta-blockers) would worsen hyperkalaemia by blocking the cellular uptake mechanism \u2014 they are NOT a treatment.'},\n {id:95,stem:'Kyasanur Forest Disease is endemic to:',correct:'South-West India',options:['West Africa','South America','South-West India','Balkans'],exp:'Kyasanur Forest Disease (KFD) is a tick-borne viral haemorrhagic fever caused by Kyasanur Forest Disease virus (a Flavivirus), transmitted by Haemaphysalis spinigera ticks. It is endemic to the Kyasanur forests of Karnataka (South-West India) and has recently spread to adjacent districts of Goa and Kerala. Monkeys act as amplifying hosts.'},\n {id:96,stem:'Which one of the following is NOT a usual cause of Type-2 respiratory failure?',correct:'Pulmonary embolism',options:['Guillain-Barr\u00e9 syndrome','Upper airway obstruction','Pulmonary embolism','Flail chest'],exp:'Type 2 (hypercapnic) respiratory failure is caused by inadequate ventilation \u2014 neuromuscular (GBS, MND, myasthenia), chest wall (flail chest, kyphoscoliosis), upper airway obstruction, COPD, severe asthma, obesity hypoventilation. Pulmonary embolism causes Type 1 (hypoxaemic) respiratory failure by V\/Q mismatch and increased dead space \u2014 PaCO2 is typically low or normal. PE is NOT a cause of Type 2 failure.'},\n {id:97,stem:'A 10-year-old girl is diagnosed with dengue fever. She has abdominal pain and persistent vomiting. Examination reveals normal blood pressure but haematocrit is increased. Which of the following is the most appropriate initial fluid management?',correct:'Ringer lactate at 5 mL\/kg\/hour',options:['Ringer lactate at 3 mL\/kg\/hour','Ringer lactate at 5 mL\/kg\/hour','Ringer lactate at 7 mL\/kg\/hour','Ringer lactate at 10 mL\/kg\/hour'],exp:'This child has dengue with warning signs (abdominal pain, persistent vomiting, rising haematocrit) but haemodynamically stable (normal BP) \u2014 WHO Group B. Initial fluid management: Ringer lactate or NS at 5\u20137 mL\/kg\/hour for 1\u20132 hours, then reassess. If stable, reduce to 3\u20135 mL\/kg\/hour. Starting rate of 5 mL\/kg\/hour is appropriate for Group B dengue.'},\n {id:98,stem:'A child presents with headache and vomiting in the emergency room following a fall from the bed. Which one of the following treatment modalities is NOT recommended in the emergency room?',correct:'Therapeutic lumbar puncture',options:['Intravenous mannitol administration','Administration of hypertonic (3%) solution','Elevate the head end by 30 degrees','Therapeutic lumbar puncture'],exp:'In a child with head injury and features of raised intracranial pressure (headache, vomiting), therapeutic lumbar puncture is ABSOLUTELY CONTRAINDICATED \u2014 it risks fatal transtentorial herniation (coning) by decompressing the lumbar subarachnoid space while the intracranial pressure remains elevated. Mannitol, hypertonic saline, and 30-degree head elevation are all accepted management for raised ICP.'},\n {id:99,stem:'The recommended ratio for chest compression to breaths administered by a single rescuer during resuscitation of a child in cardiac arrest is:',correct:'30 : 2',options:['15 : 2','30 : 2','14 : 1','7 : 1'],exp:'Per AHA\/ILCOR PALS guidelines: single rescuer performing CPR on a child uses 30:2 ratio (same as adult BLS). The 15:2 ratio is used by TWO healthcare provider rescuers in paediatric CPR (to allow more compressions with a lower ratio). Neonatal CPR uses 3:1. A single bystander should use 30:2 regardless of patient age.'},\n {id:100,stem:'A 4-year-old comatose child is assessed by the Modified Glasgow Coma Scale. Which is the correct interpretation of E2V3M2?',correct:'Eye opening to pain, cries to pain and extension to pain',options:['Eye opening to speech, makes incomprehensible sounds and abnormal flexion','Eye opening to speech, inappropriate words and abnormal flexion','Eye opening to pain, moans to pain and abnormal flexion','Eye opening to pain, cries to pain and extension to pain'],exp:'Modified GCS for children: E2 = eye opening to pain (E1=none, E2=pain, E3=speech, E4=spontaneous). In the modified paediatric verbal scale: V3 = cries to pain (age-appropriate equivalent of inappropriate words). M2 = abnormal extension\/decerebrate posturing (M1=none, M2=extension, M3=flexion, M4=withdrawal, M5=localises, M6=obeys). E2V3M2 = eye to pain, cries to pain, extension to pain.'},\n {id:101,stem:'What will a baby with mild hypothermia feel like, when touched by the back of the hand of an examiner?',correct:'The abdomen will be warm, but the hands and feet will be cold.',options:['The entire body will feel cold.','The abdomen and feet will be warm, but hands will be cold.','The abdomen will be warm, but the hands and feet will be cold.','The abdomen, feet and hands will all feel cold.'],exp:'WHO classification of neonatal hypothermia: Mild (36.0\u201336.4\u00b0C) = cold stress \u2014 abdomen\/trunk warm but hands and feet feel cold. Moderate (32.0\u201335.9\u00b0C) = entire body cold. Severe below 32\u00b0C = entire body very cold with features of shock. In mild hypothermia, peripheral vasoconstriction preserves core temperature, so the abdomen is warm while extremities are cold.'},\n {id:102,stem:'Which of the following manifestations is\/are seen in hypocalcaemia?',correct:'Dilated cardiomyopathy',options:['Nausea and vomiting','Dilated cardiomyopathy','Polyuria','Polydipsia'],exp:'Hypocalcaemia causes: neuromuscular excitability (tetany, Chvostek\/Trousseau signs, seizures), prolonged QT interval, dilated cardiomyopathy (chronic severe hypocalcaemia), laryngospasm, and cataracts. Nausea\/vomiting, polyuria, and polydipsia are features of HYPERcalcaemia. Dilated cardiomyopathy from hypocalcaemia is reversible with calcium repletion.'},\n {id:103,stem:'A 6-week-old infant presents with unconjugated hyperbilirubinaemia. Which of the following could be a likely diagnosis?',correct:'Congenital hypothyroidism',options:['Dubin Johnson syndrome','Galactosemia','Rotor syndrome','Congenital hypothyroidism'],exp:'Unconjugated hyperbilirubinaemia at 6 weeks suggests prolonged physiological jaundice or pathological causes: congenital hypothyroidism (impairs hepatic UDP-glucuronosyltransferase activity and gut motility reducing bilirubin excretion), haemolytic disorders, breast milk jaundice. Dubin-Johnson, Rotor syndrome, and galactosemia all cause CONJUGATED (direct) hyperbilirubinaemia due to hepatocellular or excretory defects.'},\n {id:104,stem:'A mother with polyhydramnios gives birth to a term newborn who develops choking and cyanosis on feeding soon after birth. There is excessive drooling and frothing from the mouth. Most likely diagnosis is:',correct:'Tracheoesophageal fistula',options:['Anorectal malformation','Diaphragmatic hernia','Arnold Chiari malformation','Tracheoesophageal fistula'],exp:'The classic triad of TOF\/OA (tracheoesophageal fistula with oesophageal atresia): maternal polyhydramnios (fetus cannot swallow amniotic fluid), early choking\/cyanosis with first feed (fluid\/milk enters the blind-ending oesophageal pouch and overflows into airway), and excessive drooling\/frothing (inability to swallow secretions). Confirmed by failure to pass nasogastric tube beyond 10\u201312 cm.'},\n {id:105,stem:'An infant has just started to watch his mother intently when she talks to him. He has not yet started smiling back. What is the approximate age of the child?',correct:'4 weeks',options:['4 weeks','6 weeks','8 weeks','12 weeks'],exp:'Visual fixation on a face and intense watching begins at around 4 weeks. Social smile (smiling in response to a face\/voice) begins at ~6 weeks. Since this infant is watching intently but has NOT yet started smiling, the developmental age is approximately 4 weeks \u2014 just before the social smile milestone.'},\n {id:106,stem:'A child demonstrates a mature pincer grasp and is able to build a tower of maximum 6 blocks and can make vertical and circular strokes with pencil. His developmental age is around:',correct:'24 months',options:['12 months','18 months','24 months','36 months'],exp:'Developmental milestones: mature pincer grasp = 12 months. Tower of 6 blocks = 24 months. Vertical stroke copy = 24 months. Circular stroke\/scribble = 24 months. At 18 months: tower of 3\u20134 blocks, scribbles. At 36 months: tower of 9\u201310 blocks, copies a circle. The combination of 6-block tower with vertical and circular strokes places this child at 24 months.'},\n {id:107,stem:'A typically developing girl is able to creep upstairs and builds a tower of 2 blocks. Which of the following skills should she also display?',correct:'Scribbling',options:['Scribbling','Running','Speaking at least 10 words','Exploring drawers'],exp:'Creeping upstairs = 15 months. Tower of 2 blocks = 15 months. At 15 months: first words (3\u20135 words), casts objects, scribbles with a crayon. Running begins at ~18 months. Speaking 10 words = ~18 months. Exploring drawers and cupboards = ~18 months. The skill appropriate for 15 months here is scribbling.'},\n {id:108,stem:'A child can ride a tricycle, hop on one foot but cannot skip. He uses alternate feet while going downstairs. Which one of the following motor skills should he be able to perform at this developmental level?',correct:'Copy a cross',options:['Copy a triangle','Copy a cross','Build a gate with blocks','Copy a rectangle'],exp:'Tricycle riding = 3 years. Hopping on one foot = 4 years. Alternate feet downstairs = 4 years. Cannot skip = not yet 5\u20136 years. Developmental age ~4 years. At 4 years: copies a cross (+), builds steps with blocks (not gate \u2014 gate is 4.5 years), can draw a person with 4+ parts. Copy a triangle = 5 years. Copy a rectangle = 4.5 years. Copying a cross is the appropriate 4-year milestone.'},\n {id:109,stem:'Which one of the following skills is a normally developing 2-year-old child unable to perform?',correct:'Copying a circle',options:['Unscrewing a lid','Turning a door knob','Building a vertical tower of 6 blocks','Copying a circle'],exp:'At 24 months: tower of 6 blocks (correct), turns door knobs, unscrews lids, turns pages singly, scribbles. Copying a CIRCLE (round shape) is a 36-month (3-year) milestone. At 2 years the child scribbles but cannot yet copy a geometric shape. A 2-year-old cannot copy a circle \u2014 this is the correct EXCEPT answer.'},\n {id:110,stem:'Which one of the following statements is age-appropriate for a normally developing 4-month-old infant?',correct:'The infant can bring his hands to the midline.',options:['The infant can bring his hands to the midline.','The infant has still not attained partial head control.','The infant has started to reach out with one hand.','The infant has started making monosyllable sounds like da or pa.'],exp:'At 4 months: brings hands to midline (midline hand play), holds head steady in sitting, rolls from prone to supine, smiles socially, coos and laughs. Partial head control starts at 3 months (not still absent at 4 months). Reaching with one hand = 5\u20136 months. Monosyllable babbling (da, pa) = 6\u20139 months. The correct age-appropriate statement is bringing hands to midline.'},\n {id:111,stem:'Which one of the following is used to estimate the surface area of burn injuries in children less than 15 years of age?',correct:'Lund and Browder chart',options:['Berkow body surface area chart','Rule of Nines','Lund and Browder chart','Parkland formula'],exp:'The Lund and Browder chart is used for estimating burn surface area in children because it accounts for the age-related changes in body proportions (relatively larger head, smaller limbs in infants). The Rule of Nines is for adults only. The Parkland formula is for calculating fluid resuscitation volumes (not for estimating burn area). Berkow chart is also age-adjusted and used by some but Lund-Browder is the standard.'},\n {id:112,stem:'A 4-year-old boy presents with ingestion of many tablets of salicylate. Which one of the following complications is he likely to develop?',correct:'Metabolic acidosis',options:['Hyperkalaemia','Rhabdomyolysis','Prolonged QRS complex in ECG','Metabolic acidosis'],exp:'Salicylate (aspirin) poisoning causes: early respiratory alkalosis (direct stimulation of respiratory centre), followed by metabolic acidosis (uncoupling of oxidative phosphorylation, lactic acid, ketoacids). In children, metabolic acidosis tends to predominate early. Hypokalaemia (not hyperkalaemia) occurs. Prolonged QRS = TCA overdose. Rhabdomyolysis = statins, extreme exertion.'},\n {id:113,stem:'A 3-year-old boy presents with parental concerns regarding delayed development, especially speech. On observation, the clinician notes decreased eye contact, inattentiveness, unresponsive to being called and toe walking. What is the most likely diagnosis?',correct:'Autism Spectrum Disorder',options:['Attention Deficit Hyperactivity Disorder','Autism Spectrum Disorder','Cerebral Palsy','Social Communication Disorder'],exp:'The triad of: (1) decreased eye contact and social reciprocity deficits, (2) language\/communication delay, and (3) restricted\/repetitive behaviours (toe walking) in a toddler is diagnostic of Autism Spectrum Disorder (DSM-5). Unresponsiveness to being called is a red flag. ADHD does not involve social communication deficits. Toe walking alone occurs in CP and idiopathic toe walking.'},\n {id:114,stem:'Atomoxetine is prescribed to children with Autism Spectrum Disorder to control symptoms of:',correct:'Hyperactivity',options:['Anxiety','Sleep disturbances','Hyperactivity','Repetitive behaviour'],exp:'Atomoxetine (a selective noradrenaline reuptake inhibitor, SNRI) is used in ASD to manage ADHD-like symptoms, particularly hyperactivity and inattention. In ASD: anxiety = SSRIs (fluoxetine); sleep disturbances = melatonin; repetitive\/stereotyped behaviours = SSRIs or risperidone; hyperactivity\/inattention = methylphenidate or atomoxetine.'},\n {id:115,stem:'Fractional inactivated intradermal poliovirus vaccine is given at which ages in the National Immunization Schedule?',correct:'6 weeks and 14 weeks',options:['6 weeks and 10 weeks','6 weeks and 14 weeks','10 weeks and 14 weeks','6 weeks, 10 weeks and 14 weeks'],exp:'India introduced fractional IPV (fIPV) given intradermally (1\/5th the intramuscular dose \u2014 0.1 mL ID) at 6 weeks and 14 weeks under the Universal Immunization Programme. This is in addition to OPV given at birth, 6, 10, and 14 weeks. The fractional ID dose achieves comparable seroconversion to full IM dose at reduced cost.'},\n {id:116,stem:'Protective efficacy of Varicella vaccine when used for post-exposure prophylaxis (given within 72 hours of contact) is approximately:',correct:'90%',options:['60%','70%','80%','90%'],exp:'Varicella vaccine given within 72 hours of exposure to a varicella case provides approximately 90% protection against disease (and near-complete protection against severe disease). Efficacy decreases to ~70% if given within 120 hours. Post-exposure prophylaxis with varicella vaccine is recommended for susceptible immunocompetent contacts as it is more effective and safer than waiting for natural infection.'},\n {id:117,stem:'A 10-year-old child presents with difficulty in word recognition, word decoding abilities, difficulty in spelling with normal listening comprehension. The most likely diagnosis is:',correct:'Dyslexia',options:['Dyslexia','Autism spectrum disorder','Rett syndrome','Attention deficit hyperactivity disorder'],exp:'Dyslexia (specific reading disorder) is characterised by unexpected difficulty in reading and spelling despite adequate intelligence, education, and intact listening comprehension. The deficit is in phonological processing \u2014 decoding written symbols. Normal listening comprehension distinguishes dyslexia from language\/intellectual disorders. It is the most common specific learning disorder.'},\n {id:118,stem:'Which of the following is the best strategy to use in the management of temper tantrums in a 3-year-old boy?',correct:\"'Time out'\",options:['Giving in to the demands','Physical punishment','Scolding',\"'Time out'\"],exp:\"Time out (brief supervised isolation \u2014 typically 1 minute per year of age in a safe, boring location) is the recommended evidence-based behavioural management for temper tantrums. It extinguishes the behaviour by removing the audience\/reinforcer. Giving in reinforces the tantrum. Physical punishment and scolding are harmful and counterproductive at this developmental stage.\"},\n {id:119,stem:'Which one of the following is the correct schedule for home visits by an ASHA for facility-born newborn babies?',correct:'On 3, 7, 14, 21, 28 and 42 days of life',options:['On 1, 3, 7, 14, 21 and 28 days of life','On 3, 7, 14, 21, 28 and 42 days of life','On 3, 7, 10, 14, 21 and 28 days of life','On 7, 14, 21, 28, 35 and 42 days of life'],exp:\"Under India's Home-Based Newborn Care (HBNC) programme, ASHA makes 6 home visits for facility-born babies at: days 3, 7, 14, 21, 28, and 42. For home-born babies, there are 7 visits including day 1 as well. The 42nd day visit coincides with immunisation at 6 weeks. This schedule was revised from the earlier 6-visit schedule.\"},\n {id:120,stem:'Which one of the following diseases is covered under Rashtriya Bal Swasthya Karyakram (RBSK)?',correct:'Rheumatic heart disease',options:['Rheumatic heart disease','Community acquired pneumonia','Systemic onset juvenile idiopathic arthritis','Nephrotic syndrome'],exp:\"RBSK (Rashtriya Bal Swasthya Karyakram) screens children from birth to 18 years for 39 conditions under the 4 D's: Defects at birth, Diseases, Deficiencies, and Development delays\/disabilities. Rheumatic heart disease IS one of the listed diseases under screening. Community-acquired pneumonia, sJIA, and nephrotic syndrome are not specifically listed as RBSK screening conditions.\"}\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 document.getElementById(NS+'-timer-display').textContent=disp;\n document.getElementById(NS+'-timer-btn').textContent='\u23f1 '+disp;\n if(timerRemaining<=300)document.getElementById(NS+'-timer-item').classList.add('warning');\n if(timerRemaining<=0){clearInterval(timerInterval);timerInterval=null;triggerGrace();}\n },1000);\n }\n function stopTimer(){if(timerInterval){clearInterval(timerInterval);timerInterval=null;}timerRunning=false;}\n function triggerGrace(){\n if(quizSubmitted)return;let count=GRACE_SECS;\n document.getElementById(NS+'-grace-count').textContent=count;\n document.getElementById(NS+'-grace').classList.add('show');\n graceInterval=setInterval(function(){count--;document.getElementById(NS+'-grace-count').textContent=count;if(count<=0){clearInterval(graceInterval);graceInterval=null;dismissGrace();showScore();}},1000);\n }\n function dismissGrace(){document.getElementById(NS+'-grace').classList.remove('show');if(graceInterval){clearInterval(graceInterval);graceInterval=null;}}\n\n function updateStats(){\n const c=Object.values(userAnswers).filter(function(v){return v==='correct';}).length;\n const w=Object.values(userAnswers).filter(function(v){return v==='wrong';}).length;\n const net=(c*4)-w;\n document.getElementById(NS+'-sc').textContent=c;\n document.getElementById(NS+'-sw').textContent=w;\n document.getElementById(NS+'-sr').textContent=TOTAL-answered;\n document.getElementById(NS+'-sn').textContent=net>=0?'+'+net:net;\n document.getElementById(NS+'-sm').textContent=MAX;\n document.getElementById(NS+'-fill').style.width=(answered\/TOTAL*100)+'%';\n }\n\n function pick(qid,oi){\n if(userAnswers[qid]!==undefined||quizSubmitted)return;\n const q=QUESTIONS.find(function(x){return x.id===qid;});\n const opts=shuffledOpts[qid],correct=opts[oi]===q.correct;\n userAnswers[qid]=correct?'correct':'wrong';answered++;\n opts.forEach(function(o,i){\n const el=document.getElementById(NS+'-o'+qid+'-'+i);\n if(o===q.correct)el.classList.add('cq-correct','cq-locked');\n else if(i===oi)el.classList.add('cq-wrong','cq-locked');\n else el.classList.add('cq-dimmed','cq-locked');\n });\n document.getElementById(NS+'-n'+qid).classList.add(correct?'ans-c':'ans-w');\n document.getElementById(NS+'-exp'+qid).style.display='block';\n updateStats();\n }\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n container.innerHTML='';userAnswers={};answered=0;shuffledOpts={};\n quizSubmitted=false;timerRunning=false;timerRemaining=TIMER_SECS;\n stopTimer();dismissGrace();\n document.getElementById(NS+'-score').style.display='none';\n document.getElementById(NS+'-timer-item').classList.remove('active','warning');\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 Start Timed Mode';btn.classList.remove('running');\n document.getElementById(NS+'-timer-display').textContent=fmtTime(TIMER_SECS);\n updateStats();\n QUESTIONS.forEach(function(q){\n const opts=shuffle(q.options);shuffledOpts[q.id]=opts;\n const card=document.createElement('div');card.className='cq-card';\n card.innerHTML='<div class=\"cq-qhead\"><div class=\"cq-qnum\" id=\"'+NS+'-n'+q.id+'\">'+q.id+'<\/div><div class=\"cq-qtext\">'+q.stem.replace(\/\\n\/g,'<br>')+'<\/div><\/div>'+\n '<div class=\"cq-options\" id=\"'+NS+'-opts'+q.id+'\">'+\n opts.map(function(o,i){return '<div class=\"cq-opt\" id=\"'+NS+'-o'+q.id+'-'+i+'\" role=\"button\" tabindex=\"0\"><span class=\"cq-opt-letter\">'+LETTERS[i]+'<\/span><span class=\"cq-opt-text\">'+o+'<\/span><\/div>';}).join('')+\n '<\/div><div class=\"cq-explanation\" id=\"'+NS+'-exp'+q.id+'\"><div class=\"cq-exp-label\">Explanation<\/div>'+q.exp+'<\/div>';\n container.appendChild(card);\n opts.forEach(function(_,i){document.getElementById(NS+'-o'+q.id+'-'+i).addEventListener('click',function(){pick(q.id,i);});});\n });\n }\n\n function showScore(){\n if(quizSubmitted)return;quizSubmitted=true;stopTimer();\n document.getElementById(NS+'-timer-btn').textContent='\u23f1 Submitted';\n document.getElementById(NS+'-timer-btn').classList.remove('running');\n const c=Object.values(userAnswers).filter(function(v){return v==='correct';}).length;\n const w=Object.values(userAnswers).filter(function(v){return v==='wrong';}).length;\n const s=TOTAL-answered,net=(c*4)-w,pct=Math.max(0,Math.round((net\/MAX)*100)),disp=Math.min(100,Math.max(0,pct));\n document.getElementById(NS+'-ring').style.background='conic-gradient(var(--teal) '+disp+'%,var(--line) 0%)';\n document.getElementById(NS+'-ring-pct').textContent=pct+'%';\n document.getElementById(NS+'-net-line').textContent='Net Score: '+net+' \/ '+MAX;\n document.getElementById(NS+'-verdict').textContent=pct>=80?'Excellent \u2014 well above the qualifying threshold.':pct>=60?'Good attempt \u2014 consolidate the weaker areas.':pct>=40?'Fair \u2014 systematic revision of these topics is recommended.':'Needs significant revision across these topics.';\n document.getElementById(NS+'-ct-c').textContent='\u2705 '+c+' Correct';\n document.getElementById(NS+'-ct-w').textContent='\u274c '+w+' Wrong';\n document.getElementById(NS+'-ct-s').textContent='\u23ed '+s+' Skipped';\n const sc=document.getElementById(NS+'-score');sc.style.display='block';sc.scrollIntoView({behavior:'smooth',block:'center'});\n }\n\n function init(){\n document.getElementById(NS+'-grace-now').addEventListener('click',function(){dismissGrace();showScore();});\n document.getElementById(NS+'-timer-btn').addEventListener('click',function(){if(!timerRunning&&!quizSubmitted)startTimer();});\n document.getElementById(NS+'-submit').addEventListener('click',showScore);\n document.getElementById(NS+'-retry').addEventListener('click',function(){build();window.scrollTo({top:0,behavior:'smooth'});});\n new IntersectionObserver(function(entries){\n document.getElementById(NS+'-statusbar').classList.toggle('visible',!entries[0].isIntersecting);\n },{threshold:0}).observe(document.getElementById(NS+'-sentinel'));\n build();updateStats();\n }\n\n if(document.readyState==='loading'){document.addEventListener('DOMContentLoaded',init);}else{init();}\n})();\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 4 Emergency Medicine \u00b7 Paediatrics Questions 91 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36596","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2021 P1 Part-4 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/\" \/>\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-4 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 4 Emergency Medicine \u00b7 Paediatrics Questions 91 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry Quiz\" \/>\n<meta property=\"og:url\" content=\"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/\" \/>\n<meta property=\"og:site_name\" content=\"atsixty\" \/>\n<meta property=\"article:published_time\" content=\"2026-04-16T02:45:48+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-19T12:34:07+00:00\" \/>\n<meta name=\"author\" content=\"Avi\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Avi\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\"},\"author\":{\"name\":\"Avi\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"headline\":\"CMS 2021 P1 Part-4\",\"datePublished\":\"2026-04-16T02:45:48+00:00\",\"dateModified\":\"2026-04-19T12:34:07+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\"},\"wordCount\":53,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"articleSection\":[\"CMS\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\",\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\",\"name\":\"CMS 2021 P1 Part-4 - atsixty\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\"},\"datePublished\":\"2026-04-16T02:45:48+00:00\",\"dateModified\":\"2026-04-19T12:34:07+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/16\\\/cms-2021-p1-part-4\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/atsixty.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CMS 2021 P1 Part-4\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\",\"url\":\"https:\\\/\\\/atsixty.com\\\/\",\"name\":\"At Sixty\",\"description\":\"The Option Taken\",\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/atsixty.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\",\"name\":\"Avi\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"url\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"contentUrl\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"width\":200,\"height\":200,\"caption\":\"Avi\"},\"logo\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\"},\"sameAs\":[\"https:\\\/\\\/atsixty.com\"],\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/author\\\/avinaux\\\/\"}]}<\/script>\n","yoast_head_json":{"title":"CMS 2021 P1 Part-4 - atsixty","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","og_locale":"en_US","og_type":"article","og_title":"CMS 2021 P1 Part-4 - atsixty","og_description":"CMS 2021 Paper I \u2013 Part 4 (Q91\u2013Q120) \u23f1 30:00 \u2705 0 \u274c 0 \u23f3 30 left Net 0 \/ 120 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2021Paper I \u00b7 Part 4 Emergency Medicine \u00b7 Paediatrics Questions 91 \u2013 120 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry Quiz","og_url":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","og_site_name":"atsixty","article_published_time":"2026-04-16T02:45:48+00:00","article_modified_time":"2026-04-19T12:34:07+00:00","author":"Avi","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Avi","Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"CMS 2021 P1 Part-4","datePublished":"2026-04-16T02:45:48+00:00","dateModified":"2026-04-19T12:34:07+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/"},"wordCount":53,"commentCount":0,"publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"articleSection":["CMS"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","url":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/","name":"CMS 2021 P1 Part-4 - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-04-16T02:45:48+00:00","dateModified":"2026-04-19T12:34:07+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/16\/cms-2021-p1-part-4\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"CMS 2021 P1 Part-4"}]},{"@type":"WebSite","@id":"https:\/\/atsixty.com\/#website","url":"https:\/\/atsixty.com\/","name":"At Sixty","description":"The Option Taken","publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/atsixty.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d","name":"Avi","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","url":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","contentUrl":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","width":200,"height":200,"caption":"Avi"},"logo":{"@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png"},"sameAs":["https:\/\/atsixty.com"],"url":"https:\/\/atsixty.com\/index.php\/author\/avinaux\/"}]}},"_links":{"self":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36596","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/comments?post=36596"}],"version-history":[{"count":2,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36596\/revisions"}],"predecessor-version":[{"id":36625,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36596\/revisions\/36625"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}