CMS 2022 Paper I \u2013 Part A (Q1\u2013Q40)<\/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#cms22p1a *,#cms22p1a *::before,#cms22p1a *::after{box-sizing:border-box;margin:0;padding:0}\n#cms22p1a{\n --ter:#1A5EA8;--ter-light:#2E82D5;--ter-pale:#EBF3FD;\n --teal:#1A3A5C;--teal-light:#24527F;--teal-pale:#E8F0F9;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#dde4ed;--bg:#f8fafd;--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;font-size:16px;color:var(--ink);background:var(--bg);line-height:1.7;padding:0 0 48px;\n}\n#cms22p1a .cq-sentinel{height:1px}\n#cms22p1a .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#cms22p1a .cq-statusbar.visible{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms22p1a .cq-sb-stats{display:flex;align-items:center;padding:0.38rem 0.7rem;font-size:0.73rem;color:var(--ink-soft)}\n#cms22p1a .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#cms22p1a .cq-sb-item:last-child{border-right:none}\n#cms22p1a .cq-sb-item strong{color:var(--ink);font-size:0.8rem;font-weight:700}\n#cms22p1a .cq-sb-sep{flex:1}\n#cms22p1a .cq-sb-progress{height:4px;background:var(--line);overflow:hidden}\n#cms22p1a .cq-sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width 0.4s ease}\n#cms22p1a .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#cms22p1a .cq-timer-item.active{display:flex}\n#cms22p1a .cq-timer-item strong{font-size:0.8rem;font-weight:700;color:var(--ter);font-variant-numeric:tabular-nums}\n#cms22p1a .cq-timer-item.warning strong{color:var(--wrong)}\n#cms22p1a .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#cms22p1a .cq-grace.show{display:flex}\n#cms22p1a .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#cms22p1a .cq-grace-box h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wrong);margin-bottom:10px}\n#cms22p1a .cq-grace-box p{font-size:0.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms22p1a .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#cms22p1a .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#cms22p1a .cq-grace-btn:hover{background:#c62828}\n#cms22p1a .cq-header{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center}\n#cms22p1a .cq-header h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;letter-spacing:0.01em;line-height:1.3}\n#cms22p1a .cq-header p{font-size:0.85rem;opacity:0.85;margin-top:6px;font-style:italic}\n#cms22p1a .cq-meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms22p1a .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#cms22p1a .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#cms22p1a .cq-timer-btn:hover{background:rgba(255,255,255,0.15)}\n#cms22p1a .cq-timer-btn.running{background:rgba(255,255,255,0.2);border-color:var(--white)}\n#cms22p1a .cq-body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms22p1a .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#cms22p1a .cq-card:hover{box-shadow:0 2px 12px rgba(26,94,168,0.1)}\n#cms22p1a .cq-qhead{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start}\n#cms22p1a .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#cms22p1a .cq-qnum.ans-c{background:var(--correct-border)}\n#cms22p1a .cq-qnum.ans-w{background:var(--wrong-border)}\n#cms22p1a .cq-qtext{font-size:0.93rem;color:var(--ink);line-height:1.65}\n#cms22p1a .cq-options{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms22p1a .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#cms22p1a .cq-opt:hover:not(.cq-locked){border-color:var(--ter);background:var(--ter-pale)}\n#cms22p1a .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#cms22p1a .cq-opt-text{font-size:0.89rem;color:var(--ink-mid);line-height:1.55}\n#cms22p1a .cq-opt.cq-correct{border-color:var(--correct-border);background:var(--correct-bg);cursor:default}\n#cms22p1a .cq-opt.cq-correct .cq-opt-letter{background:var(--correct-border);border-color:var(--correct-border);color:#fff}\n#cms22p1a .cq-opt.cq-correct .cq-opt-text{color:var(--correct);font-weight:600}\n#cms22p1a .cq-opt.cq-wrong{border-color:var(--wrong-border);background:var(--wrong-bg);cursor:default}\n#cms22p1a .cq-opt.cq-wrong .cq-opt-letter{background:var(--wrong-border);border-color:var(--wrong-border);color:#fff}\n#cms22p1a .cq-opt.cq-wrong .cq-opt-text{color:var(--wrong)}\n#cms22p1a .cq-opt.cq-dimmed{opacity:0.42;cursor:default}\n#cms22p1a .cq-opt.cq-locked{cursor:default}\n#cms22p1a .cq-explanation{display:none;background:var(--teal-pale);border-top:1px solid #b8ccdf;padding:10px 18px 12px;font-size:0.82rem;color:#152d45;line-height:1.62}\n#cms22p1a .cq-exp-label{font-size:0.7rem;font-weight:700;letter-spacing:0.08em;text-transform:uppercase;color:var(--ter);margin-bottom:4px}\n#cms22p1a .cq-submit-wrap{text-align:center;padding:28px 16px 8px}\n#cms22p1a .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#cms22p1a .cq-btn:hover{background:var(--teal-light)}\n#cms22p1a .cq-btn:active{transform:scale(0.98)}\n#cms22p1a .cq-score{display:none;background:var(--white);border:2px solid var(--ter);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms22p1a .cq-score-ring{width:110px;height:110px;border-radius:50%;background:conic-gradient(var(--ter) 0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms22p1a .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms22p1a .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms22p1a .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--ter)}\n#cms22p1a .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms22p1a .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms22p1a .cq-net-line{font-size:1rem;color:var(--ter);font-weight:600;margin-bottom:6px}\n#cms22p1a .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms22p1a .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms22p1a .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms22p1a .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms22p1a .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms22p1a .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms22p1a .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid var(--ter);color:var(--ter);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#cms22p1a .cq-retry-btn:hover{background:var(--ter);color:var(--white)}\n@media(max-width:480px){#cms22p1a .cq-header h1{font-size:1.15rem}#cms22p1a .cq-qtext{font-size:0.88rem}#cms22p1a .cq-opt-text{font-size:0.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms22p1a\">\n <div class=\"cq-sentinel\" id=\"cms22p1a-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms22p1a-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms22p1a-timer-item\">\u23f1 <strong id=\"cms22p1a-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms22p1a-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms22p1a-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms22p1a-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms22p1a-sn\">0<\/strong> \/ <strong id=\"cms22p1a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms22p1a-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms22p1a-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms22p1a-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms22p1a-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2022<br>General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A<\/h1>\n <p>Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 1 \u2013 40<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms22p1a-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms22p1a-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms22p1a-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms22p1a-score\">\n <div class=\"cq-score-ring\" id=\"cms22p1a-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms22p1a-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=\"cms22p1a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms22p1a-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms22p1a-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms22p1a-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms22p1a-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms22p1a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms22p1a',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\n const QUESTIONS=[\n {id:1,stem:'A 52 year old man with history of coronary artery disease is currently on sublingual nitroglycerin 0\u00b75 mg SOS, metoprolol 50 mg twice a day, aspirin 75 mg once a day, enalapril 5 mg once a day, for the last one year. The patient is now complaining of breathlessness and wheeze. Which one of the following drugs is most likely to be implicated for this new symptom?',correct:'Enalapril',options:['Enalapril','Metoprolol','Nitroglycerin','Aspirin'],exp:'ACE inhibitors such as enalapril cause bradykinin-mediated respiratory symptoms \u2014 dry cough in ~10\u201315% of patients; in those with underlying airway hyperreactivity this may manifest as bronchospasm and wheeze. New cough or wheeze in a patient started on an ACE inhibitor should prompt substitution with an ARB (e.g. losartan). Metoprolol can also precipitate bronchospasm but enalapril is the drug implicated in this context.'},\n {id:2,stem:'A patient with ischaemic heart disease on regular follow-up has a resting heart rate of 90 beats\/minute. The patient is taking metoprolol 50 mg twice a day. Which one of the following drugs may be added to his prescription if he also has signs of heart failure?',correct:'Ivabradine',options:['Ranolazine','Diclofenac','Prednisolone','Ivabradine'],exp:'Ivabradine selectively inhibits the I\u1da0 (funny\/HCN) current in the SA node, slowing heart rate without affecting contractility. In HFrEF, when resting HR remains \u226570 bpm on maximally tolerated beta-blocker, ivabradine is a guideline-recommended add-on. NSAIDs (diclofenac) and glucocorticoids (prednisolone) worsen heart failure by promoting sodium and water retention and are contraindicated.'},\n {id:3,stem:'An 18 year old boy got frost bite of left feet after working in a snowy field for 5\u20136 hours. He complained of pain, numbness and limited movement of his toes. The skin appeared white and waxy. Which one of the following is contraindicated as initial treatment?',correct:'Massage',options:['Rewarming by immersion of feet in water bath at 40\u201344\u00b0C','Massage','Cleaning of injured area with soap','Use of analgesia and sterile dressing'],exp:'Massage is strictly contraindicated in frostbite. Ice crystals within frozen tissue are shattered by mechanical rubbing, causing further vascular and cellular injury. Standard management is rapid controlled rewarming in a water bath at 40\u201344\u00b0C, analgesia, and sterile non-compressive dressings. Rubbing with snow is a harmful historical myth.'},\n {id:4,stem:'Which of the following anti-coagulant agents can be administered by oral route?\\n1. Rivaroxaban\\n2. Fondaparinux\\n3. Apixaban\\n4. Dabigatran',correct:'1, 3 and 4',options:['1 and 3 only','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Rivaroxaban (oral Factor Xa inhibitor), apixaban (oral Factor Xa inhibitor), and dabigatran (oral direct thrombin inhibitor) are all DOACs taken by mouth. Fondaparinux is a synthetic pentasaccharide Factor Xa inhibitor available only as a subcutaneous injection \u2014 there is no oral formulation. Statements 1, 3, and 4 are correct.'},\n {id:5,stem:'Which of the following drugs may be associated with leg swelling?\\n1. Calcium channel blockers\\n2. NSAIDs\\n3. Glucocorticoids\\n4. Mineralocorticoids',correct:'1, 2, 3 and 4',options:['1 and 2 only','2, 3 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:'All four drug classes cause peripheral oedema by distinct mechanisms. Dihydropyridine CCBs dilate arterioles raising capillary hydrostatic pressure. NSAIDs inhibit prostaglandin-mediated natriuresis promoting sodium and water retention. Glucocorticoids have intrinsic mineralocorticoid activity causing sodium retention. Mineralocorticoids directly upregulate ENaC in the collecting duct maximally retaining sodium. All four are correct.'},\n {id:6,stem:'Which of the following produce loud S1 on cardiac auscultation?\\n1. Anaemia\\n2. Pregnancy\\n3. Thyrotoxicosis\\n4. Mitral regurgitation',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'S1 is loud when high-output states (anaemia, pregnancy, thyrotoxicosis) increase LV filling velocity and leaflet excursion, intensifying S1. In mitral regurgitation the valve leaflets are deformed and fail to coapt firmly, producing a soft S1. Mitral stenosis (not regurgitation) produces a loud S1 when the valve is still mobile. Statements 1, 2, and 3 are correct.'},\n {id:7,stem:'Which of the following are correct about Ivabradine?\\n1. It may be of use in severe heart failure\\n2. It acts on SA node\\n3. It reduces heart rate\\n4. It is effective in atrial fibrillation',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'Ivabradine blocks HCN (I\u1da0) channels in the sinoatrial node, reducing heart rate (statements 2 and 3 correct). It is beneficial in HFrEF when HR \u226570 bpm on maximum beta-blocker \u2014 SHIFT trial (statement 1 correct). It is completely ineffective in atrial fibrillation (statement 4 false) \u2014 AF is driven by re-entry circuits, not SA node automaticity. Statements 1, 2, and 3 are correct.'},\n {id:8,stem:'Left atrial dilatation on X-ray chest is characterised by which of the following?\\n1. Straight left heart border\\n2. Rounding of left heart border\\n3. Double cardiac shadow\\n4. Widening of the angle of carina',correct:'1, 3 and 4',options:['1 and 3 only','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Left atrial enlargement on PA CXR: (1) Straightening of left heart border (loss of normal concavity at the LA appendage level); (3) Double cardiac shadow (enlarged LA visible inside the right heart border); (4) Widening of carina angle >70\u00b0 from inferior displacement of left main bronchus. Rounding of the left border indicates LV enlargement, not LA. Statements 1, 3, and 4 are correct.'},\n {id:9,stem:'A 30 year old male is being evaluated for shortness of breath. On examination of the jugular venous pulse (JVP), there is a rise in the JVP on inspiration. Which one of the following is most likely diagnosis?',correct:'Constrictive pericarditis',options:['Constrictive pericarditis','Atrial septal defect','Aortic regurgitation','Severe mitral stenosis'],exp:\"A paradoxical rise in JVP on inspiration is Kussmaul's sign. Normally, inspiration reduces intrathoracic pressure and JVP falls. In constrictive pericarditis the rigid fibrocalcific pericardium cannot accommodate increased systemic venous return, forcing JVP upward. ASD, aortic regurgitation, and mitral stenosis do not produce Kussmaul's sign.\"},\n {id:10,stem:'A 24 year old man presents with acute onset shortness of breath with precordial chest pain. ECG reveals ST elevation with upward concavity and PR segment depression in leads V\u2082 to V\u2086 and reciprocal changes in lead aVR. The most likely diagnosis is',correct:'Acute pericarditis',options:['Anterior wall myocardial infarction','Acute pericarditis','Anterior wall aneurysm','Aortic dissection'],exp:'Classic ECG of acute pericarditis: diffuse saddle-shaped (concave upward) ST elevation \u2014 not the convex tombstone pattern of STEMI; PR segment depression (most specific ECG sign); reciprocal PR elevation in aVR. Changes are diffuse, not following a coronary territory. Young age, pleuritic positional chest pain, and recent viral illness are additional clues.'},\n {id:11,stem:'Which of the following are Controller Therapies in the management of acute asthma?\\n1. Anticholinergics\\n2. Systemic glucocorticoids\\n3. Inhaled glucocorticoids\\n4. Omalizumab',correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Controller (preventer) therapies reduce underlying airway inflammation and prevent exacerbations \u2014 used long-term. Inhaled corticosteroids are the cornerstone. Systemic glucocorticoids are used for exacerbations and as step-up controller therapy. Omalizumab (anti-IgE) is an add-on biologic controller for severe allergic asthma. Anticholinergics (ipratropium) are bronchodilators \u2014 classified as reliever\/rescue therapy. Statements 2, 3, and 4 are correct.'},\n {id:12,stem:'Low pleural fluid glucose (< 60 mg%) may be observed in which of the following?\\n1. Pyogenic pleural effusion\\n2. Rheumatoid pleuritis\\n3. Malignant pleural effusion\\n4. Hepatic hydrothorax',correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2, 3 and 4'],exp:'Pleural glucose <60 mg\/dL results from high metabolic consumption or impaired glucose transport. Pyogenic empyema: bacteria and neutrophils consume glucose (values may approach zero). Rheumatoid pleuritis: immune complex deposition impairs glucose transport (often <10 mg\/dL \u2014 lowest of any effusion). Malignant effusion: tumour cells consume glucose (moderately low). Hepatic hydrothorax is a transudate \u2014 glucose equals serum glucose (normal). Statements 1, 2, and 3 are correct.'},\n {id:13,stem:'Which of the following are correct regarding Idiopathic Pulmonary Fibrosis?\\n1. Radiological pattern of usual interstitial pneumonia\\n2. Finger clubbing\\n3. More common in elderly',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are correct. (1) IPF is defined by the UIP pattern on HRCT: bibasal subpleural honeycombing \u00b1 traction bronchiectasis. (2) Finger clubbing occurs in approximately 50% of IPF patients from chronic hypoxia. (3) IPF incidence rises sharply above 60 years, predominantly affecting male smokers. All three are correct.'},\n {id:14,stem:'Diagnostic work-up for a case of suspected Bronchial asthma should reveal which of the following abnormalities?\\n1. Reduced FEV\u2081\/FVC\\n2. Increased functional residual volume\\n3. Reduced diffusion capacity\\n4. Increment in FEV\u2081 in response to inhaled bronchodilators',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'Asthma spirometry: (1) Reduced FEV\u2081\/FVC \u2014 obstructive pattern; (2) Increased FRC \u2014 dynamic hyperinflation\/air trapping; (4) \u226512% and \u2265200 mL post-bronchodilator FEV\u2081 rise \u2014 reversibility, the hallmark diagnostic criterion. Reduced DLCO is characteristic of emphysema where alveolar walls are destroyed; in asthma alveolar structure is intact and DLCO is normal. Statement 3 is incorrect. Statements 1, 2, and 4 are correct.'},\n {id:15,stem:'Which of the following conditions predispose to obstructive sleep apnea?\\n1. Hyperthyroidism\\n2. Acromegaly\\n3. Obesity\\n4. Use of alcohol \/ sedatives',correct:'2, 3 and 4',options:['2 and 3 only','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'OSA results from collapse of the upper airway during sleep. Acromegaly causes macroglossia, prognathism, and pharyngeal soft tissue hypertrophy. Obesity deposits fat in pharyngeal walls reducing airway calibre. Alcohol and sedatives relax pharyngeal dilator muscles worsening nocturnal collapse. Hyperthyroidism is NOT a risk factor \u2014 Hypothyroidism (via myxoedematous pharyngeal infiltration) predisposes to OSA. Statements 2, 3, and 4 are correct.'},\n {id:16,stem:'Which of the following are correct with regard to acute fatty liver of pregnancy?\\n1. It is typically present in first trimester\\n2. It is more common in multiple pregnancies\\n3. Liver biopsy is rarely needed\\n4. Delivery of fetus is indicated',correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'AFLP presents in the third trimester (28\u201336 weeks), NOT the first trimester \u2014 statement 1 is false. It is associated with multiple pregnancies and male foetuses due to LCHAD mutations \u2014 statement 2 is correct. Diagnosis is primarily clinical (Swansea criteria); liver biopsy is rarely performed given coagulopathy risk \u2014 statement 3 is correct. Prompt delivery is the only definitive treatment \u2014 statement 4 is correct. Statements 2, 3, and 4 are correct.'},\n {id:17,stem:\"Which one of the following are markers of poor prognosis in acute pancreatitis?\\n1. Elderly individual\\n2. Increased white blood cell count\\n3. Low serum calcium\\n4. Hypercarbia\",correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Ranson's criteria: On admission \u2014 age >55 (elderly), WBC >16,000\/\u03bcL, blood glucose >200 mg\/dL, LDH >350 IU\/L, AST >250 IU\/L. At 48 hours \u2014 haematocrit fall >10%, BUN rise >5 mg\/dL, serum calcium <8 mg\/dL, PaO\u2082 <60 mmHg (hypoxaemia). Hypercarbia (raised PaCO\u2082) is not a Ranson criterion; hypoxaemia (low PaO\u2082) is. Statements 1, 2, and 3 are correct.\"},\n {id:18,stem:'Which of the following are the common causes of acute pancreatitis?\\n1. Gallstone\\n2. Alcohol\\n3. Post-ERCP\\n4. Campylobacter jejuni',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Gallstones (~40%) and alcohol (~30\u201335%) are the two leading causes of acute pancreatitis (GET SMASHED mnemonic). Post-ERCP pancreatitis occurs in 2\u20135% of procedures. Campylobacter jejuni causes bacterial enteritis and dysentery but is not a recognised cause of acute pancreatitis. Statements 1, 2, and 3 are correct.'},\n {id:19,stem:'Which of the following are the aetiologies of haemochromatosis?\\n1. Thalassaemia\\n2. Anaemia of pyruvate kinase deficiency\\n3. Chronic cor pulmonale\\n4. Porphyria cutanea tarda',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'Secondary haemochromatosis: thalassaemia major causes iron loading from chronic ineffective erythropoiesis and repeated transfusions. Pyruvate kinase deficiency causes chronic haemolytic anaemia with compensatory increased iron absorption. Porphyria cutanea tarda is strongly associated with hepatic iron overload \u2014 venesection improves PCT. Chronic cor pulmonale does NOT cause iron overload \u2014 it is unrelated. Statements 1, 2, and 4 are correct.'},\n {id:20,stem:'Which of the following drugs are implicated in peptic ulcer disease, not caused by Helicobacter pylori and NSAIDs?\\n1. Clopidogrel\\n2. Glucocorticoids\\n3. Bisphosphonates\\n4. Colloidal bismuth subcitrate',correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2 and 4 only'],exp:'Clopidogrel impairs platelet-derived growth factor release, reducing mucosal healing. Glucocorticoids suppress phospholipase A\u2082, reducing mucosal prostaglandins, and increase gastric acid secretion. Bisphosphonates (oral alendronate) cause direct oesophageal and gastric mucosal erosion. Colloidal bismuth subcitrate is actually gastroprotective \u2014 it coats ulcer craters and has anti-H. pylori activity. Statement 4 is incorrect. Statements 1, 2, and 3 are correct.'},\n {id:21,stem:'Which of the following are symptoms of irritable bowel syndrome?\\n1. Gas and flatulence\\n2. Abdominal pain\\n3. Blood in stools\\n4. Diarrhoea',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'IBS (Rome IV) is defined by recurrent abdominal pain with bloating and altered bowel habit. Gas, flatulence, and abdominal discomfort are cardinal features. Blood in stool is a red flag that excludes IBS and mandates investigation for IBD or colorectal carcinoma. The absence of rectal bleeding is an implicit diagnostic criterion for IBS. Statements 1, 2, and 4 are correct.'},\n {id:22,stem:'Vertical transmission of hepatitis B can be prevented by which of the following interventions?\\n1. Passive immunisation of infant at birth\\n2. Active immunisation of infant at birth\\n3. Antiviral therapy in third trimester for mother with HBV-DNA level of > 2,00,000 IU\/mL',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'Perinatal HBV prevention uses a three-pronged approach. HBIG (passive) given within 12 hours provides immediate antibody protection. HBV vaccine (active) at birth induces long-term immunity. Together these prevent ~90\u201395% of vertical transmission. For highly viraemic mothers (HBV-DNA >200,000 IU\/mL), third-trimester tenofovir eliminates residual transmission risk. All three interventions are guideline-recommended.'},\n {id:23,stem:'Which of the following are correct in respect of jaundice?\\n1. Patients complain of darkening of urine before they notice jaundice\\n2. Jaundice is usually detectable with a serum bilirubin level of over 1\u00b78 mg\/dl\\n3. In Gilbert syndrome, jaundice is more noticeable after fasting',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are correct. (1) Conjugated bilirubin is water-soluble; it spills into urine at serum levels below those producing visible icterus \u2014 dark urine is an earlier symptom than visible yellowing. (2) Scleral icterus becomes detectable when bilirubin exceeds ~1.8 mg\/dL. (3) In Gilbert syndrome, fasting reduces caloric intake, increases unconjugated bilirubin production, and decreases UGT activity \u2014 precipitating mild visible jaundice. All three are correct.'},\n {id:24,stem:'Irritable bowel syndrome is favoured by which of the following?\\n1. Worsening of symptoms by stress\\n2. Recurrent abdominal discomfort\\n3. Age more than 50 years at onset\\n4. Alternating diarrhoea and constipation',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'IBS: stress-worsened symptoms (dysregulated gut\u2013brain axis), recurrent abdominal discomfort improved by defaecation, and alternating bowel habit (IBS-M) are characteristic. Onset after age 50 is a red flag alarm symptom that argues against IBS and requires investigation to exclude colorectal cancer or IBD. Statement 3 (age >50) is an alarm feature, not a feature favouring IBS. Statements 1, 2, and 4 are correct.'},\n {id:25,stem:'The diagnosis of protein losing enteropathy can be confirmed by',correct:'Fecal clearance of alpha-1 antitrypsin',options:['Hydrogen breath test','Fecal clearance of alpha-1 antitrypsin','Fecal \u2075\u00b9Cr\u02c9 labelled transthyretin level','Fecal calprotectin level'],exp:'\u03b1\u2081-antitrypsin (MW ~50 kDa, similar to albumin) is neither digested by intestinal proteases nor absorbed in the gut. Its presence in stool directly reflects enteric protein leakage. A 24-hour fecal AAT clearance >24 mL\/day is the standard diagnostic test for protein-losing enteropathy. Hydrogen breath test detects carbohydrate malabsorption. Fecal calprotectin indicates intestinal inflammation. Fecal AAT clearance is the correct answer.'},\n {id:26,stem:'RBC casts on urine analysis are seen in which of the following?\\n1. Glomerulonephritis\\n2. Interstitial nephritis\\n3. Vasculitis\\n4. Malignant hypertension',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'RBC casts form when erythrocytes pass through damaged glomerular capillary walls into tubular lumina \u2014 pathognomonic of glomerular injury: glomerulonephritis, vasculitis (pauci-immune GN), and malignant hypertension (fibrinoid necrosis of glomerular arterioles). Interstitial nephritis characteristically produces WBC casts, tubular epithelial cell casts, and eosinophiluria \u2014 not RBC casts, as glomeruli are spared. Statements 1, 3, and 4 are correct.'},\n {id:27,stem:'Which of the following are correct regarding Essential Tremors?\\n1. It may present at any age\\n2. Head is almost never involved\\n3. Tremor may improve with small amount of alcohol',correct:'1 and 3 only',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'Statement 1 is correct \u2014 essential tremor can present at any age with bimodal peaks in the 2nd and 6th decades. Statement 2 is false \u2014 head (titubation), voice, and jaw tremor are features of essential tremor in ~30\u201340% of patients; it is in Parkinson\\'s disease that head tremor is uncommon. Statement 3 is correct \u2014 small amounts of alcohol dramatically suppress essential tremor (likely via GABA-A modulation), a useful distinguishing feature. Statements 1 and 3 only are correct.'},\n {id:28,stem:\"Which of the following drugs may be associated with Parkinson's disease?\\n1. Atypical anti-psychotic drugs\\n2. Lithium\\n3. MPTP (methyl-phenyl-tetrahydropyridine)\",correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are correct. (1) Atypical antipsychotics (risperidone, quetiapine, olanzapine) block striatal D\u2082 receptors causing drug-induced parkinsonism \u2014 reversible on discontinuation. (2) Lithium at toxic levels causes extrapyramidal side effects resembling parkinsonism. (3) MPTP is oxidised by MAO-B to MPP\u207a which selectively destroys nigrostriatal dopaminergic neurons \u2014 the MPTP primate model is foundational to PD research. All three are correct.'},\n {id:29,stem:\"Which of the following are suggestive of Parkinson's disease?\\n1. Lead pipe rigidity\\n2. Cog wheel rigidity\\n3. Festinating gait\\n4. Romberg test positive\",correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1 and 3 only','2, 3 and 4'],exp:\"PD features: Lead-pipe rigidity (uniform velocity-independent resistance) and cogwheel rigidity (lead-pipe plus superimposed resting tremor producing a ratchet-like sensation) are both extrapyramidal rigidity forms in PD. Festinating gait (short shuffling steps, forward trunk flexion, accelerating pace) is characteristic. Romberg's test assesses proprioceptive integrity and is positive in dorsal column disease (tabes dorsalis, subacute combined degeneration) \u2014 not a feature of PD. Statements 1, 2, and 3 are correct.\"},\n {id:30,stem:\"Which of the following are correct regarding Idiopathic Parkinson's disease?\\n1. Motor symptoms are almost always initially symmetrical\\n2. Non-motor symptoms include hyposmia and constipation\\n3. Cognition is spared in early disease\\n4. Speech may become softer and indistinct\",correct:'2, 3 and 4',options:['2 and 3 only','1 and 4 only','1, 3 and 4','2, 3 and 4'],exp:'Statement 1 is false \u2014 asymmetric onset is a cardinal feature distinguishing idiopathic PD from atypical parkinsonism; PD almost always begins unilaterally. Statement 2 is correct \u2014 premotor non-motor symptoms: hyposmia, REM sleep behaviour disorder, constipation, and depression may precede motor onset by years. Statement 3 is correct \u2014 cognition is relatively intact early. Statement 4 is correct \u2014 hypophonia (soft, monotone voice) and dysarthria are characteristic. Statements 2, 3, and 4 are correct.'},\n {id:31,stem:'Which of the following are correct with regard to Levodopa?\\n1. It is most effective for relieving tremors\\n2. Only a small portion of total drug reaches the brain\\n3. Nausea may be offset by domperidone\\n4. It may trigger hallucinations',correct:'2, 3 and 4',options:['1, 2 and 3','2 and 4 only','1 and 3 only','2, 3 and 4'],exp:'Statement 1 is false \u2014 levodopa most effectively treats bradykinesia and rigidity; resting tremor responds least well. Statement 2 is correct \u2014 only ~1\u20133% of oral levodopa crosses the BBB; the rest is decarboxylated peripherally \u2014 hence carbidopa is co-formulated. Statement 3 is correct \u2014 domperidone (peripheral D\u2082 blocker that does not cross the BBB) is the antiemetic of choice; metoclopramide is contraindicated. Statement 4 is correct \u2014 dopaminergic stimulation causes visual hallucinations especially in elderly and advanced disease. Statements 2, 3, and 4 are correct.'},\n {id:32,stem:'Which of the following are risk factors for Stroke?\\n1. Sickle cell disease\\n2. Cigarette smoking\\n3. Hypofibrinogenaemia\\n4. Atrial fibrillation',correct:'1, 2 and 4',options:['1 and 2 only','1, 2 and 4','1, 3 and 4','2 and 4 only'],exp:'Sickle cell disease causes stroke through RBC vaso-occlusion in cerebral vessels. Cigarette smoking accelerates cerebral atherosclerosis and promotes hypercoagulability. Atrial fibrillation generates left atrial thrombus causing cardioembolic stroke (~20% of all ischaemic strokes). Hypofibrinogenaemia reduces clot formation capacity and would lower \u2014 not raise \u2014 thrombotic stroke risk. Statements 1, 2, and 4 are correct.'},\n {id:33,stem:'Which of the following are correct in respect of Myasthenia gravis?\\n1. Symptoms worsen towards the end of the day\\n2. There may be difficulty in chewing and swallowing\\n3. Acetylcholine receptors in the pre-junctional membrane are involved\\n4. Penicillamine may precipitate similar illness',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 3 only','2 and 4 only'],exp:'Statement 1 is correct \u2014 fatigability is the hallmark; symptoms worsen with sustained activity and are worst towards the end of the day. Statement 2 is correct \u2014 bulbar MG (dysphagia, dysarthria) is common. Statement 3 is false \u2014 MG autoantibodies (anti-AChR, anti-MuSK) target the POST-junctional motor end-plate; Lambert-Eaton involves the pre-junctional terminal. Statement 4 is correct \u2014 D-penicillamine induces anti-AChR antibody production causing drug-associated MG, reversible on discontinuation. Statements 1, 2, and 4 are correct.'},\n {id:34,stem:'Which of the following are the tests for functional assessment of encephalopathy?\\n1. Flapping tremors\\n2. Number connection test\\n3. Constructional apraxia',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are standard bedside tests for hepatic encephalopathy. Asterixis (liver flap): elicited by sustained wrist dorsiflexion \u2014 episodic loss of posture from ammonia accumulation; grades HE severity. Number Connection Test (Trail Making Test A): connects numbered dots 1\u219225, measures psychomotor speed, highly sensitive for minimal HE. Constructional apraxia (inability to copy a five-pointed star): assesses visuospatial function impaired by HE, used serially to track clinical response. All three are correct.'},\n {id:35,stem:'Which one of the following is correct regarding blood components in clinical practice?',correct:'Transfusion associated GVHD can be prevented by prior irradiation of transfused blood',options:['ABO blood group antigens are polypeptide chains on the surface of RBCs','Platelets can be stored for upto 35 days','Hemolytic disease of newborn occurs when mother\\'s IgA anti-RBC antibodies cross the placenta and lyse fetal RBCs','Transfusion associated GVHD can be prevented by prior irradiation of transfused blood'],exp:'ABO blood group antigens are polysaccharide (carbohydrate) chains \u2014 NOT polypeptides. Platelet concentrates are stored for only 5\u20137 days (not 35 days); red cells store for up to 35\u201342 days. HDN is caused by maternal IgG antibodies (anti-D, anti-Kell) \u2014 NOT IgA; only IgG crosses the placenta. Transfusion-associated GVHD occurs when viable donor T-lymphocytes engraft in an immunocompromised host; gamma irradiation (25 Gy) of cellular blood components inactivates donor lymphocytes and reliably prevents TA-GVHD. The last option is the only correct statement.'},\n {id:36,stem:'Which one of the following is an oral direct Thrombin inhibitor?',correct:'Dabigatran',options:['Apixaban','Rivaroxaban','Dabigatran','Argatroban'],exp:'Dabigatran etexilate is a prodrug converted to dabigatran \u2014 an oral direct thrombin (Factor IIa) inhibitor. Its specific reversal agent is idarucizumab. Apixaban and rivaroxaban are oral direct Factor Xa inhibitors (reversed by andexanet alfa). Argatroban is a parenteral (IV only) direct thrombin inhibitor used in heparin-induced thrombocytopenia \u2014 it has no oral formulation. Dabigatran is the only oral direct thrombin inhibitor in clinical use.'},\n {id:37,stem:'Which of the following are correct with regard to metformin?\\n1. The maximum tolerated dose is 2000 mg\/day\\n2. Lactic acidosis is the major adverse effect of metformin\\n3. It may lower the blood levels of Vitamin B12',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three statements are correct. The maximum commonly tolerated dose is approximately 2000\u20132550 mg\/day in divided doses. Lactic acidosis (type B), though rare (~3\/100,000 patient-years), is the most serious adverse effect, occurring with renal impairment, hepatic failure, or dehydration. Metformin impairs vitamin B12 absorption by approximately 10\u201330% by interfering with cubilin receptor binding at the terminal ileum; annual B12 monitoring is recommended. All three are correct.'},\n {id:38,stem:'Which of the following statements are correct regarding short stature?\\n1. Linear bone growth rates are pituitary dependent\\n2. Normal bone age in a child with short stature suggests hormonal disorder\\n3. Final height in boys can be estimated by adding 6\u00b75 cm to mid-parental height\\n4. Replacement therapy with recombinant GH restores growth velocity in GH-deficient children',correct:'1, 3 and 4',options:['1 and 2 only','1, 2 and 4','1, 3 and 4','3 and 4 only'],exp:'Statement 1 is correct \u2014 linear bone growth is driven by GH (via IGF-1) from the anterior pituitary; GH deficiency causes significantly reduced growth velocity. Statement 2 is false \u2014 normal bone age in a short child points to familial short stature or constitutional delay (variant of normal); delayed bone age points to hormonal or pathological causes. Statement 3 is correct \u2014 target height for boys = mid-parental height + 6.5 cm; for girls = mid-parental height \u2212 6.5 cm. Statement 4 is correct \u2014 recombinant human GH restores growth velocity to near normal in GH-deficient children. Statements 1, 3, and 4 are correct.'},\n {id:39,stem:'Which one of the following drugs used to treat Diabetes mellitus is least likely to cause hypoglycaemia?',correct:'Sitagliptin',options:['Insulin','Glimepiride','Sitagliptin','Repaglinide'],exp:'Sitagliptin is a DPP-4 inhibitor. It enhances insulin secretion in a strictly glucose-dependent manner \u2014 when blood glucose normalises, the incretin effect plateaus and insulin secretion does not increase further, making hypoglycaemia extremely unlikely as monotherapy. By contrast, insulin delivers exogenous insulin regardless of glucose level; glimepiride (sulfonylurea) stimulates insulin secretion tonically; repaglinide (meglitinide) also stimulates insulin secretion with significant hypoglycaemia risk. Sitagliptin is least likely to cause hypoglycaemia.'},\n {id:40,stem:\"Which of the following constitute differential diagnosis of hypocalcaemia?\\n1. Hypomagnesaemia\\n2. Chronic alcoholism\\n3. Pseudohypoparathyroidism\\n4. Paget's disease\",correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','3 and 4 only','2, 3 and 4'],exp:\"Hypomagnesaemia impairs PTH secretion AND induces end-organ resistance to PTH, causing hypocalcaemia \u2014 magnesium must be repleted first. Chronic alcoholism causes renal and GI magnesium wasting, leading to hypomagnesaemia and consequent hypocalcaemia, plus direct PTH suppression. Pseudohypoparathyroidism (PHP type 1a) is end-organ resistance to PTH: PTH is high but calcium is low. Paget's disease of bone causes pathological bone resorption which during immobilisation can cause HYPERcalcaemia (not hypocalcaemia) \u2014 statement 4 is incorrect. Statements 1, 2, and 3 are correct.\"}\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 function startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');btn.textContent='\u23f1 '+fmtTime(timerRemaining);btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n timerRemaining--;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 function updateStats(){\n const c=Object.values(userAnswers).filter(v=>v==='correct').length;\n const w=Object.values(userAnswers).filter(v=>v==='wrong').length;\n const net=(c*4)-w;\n document.getElementById(NS+'-sc').textContent=c;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 function pick(qid,oi){\n if(userAnswers[qid]!==undefined||quizSubmitted)return;\n const q=QUESTIONS.find(x=>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 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');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\">'+opts.map((o,i)=>'<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('')+'<\/div>'+\n '<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((_,i)=>document.getElementById(NS+'-o'+q.id+'-'+i).addEventListener('click',()=>pick(q.id,i)));\n });\n }\n function showScore(){\n if(quizSubmitted)return;quizSubmitted=true;stopTimer();\n document.getElementById(NS+'-timer-btn').textContent='\u23f1 Submitted';document.getElementById(NS+'-timer-btn').classList.remove('running');\n const c=Object.values(userAnswers).filter(v=>v==='correct').length;\n const w=Object.values(userAnswers).filter(v=>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(--ter) '+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 function init(){\n document.getElementById(NS+'-grace-now').addEventListener('click',()=>{dismissGrace();showScore();});\n document.getElementById(NS+'-timer-btn').addEventListener('click',()=>{if(!timerRunning&&!quizSubmitted)startTimer();});\n document.getElementById(NS+'-submit').addEventListener('click',showScore);\n document.getElementById(NS+'-retry').addEventListener('click',()=>{build();window.scrollTo({top:0,behavior:'smooth'});});\n new IntersectionObserver(entries=>{document.getElementById(NS+'-statusbar').classList.toggle('visible',!entries[0].isIntersecting);},{threshold:0}).observe(document.getElementById(NS+'-sentinel'));\n build();updateStats();\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 2022 Paper I \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit… <\/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-36610","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2022 P1 Part-1 - 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\/18\/cms-2022-p1-part-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2022 P1 Part-1 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2022 Paper I \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit… \" \/>\n<meta property=\"og:url\" content=\"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/\" \/>\n<meta property=\"og:site_name\" content=\"atsixty\" \/>\n<meta property=\"article:published_time\" content=\"2026-04-18T08:13:19+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-20T00:40:58+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\\\/18\\\/cms-2022-p1-part-1\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\"},\"author\":{\"name\":\"Avi\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"headline\":\"CMS 2022 P1 Part-1\",\"datePublished\":\"2026-04-18T08:13:19+00:00\",\"dateModified\":\"2026-04-20T00:40:58+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\"},\"wordCount\":59,\"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\\\/18\\\/cms-2022-p1-part-1\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\",\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\",\"name\":\"CMS 2022 P1 Part-1 - atsixty\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\"},\"datePublished\":\"2026-04-18T08:13:19+00:00\",\"dateModified\":\"2026-04-20T00:40:58+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/atsixty.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CMS 2022 P1 Part-1\"}]},{\"@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 2022 P1 Part-1 - 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\/18\/cms-2022-p1-part-1\/","og_locale":"en_US","og_type":"article","og_title":"CMS 2022 P1 Part-1 - atsixty","og_description":"CMS 2022 Paper I \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit… ","og_url":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","og_site_name":"atsixty","article_published_time":"2026-04-18T08:13:19+00:00","article_modified_time":"2026-04-20T00:40:58+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\/18\/cms-2022-p1-part-1\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"CMS 2022 P1 Part-1","datePublished":"2026-04-18T08:13:19+00:00","dateModified":"2026-04-20T00:40:58+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/"},"wordCount":59,"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\/18\/cms-2022-p1-part-1\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","url":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","name":"CMS 2022 P1 Part-1 - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-04-18T08:13:19+00:00","dateModified":"2026-04-20T00:40:58+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"CMS 2022 P1 Part-1"}]},{"@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\/36610","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=36610"}],"version-history":[{"count":3,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36610\/revisions"}],"predecessor-version":[{"id":36635,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36610\/revisions\/36635"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36610"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36610"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36610"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

{"id":36610,"date":"2026-04-18T13:43:19","date_gmt":"2026-04-18T08:13:19","guid":{"rendered":"https:\/\/atsixty.com\/?p=36610"},"modified":"2026-04-20T06:10:58","modified_gmt":"2026-04-20T00:40:58","slug":"cms-2022-p1-part-1","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","title":{"rendered":"CMS 2022 P1 Part-1"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2022 Paper I \u2013 Part A (Q1\u2013Q40)<\/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#cms22p1a *,#cms22p1a *::before,#cms22p1a *::after{box-sizing:border-box;margin:0;padding:0}\n#cms22p1a{\n --ter:#1A5EA8;--ter-light:#2E82D5;--ter-pale:#EBF3FD;\n --teal:#1A3A5C;--teal-light:#24527F;--teal-pale:#E8F0F9;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#dde4ed;--bg:#f8fafd;--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;font-size:16px;color:var(--ink);background:var(--bg);line-height:1.7;padding:0 0 48px;\n}\n#cms22p1a .cq-sentinel{height:1px}\n#cms22p1a .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#cms22p1a .cq-statusbar.visible{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms22p1a .cq-sb-stats{display:flex;align-items:center;padding:0.38rem 0.7rem;font-size:0.73rem;color:var(--ink-soft)}\n#cms22p1a .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#cms22p1a .cq-sb-item:last-child{border-right:none}\n#cms22p1a .cq-sb-item strong{color:var(--ink);font-size:0.8rem;font-weight:700}\n#cms22p1a .cq-sb-sep{flex:1}\n#cms22p1a .cq-sb-progress{height:4px;background:var(--line);overflow:hidden}\n#cms22p1a .cq-sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width 0.4s ease}\n#cms22p1a .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#cms22p1a .cq-timer-item.active{display:flex}\n#cms22p1a .cq-timer-item strong{font-size:0.8rem;font-weight:700;color:var(--ter);font-variant-numeric:tabular-nums}\n#cms22p1a .cq-timer-item.warning strong{color:var(--wrong)}\n#cms22p1a .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#cms22p1a .cq-grace.show{display:flex}\n#cms22p1a .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#cms22p1a .cq-grace-box h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wrong);margin-bottom:10px}\n#cms22p1a .cq-grace-box p{font-size:0.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms22p1a .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#cms22p1a .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#cms22p1a .cq-grace-btn:hover{background:#c62828}\n#cms22p1a .cq-header{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center}\n#cms22p1a .cq-header h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;letter-spacing:0.01em;line-height:1.3}\n#cms22p1a .cq-header p{font-size:0.85rem;opacity:0.85;margin-top:6px;font-style:italic}\n#cms22p1a .cq-meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms22p1a .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#cms22p1a .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#cms22p1a .cq-timer-btn:hover{background:rgba(255,255,255,0.15)}\n#cms22p1a .cq-timer-btn.running{background:rgba(255,255,255,0.2);border-color:var(--white)}\n#cms22p1a .cq-body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms22p1a .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#cms22p1a .cq-card:hover{box-shadow:0 2px 12px rgba(26,94,168,0.1)}\n#cms22p1a .cq-qhead{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start}\n#cms22p1a .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#cms22p1a .cq-qnum.ans-c{background:var(--correct-border)}\n#cms22p1a .cq-qnum.ans-w{background:var(--wrong-border)}\n#cms22p1a .cq-qtext{font-size:0.93rem;color:var(--ink);line-height:1.65}\n#cms22p1a .cq-options{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms22p1a .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#cms22p1a .cq-opt:hover:not(.cq-locked){border-color:var(--ter);background:var(--ter-pale)}\n#cms22p1a .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#cms22p1a .cq-opt-text{font-size:0.89rem;color:var(--ink-mid);line-height:1.55}\n#cms22p1a .cq-opt.cq-correct{border-color:var(--correct-border);background:var(--correct-bg);cursor:default}\n#cms22p1a .cq-opt.cq-correct .cq-opt-letter{background:var(--correct-border);border-color:var(--correct-border);color:#fff}\n#cms22p1a .cq-opt.cq-correct .cq-opt-text{color:var(--correct);font-weight:600}\n#cms22p1a .cq-opt.cq-wrong{border-color:var(--wrong-border);background:var(--wrong-bg);cursor:default}\n#cms22p1a .cq-opt.cq-wrong .cq-opt-letter{background:var(--wrong-border);border-color:var(--wrong-border);color:#fff}\n#cms22p1a .cq-opt.cq-wrong .cq-opt-text{color:var(--wrong)}\n#cms22p1a .cq-opt.cq-dimmed{opacity:0.42;cursor:default}\n#cms22p1a .cq-opt.cq-locked{cursor:default}\n#cms22p1a .cq-explanation{display:none;background:var(--teal-pale);border-top:1px solid #b8ccdf;padding:10px 18px 12px;font-size:0.82rem;color:#152d45;line-height:1.62}\n#cms22p1a .cq-exp-label{font-size:0.7rem;font-weight:700;letter-spacing:0.08em;text-transform:uppercase;color:var(--ter);margin-bottom:4px}\n#cms22p1a .cq-submit-wrap{text-align:center;padding:28px 16px 8px}\n#cms22p1a .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#cms22p1a .cq-btn:hover{background:var(--teal-light)}\n#cms22p1a .cq-btn:active{transform:scale(0.98)}\n#cms22p1a .cq-score{display:none;background:var(--white);border:2px solid var(--ter);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms22p1a .cq-score-ring{width:110px;height:110px;border-radius:50%;background:conic-gradient(var(--ter) 0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms22p1a .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms22p1a .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms22p1a .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--ter)}\n#cms22p1a .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms22p1a .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms22p1a .cq-net-line{font-size:1rem;color:var(--ter);font-weight:600;margin-bottom:6px}\n#cms22p1a .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms22p1a .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms22p1a .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms22p1a .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms22p1a .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms22p1a .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms22p1a .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid var(--ter);color:var(--ter);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#cms22p1a .cq-retry-btn:hover{background:var(--ter);color:var(--white)}\n@media(max-width:480px){#cms22p1a .cq-header h1{font-size:1.15rem}#cms22p1a .cq-qtext{font-size:0.88rem}#cms22p1a .cq-opt-text{font-size:0.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms22p1a\">\n <div class=\"cq-sentinel\" id=\"cms22p1a-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms22p1a-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms22p1a-timer-item\">\u23f1 <strong id=\"cms22p1a-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms22p1a-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms22p1a-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms22p1a-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms22p1a-sn\">0<\/strong> \/ <strong id=\"cms22p1a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms22p1a-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms22p1a-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms22p1a-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms22p1a-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2022<br>General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A<\/h1>\n <p>Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 1 \u2013 40<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms22p1a-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms22p1a-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms22p1a-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms22p1a-score\">\n <div class=\"cq-score-ring\" id=\"cms22p1a-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms22p1a-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=\"cms22p1a-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms22p1a-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms22p1a-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms22p1a-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms22p1a-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms22p1a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms22p1a',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\n const QUESTIONS=[\n {id:1,stem:'A 52 year old man with history of coronary artery disease is currently on sublingual nitroglycerin 0\u00b75 mg SOS, metoprolol 50 mg twice a day, aspirin 75 mg once a day, enalapril 5 mg once a day, for the last one year. The patient is now complaining of breathlessness and wheeze. Which one of the following drugs is most likely to be implicated for this new symptom?',correct:'Enalapril',options:['Enalapril','Metoprolol','Nitroglycerin','Aspirin'],exp:'ACE inhibitors such as enalapril cause bradykinin-mediated respiratory symptoms \u2014 dry cough in ~10\u201315% of patients; in those with underlying airway hyperreactivity this may manifest as bronchospasm and wheeze. New cough or wheeze in a patient started on an ACE inhibitor should prompt substitution with an ARB (e.g. losartan). Metoprolol can also precipitate bronchospasm but enalapril is the drug implicated in this context.'},\n {id:2,stem:'A patient with ischaemic heart disease on regular follow-up has a resting heart rate of 90 beats\/minute. The patient is taking metoprolol 50 mg twice a day. Which one of the following drugs may be added to his prescription if he also has signs of heart failure?',correct:'Ivabradine',options:['Ranolazine','Diclofenac','Prednisolone','Ivabradine'],exp:'Ivabradine selectively inhibits the I\u1da0 (funny\/HCN) current in the SA node, slowing heart rate without affecting contractility. In HFrEF, when resting HR remains \u226570 bpm on maximally tolerated beta-blocker, ivabradine is a guideline-recommended add-on. NSAIDs (diclofenac) and glucocorticoids (prednisolone) worsen heart failure by promoting sodium and water retention and are contraindicated.'},\n {id:3,stem:'An 18 year old boy got frost bite of left feet after working in a snowy field for 5\u20136 hours. He complained of pain, numbness and limited movement of his toes. The skin appeared white and waxy. Which one of the following is contraindicated as initial treatment?',correct:'Massage',options:['Rewarming by immersion of feet in water bath at 40\u201344\u00b0C','Massage','Cleaning of injured area with soap','Use of analgesia and sterile dressing'],exp:'Massage is strictly contraindicated in frostbite. Ice crystals within frozen tissue are shattered by mechanical rubbing, causing further vascular and cellular injury. Standard management is rapid controlled rewarming in a water bath at 40\u201344\u00b0C, analgesia, and sterile non-compressive dressings. Rubbing with snow is a harmful historical myth.'},\n {id:4,stem:'Which of the following anti-coagulant agents can be administered by oral route?\\n1. Rivaroxaban\\n2. Fondaparinux\\n3. Apixaban\\n4. Dabigatran',correct:'1, 3 and 4',options:['1 and 3 only','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Rivaroxaban (oral Factor Xa inhibitor), apixaban (oral Factor Xa inhibitor), and dabigatran (oral direct thrombin inhibitor) are all DOACs taken by mouth. Fondaparinux is a synthetic pentasaccharide Factor Xa inhibitor available only as a subcutaneous injection \u2014 there is no oral formulation. Statements 1, 3, and 4 are correct.'},\n {id:5,stem:'Which of the following drugs may be associated with leg swelling?\\n1. Calcium channel blockers\\n2. NSAIDs\\n3. Glucocorticoids\\n4. Mineralocorticoids',correct:'1, 2, 3 and 4',options:['1 and 2 only','2, 3 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:'All four drug classes cause peripheral oedema by distinct mechanisms. Dihydropyridine CCBs dilate arterioles raising capillary hydrostatic pressure. NSAIDs inhibit prostaglandin-mediated natriuresis promoting sodium and water retention. Glucocorticoids have intrinsic mineralocorticoid activity causing sodium retention. Mineralocorticoids directly upregulate ENaC in the collecting duct maximally retaining sodium. All four are correct.'},\n {id:6,stem:'Which of the following produce loud S1 on cardiac auscultation?\\n1. Anaemia\\n2. Pregnancy\\n3. Thyrotoxicosis\\n4. Mitral regurgitation',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'S1 is loud when high-output states (anaemia, pregnancy, thyrotoxicosis) increase LV filling velocity and leaflet excursion, intensifying S1. In mitral regurgitation the valve leaflets are deformed and fail to coapt firmly, producing a soft S1. Mitral stenosis (not regurgitation) produces a loud S1 when the valve is still mobile. Statements 1, 2, and 3 are correct.'},\n {id:7,stem:'Which of the following are correct about Ivabradine?\\n1. It may be of use in severe heart failure\\n2. It acts on SA node\\n3. It reduces heart rate\\n4. It is effective in atrial fibrillation',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'Ivabradine blocks HCN (I\u1da0) channels in the sinoatrial node, reducing heart rate (statements 2 and 3 correct). It is beneficial in HFrEF when HR \u226570 bpm on maximum beta-blocker \u2014 SHIFT trial (statement 1 correct). It is completely ineffective in atrial fibrillation (statement 4 false) \u2014 AF is driven by re-entry circuits, not SA node automaticity. Statements 1, 2, and 3 are correct.'},\n {id:8,stem:'Left atrial dilatation on X-ray chest is characterised by which of the following?\\n1. Straight left heart border\\n2. Rounding of left heart border\\n3. Double cardiac shadow\\n4. Widening of the angle of carina',correct:'1, 3 and 4',options:['1 and 3 only','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Left atrial enlargement on PA CXR: (1) Straightening of left heart border (loss of normal concavity at the LA appendage level); (3) Double cardiac shadow (enlarged LA visible inside the right heart border); (4) Widening of carina angle >70\u00b0 from inferior displacement of left main bronchus. Rounding of the left border indicates LV enlargement, not LA. Statements 1, 3, and 4 are correct.'},\n {id:9,stem:'A 30 year old male is being evaluated for shortness of breath. On examination of the jugular venous pulse (JVP), there is a rise in the JVP on inspiration. Which one of the following is most likely diagnosis?',correct:'Constrictive pericarditis',options:['Constrictive pericarditis','Atrial septal defect','Aortic regurgitation','Severe mitral stenosis'],exp:\"A paradoxical rise in JVP on inspiration is Kussmaul's sign. Normally, inspiration reduces intrathoracic pressure and JVP falls. In constrictive pericarditis the rigid fibrocalcific pericardium cannot accommodate increased systemic venous return, forcing JVP upward. ASD, aortic regurgitation, and mitral stenosis do not produce Kussmaul's sign.\"},\n {id:10,stem:'A 24 year old man presents with acute onset shortness of breath with precordial chest pain. ECG reveals ST elevation with upward concavity and PR segment depression in leads V\u2082 to V\u2086 and reciprocal changes in lead aVR. The most likely diagnosis is',correct:'Acute pericarditis',options:['Anterior wall myocardial infarction','Acute pericarditis','Anterior wall aneurysm','Aortic dissection'],exp:'Classic ECG of acute pericarditis: diffuse saddle-shaped (concave upward) ST elevation \u2014 not the convex tombstone pattern of STEMI; PR segment depression (most specific ECG sign); reciprocal PR elevation in aVR. Changes are diffuse, not following a coronary territory. Young age, pleuritic positional chest pain, and recent viral illness are additional clues.'},\n {id:11,stem:'Which of the following are Controller Therapies in the management of acute asthma?\\n1. Anticholinergics\\n2. Systemic glucocorticoids\\n3. Inhaled glucocorticoids\\n4. Omalizumab',correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Controller (preventer) therapies reduce underlying airway inflammation and prevent exacerbations \u2014 used long-term. Inhaled corticosteroids are the cornerstone. Systemic glucocorticoids are used for exacerbations and as step-up controller therapy. Omalizumab (anti-IgE) is an add-on biologic controller for severe allergic asthma. Anticholinergics (ipratropium) are bronchodilators \u2014 classified as reliever\/rescue therapy. Statements 2, 3, and 4 are correct.'},\n {id:12,stem:'Low pleural fluid glucose (< 60 mg%) may be observed in which of the following?\\n1. Pyogenic pleural effusion\\n2. Rheumatoid pleuritis\\n3. Malignant pleural effusion\\n4. Hepatic hydrothorax',correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2, 3 and 4'],exp:'Pleural glucose <60 mg\/dL results from high metabolic consumption or impaired glucose transport. Pyogenic empyema: bacteria and neutrophils consume glucose (values may approach zero). Rheumatoid pleuritis: immune complex deposition impairs glucose transport (often <10 mg\/dL \u2014 lowest of any effusion). Malignant effusion: tumour cells consume glucose (moderately low). Hepatic hydrothorax is a transudate \u2014 glucose equals serum glucose (normal). Statements 1, 2, and 3 are correct.'},\n {id:13,stem:'Which of the following are correct regarding Idiopathic Pulmonary Fibrosis?\\n1. Radiological pattern of usual interstitial pneumonia\\n2. Finger clubbing\\n3. More common in elderly',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are correct. (1) IPF is defined by the UIP pattern on HRCT: bibasal subpleural honeycombing \u00b1 traction bronchiectasis. (2) Finger clubbing occurs in approximately 50% of IPF patients from chronic hypoxia. (3) IPF incidence rises sharply above 60 years, predominantly affecting male smokers. All three are correct.'},\n {id:14,stem:'Diagnostic work-up for a case of suspected Bronchial asthma should reveal which of the following abnormalities?\\n1. Reduced FEV\u2081\/FVC\\n2. Increased functional residual volume\\n3. Reduced diffusion capacity\\n4. Increment in FEV\u2081 in response to inhaled bronchodilators',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'Asthma spirometry: (1) Reduced FEV\u2081\/FVC \u2014 obstructive pattern; (2) Increased FRC \u2014 dynamic hyperinflation\/air trapping; (4) \u226512% and \u2265200 mL post-bronchodilator FEV\u2081 rise \u2014 reversibility, the hallmark diagnostic criterion. Reduced DLCO is characteristic of emphysema where alveolar walls are destroyed; in asthma alveolar structure is intact and DLCO is normal. Statement 3 is incorrect. Statements 1, 2, and 4 are correct.'},\n {id:15,stem:'Which of the following conditions predispose to obstructive sleep apnea?\\n1. Hyperthyroidism\\n2. Acromegaly\\n3. Obesity\\n4. Use of alcohol \/ sedatives',correct:'2, 3 and 4',options:['2 and 3 only','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'OSA results from collapse of the upper airway during sleep. Acromegaly causes macroglossia, prognathism, and pharyngeal soft tissue hypertrophy. Obesity deposits fat in pharyngeal walls reducing airway calibre. Alcohol and sedatives relax pharyngeal dilator muscles worsening nocturnal collapse. Hyperthyroidism is NOT a risk factor \u2014 Hypothyroidism (via myxoedematous pharyngeal infiltration) predisposes to OSA. Statements 2, 3, and 4 are correct.'},\n {id:16,stem:'Which of the following are correct with regard to acute fatty liver of pregnancy?\\n1. It is typically present in first trimester\\n2. It is more common in multiple pregnancies\\n3. Liver biopsy is rarely needed\\n4. Delivery of fetus is indicated',correct:'2, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'AFLP presents in the third trimester (28\u201336 weeks), NOT the first trimester \u2014 statement 1 is false. It is associated with multiple pregnancies and male foetuses due to LCHAD mutations \u2014 statement 2 is correct. Diagnosis is primarily clinical (Swansea criteria); liver biopsy is rarely performed given coagulopathy risk \u2014 statement 3 is correct. Prompt delivery is the only definitive treatment \u2014 statement 4 is correct. Statements 2, 3, and 4 are correct.'},\n {id:17,stem:\"Which one of the following are markers of poor prognosis in acute pancreatitis?\\n1. Elderly individual\\n2. Increased white blood cell count\\n3. Low serum calcium\\n4. Hypercarbia\",correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Ranson's criteria: On admission \u2014 age >55 (elderly), WBC >16,000\/\u03bcL, blood glucose >200 mg\/dL, LDH >350 IU\/L, AST >250 IU\/L. At 48 hours \u2014 haematocrit fall >10%, BUN rise >5 mg\/dL, serum calcium <8 mg\/dL, PaO\u2082 <60 mmHg (hypoxaemia). Hypercarbia (raised PaCO\u2082) is not a Ranson criterion; hypoxaemia (low PaO\u2082) is. Statements 1, 2, and 3 are correct.\"},\n {id:18,stem:'Which of the following are the common causes of acute pancreatitis?\\n1. Gallstone\\n2. Alcohol\\n3. Post-ERCP\\n4. Campylobacter jejuni',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'Gallstones (~40%) and alcohol (~30\u201335%) are the two leading causes of acute pancreatitis (GET SMASHED mnemonic). Post-ERCP pancreatitis occurs in 2\u20135% of procedures. Campylobacter jejuni causes bacterial enteritis and dysentery but is not a recognised cause of acute pancreatitis. Statements 1, 2, and 3 are correct.'},\n {id:19,stem:'Which of the following are the aetiologies of haemochromatosis?\\n1. Thalassaemia\\n2. Anaemia of pyruvate kinase deficiency\\n3. Chronic cor pulmonale\\n4. Porphyria cutanea tarda',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 4 only','2, 3 and 4'],exp:'Secondary haemochromatosis: thalassaemia major causes iron loading from chronic ineffective erythropoiesis and repeated transfusions. Pyruvate kinase deficiency causes chronic haemolytic anaemia with compensatory increased iron absorption. Porphyria cutanea tarda is strongly associated with hepatic iron overload \u2014 venesection improves PCT. Chronic cor pulmonale does NOT cause iron overload \u2014 it is unrelated. Statements 1, 2, and 4 are correct.'},\n {id:20,stem:'Which of the following drugs are implicated in peptic ulcer disease, not caused by Helicobacter pylori and NSAIDs?\\n1. Clopidogrel\\n2. Glucocorticoids\\n3. Bisphosphonates\\n4. Colloidal bismuth subcitrate',correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1, 3 and 4','2 and 4 only'],exp:'Clopidogrel impairs platelet-derived growth factor release, reducing mucosal healing. Glucocorticoids suppress phospholipase A\u2082, reducing mucosal prostaglandins, and increase gastric acid secretion. Bisphosphonates (oral alendronate) cause direct oesophageal and gastric mucosal erosion. Colloidal bismuth subcitrate is actually gastroprotective \u2014 it coats ulcer craters and has anti-H. pylori activity. Statement 4 is incorrect. Statements 1, 2, and 3 are correct.'},\n {id:21,stem:'Which of the following are symptoms of irritable bowel syndrome?\\n1. Gas and flatulence\\n2. Abdominal pain\\n3. Blood in stools\\n4. Diarrhoea',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'IBS (Rome IV) is defined by recurrent abdominal pain with bloating and altered bowel habit. Gas, flatulence, and abdominal discomfort are cardinal features. Blood in stool is a red flag that excludes IBS and mandates investigation for IBD or colorectal carcinoma. The absence of rectal bleeding is an implicit diagnostic criterion for IBS. Statements 1, 2, and 4 are correct.'},\n {id:22,stem:'Vertical transmission of hepatitis B can be prevented by which of the following interventions?\\n1. Passive immunisation of infant at birth\\n2. Active immunisation of infant at birth\\n3. Antiviral therapy in third trimester for mother with HBV-DNA level of > 2,00,000 IU\/mL',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'Perinatal HBV prevention uses a three-pronged approach. HBIG (passive) given within 12 hours provides immediate antibody protection. HBV vaccine (active) at birth induces long-term immunity. Together these prevent ~90\u201395% of vertical transmission. For highly viraemic mothers (HBV-DNA >200,000 IU\/mL), third-trimester tenofovir eliminates residual transmission risk. All three interventions are guideline-recommended.'},\n {id:23,stem:'Which of the following are correct in respect of jaundice?\\n1. Patients complain of darkening of urine before they notice jaundice\\n2. Jaundice is usually detectable with a serum bilirubin level of over 1\u00b78 mg\/dl\\n3. In Gilbert syndrome, jaundice is more noticeable after fasting',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are correct. (1) Conjugated bilirubin is water-soluble; it spills into urine at serum levels below those producing visible icterus \u2014 dark urine is an earlier symptom than visible yellowing. (2) Scleral icterus becomes detectable when bilirubin exceeds ~1.8 mg\/dL. (3) In Gilbert syndrome, fasting reduces caloric intake, increases unconjugated bilirubin production, and decreases UGT activity \u2014 precipitating mild visible jaundice. All three are correct.'},\n {id:24,stem:'Irritable bowel syndrome is favoured by which of the following?\\n1. Worsening of symptoms by stress\\n2. Recurrent abdominal discomfort\\n3. Age more than 50 years at onset\\n4. Alternating diarrhoea and constipation',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:'IBS: stress-worsened symptoms (dysregulated gut\u2013brain axis), recurrent abdominal discomfort improved by defaecation, and alternating bowel habit (IBS-M) are characteristic. Onset after age 50 is a red flag alarm symptom that argues against IBS and requires investigation to exclude colorectal cancer or IBD. Statement 3 (age >50) is an alarm feature, not a feature favouring IBS. Statements 1, 2, and 4 are correct.'},\n {id:25,stem:'The diagnosis of protein losing enteropathy can be confirmed by',correct:'Fecal clearance of alpha-1 antitrypsin',options:['Hydrogen breath test','Fecal clearance of alpha-1 antitrypsin','Fecal \u2075\u00b9Cr\u02c9 labelled transthyretin level','Fecal calprotectin level'],exp:'\u03b1\u2081-antitrypsin (MW ~50 kDa, similar to albumin) is neither digested by intestinal proteases nor absorbed in the gut. Its presence in stool directly reflects enteric protein leakage. A 24-hour fecal AAT clearance >24 mL\/day is the standard diagnostic test for protein-losing enteropathy. Hydrogen breath test detects carbohydrate malabsorption. Fecal calprotectin indicates intestinal inflammation. Fecal AAT clearance is the correct answer.'},\n {id:26,stem:'RBC casts on urine analysis are seen in which of the following?\\n1. Glomerulonephritis\\n2. Interstitial nephritis\\n3. Vasculitis\\n4. Malignant hypertension',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2 and 3 only'],exp:'RBC casts form when erythrocytes pass through damaged glomerular capillary walls into tubular lumina \u2014 pathognomonic of glomerular injury: glomerulonephritis, vasculitis (pauci-immune GN), and malignant hypertension (fibrinoid necrosis of glomerular arterioles). Interstitial nephritis characteristically produces WBC casts, tubular epithelial cell casts, and eosinophiluria \u2014 not RBC casts, as glomeruli are spared. Statements 1, 3, and 4 are correct.'},\n {id:27,stem:'Which of the following are correct regarding Essential Tremors?\\n1. It may present at any age\\n2. Head is almost never involved\\n3. Tremor may improve with small amount of alcohol',correct:'1 and 3 only',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'Statement 1 is correct \u2014 essential tremor can present at any age with bimodal peaks in the 2nd and 6th decades. Statement 2 is false \u2014 head (titubation), voice, and jaw tremor are features of essential tremor in ~30\u201340% of patients; it is in Parkinson\\'s disease that head tremor is uncommon. Statement 3 is correct \u2014 small amounts of alcohol dramatically suppress essential tremor (likely via GABA-A modulation), a useful distinguishing feature. Statements 1 and 3 only are correct.'},\n {id:28,stem:\"Which of the following drugs may be associated with Parkinson's disease?\\n1. Atypical anti-psychotic drugs\\n2. Lithium\\n3. MPTP (methyl-phenyl-tetrahydropyridine)\",correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are correct. (1) Atypical antipsychotics (risperidone, quetiapine, olanzapine) block striatal D\u2082 receptors causing drug-induced parkinsonism \u2014 reversible on discontinuation. (2) Lithium at toxic levels causes extrapyramidal side effects resembling parkinsonism. (3) MPTP is oxidised by MAO-B to MPP\u207a which selectively destroys nigrostriatal dopaminergic neurons \u2014 the MPTP primate model is foundational to PD research. All three are correct.'},\n {id:29,stem:\"Which of the following are suggestive of Parkinson's disease?\\n1. Lead pipe rigidity\\n2. Cog wheel rigidity\\n3. Festinating gait\\n4. Romberg test positive\",correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','1 and 3 only','2, 3 and 4'],exp:\"PD features: Lead-pipe rigidity (uniform velocity-independent resistance) and cogwheel rigidity (lead-pipe plus superimposed resting tremor producing a ratchet-like sensation) are both extrapyramidal rigidity forms in PD. Festinating gait (short shuffling steps, forward trunk flexion, accelerating pace) is characteristic. Romberg's test assesses proprioceptive integrity and is positive in dorsal column disease (tabes dorsalis, subacute combined degeneration) \u2014 not a feature of PD. Statements 1, 2, and 3 are correct.\"},\n {id:30,stem:\"Which of the following are correct regarding Idiopathic Parkinson's disease?\\n1. Motor symptoms are almost always initially symmetrical\\n2. Non-motor symptoms include hyposmia and constipation\\n3. Cognition is spared in early disease\\n4. Speech may become softer and indistinct\",correct:'2, 3 and 4',options:['2 and 3 only','1 and 4 only','1, 3 and 4','2, 3 and 4'],exp:'Statement 1 is false \u2014 asymmetric onset is a cardinal feature distinguishing idiopathic PD from atypical parkinsonism; PD almost always begins unilaterally. Statement 2 is correct \u2014 premotor non-motor symptoms: hyposmia, REM sleep behaviour disorder, constipation, and depression may precede motor onset by years. Statement 3 is correct \u2014 cognition is relatively intact early. Statement 4 is correct \u2014 hypophonia (soft, monotone voice) and dysarthria are characteristic. Statements 2, 3, and 4 are correct.'},\n {id:31,stem:'Which of the following are correct with regard to Levodopa?\\n1. It is most effective for relieving tremors\\n2. Only a small portion of total drug reaches the brain\\n3. Nausea may be offset by domperidone\\n4. It may trigger hallucinations',correct:'2, 3 and 4',options:['1, 2 and 3','2 and 4 only','1 and 3 only','2, 3 and 4'],exp:'Statement 1 is false \u2014 levodopa most effectively treats bradykinesia and rigidity; resting tremor responds least well. Statement 2 is correct \u2014 only ~1\u20133% of oral levodopa crosses the BBB; the rest is decarboxylated peripherally \u2014 hence carbidopa is co-formulated. Statement 3 is correct \u2014 domperidone (peripheral D\u2082 blocker that does not cross the BBB) is the antiemetic of choice; metoclopramide is contraindicated. Statement 4 is correct \u2014 dopaminergic stimulation causes visual hallucinations especially in elderly and advanced disease. Statements 2, 3, and 4 are correct.'},\n {id:32,stem:'Which of the following are risk factors for Stroke?\\n1. Sickle cell disease\\n2. Cigarette smoking\\n3. Hypofibrinogenaemia\\n4. Atrial fibrillation',correct:'1, 2 and 4',options:['1 and 2 only','1, 2 and 4','1, 3 and 4','2 and 4 only'],exp:'Sickle cell disease causes stroke through RBC vaso-occlusion in cerebral vessels. Cigarette smoking accelerates cerebral atherosclerosis and promotes hypercoagulability. Atrial fibrillation generates left atrial thrombus causing cardioembolic stroke (~20% of all ischaemic strokes). Hypofibrinogenaemia reduces clot formation capacity and would lower \u2014 not raise \u2014 thrombotic stroke risk. Statements 1, 2, and 4 are correct.'},\n {id:33,stem:'Which of the following are correct in respect of Myasthenia gravis?\\n1. Symptoms worsen towards the end of the day\\n2. There may be difficulty in chewing and swallowing\\n3. Acetylcholine receptors in the pre-junctional membrane are involved\\n4. Penicillamine may precipitate similar illness',correct:'1, 2 and 4',options:['1, 2 and 3','1, 2 and 4','1 and 3 only','2 and 4 only'],exp:'Statement 1 is correct \u2014 fatigability is the hallmark; symptoms worsen with sustained activity and are worst towards the end of the day. Statement 2 is correct \u2014 bulbar MG (dysphagia, dysarthria) is common. Statement 3 is false \u2014 MG autoantibodies (anti-AChR, anti-MuSK) target the POST-junctional motor end-plate; Lambert-Eaton involves the pre-junctional terminal. Statement 4 is correct \u2014 D-penicillamine induces anti-AChR antibody production causing drug-associated MG, reversible on discontinuation. Statements 1, 2, and 4 are correct.'},\n {id:34,stem:'Which of the following are the tests for functional assessment of encephalopathy?\\n1. Flapping tremors\\n2. Number connection test\\n3. Constructional apraxia',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three are standard bedside tests for hepatic encephalopathy. Asterixis (liver flap): elicited by sustained wrist dorsiflexion \u2014 episodic loss of posture from ammonia accumulation; grades HE severity. Number Connection Test (Trail Making Test A): connects numbered dots 1\u219225, measures psychomotor speed, highly sensitive for minimal HE. Constructional apraxia (inability to copy a five-pointed star): assesses visuospatial function impaired by HE, used serially to track clinical response. All three are correct.'},\n {id:35,stem:'Which one of the following is correct regarding blood components in clinical practice?',correct:'Transfusion associated GVHD can be prevented by prior irradiation of transfused blood',options:['ABO blood group antigens are polypeptide chains on the surface of RBCs','Platelets can be stored for upto 35 days','Hemolytic disease of newborn occurs when mother\\'s IgA anti-RBC antibodies cross the placenta and lyse fetal RBCs','Transfusion associated GVHD can be prevented by prior irradiation of transfused blood'],exp:'ABO blood group antigens are polysaccharide (carbohydrate) chains \u2014 NOT polypeptides. Platelet concentrates are stored for only 5\u20137 days (not 35 days); red cells store for up to 35\u201342 days. HDN is caused by maternal IgG antibodies (anti-D, anti-Kell) \u2014 NOT IgA; only IgG crosses the placenta. Transfusion-associated GVHD occurs when viable donor T-lymphocytes engraft in an immunocompromised host; gamma irradiation (25 Gy) of cellular blood components inactivates donor lymphocytes and reliably prevents TA-GVHD. The last option is the only correct statement.'},\n {id:36,stem:'Which one of the following is an oral direct Thrombin inhibitor?',correct:'Dabigatran',options:['Apixaban','Rivaroxaban','Dabigatran','Argatroban'],exp:'Dabigatran etexilate is a prodrug converted to dabigatran \u2014 an oral direct thrombin (Factor IIa) inhibitor. Its specific reversal agent is idarucizumab. Apixaban and rivaroxaban are oral direct Factor Xa inhibitors (reversed by andexanet alfa). Argatroban is a parenteral (IV only) direct thrombin inhibitor used in heparin-induced thrombocytopenia \u2014 it has no oral formulation. Dabigatran is the only oral direct thrombin inhibitor in clinical use.'},\n {id:37,stem:'Which of the following are correct with regard to metformin?\\n1. The maximum tolerated dose is 2000 mg\/day\\n2. Lactic acidosis is the major adverse effect of metformin\\n3. It may lower the blood levels of Vitamin B12',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'All three statements are correct. The maximum commonly tolerated dose is approximately 2000\u20132550 mg\/day in divided doses. Lactic acidosis (type B), though rare (~3\/100,000 patient-years), is the most serious adverse effect, occurring with renal impairment, hepatic failure, or dehydration. Metformin impairs vitamin B12 absorption by approximately 10\u201330% by interfering with cubilin receptor binding at the terminal ileum; annual B12 monitoring is recommended. All three are correct.'},\n {id:38,stem:'Which of the following statements are correct regarding short stature?\\n1. Linear bone growth rates are pituitary dependent\\n2. Normal bone age in a child with short stature suggests hormonal disorder\\n3. Final height in boys can be estimated by adding 6\u00b75 cm to mid-parental height\\n4. Replacement therapy with recombinant GH restores growth velocity in GH-deficient children',correct:'1, 3 and 4',options:['1 and 2 only','1, 2 and 4','1, 3 and 4','3 and 4 only'],exp:'Statement 1 is correct \u2014 linear bone growth is driven by GH (via IGF-1) from the anterior pituitary; GH deficiency causes significantly reduced growth velocity. Statement 2 is false \u2014 normal bone age in a short child points to familial short stature or constitutional delay (variant of normal); delayed bone age points to hormonal or pathological causes. Statement 3 is correct \u2014 target height for boys = mid-parental height + 6.5 cm; for girls = mid-parental height \u2212 6.5 cm. Statement 4 is correct \u2014 recombinant human GH restores growth velocity to near normal in GH-deficient children. Statements 1, 3, and 4 are correct.'},\n {id:39,stem:'Which one of the following drugs used to treat Diabetes mellitus is least likely to cause hypoglycaemia?',correct:'Sitagliptin',options:['Insulin','Glimepiride','Sitagliptin','Repaglinide'],exp:'Sitagliptin is a DPP-4 inhibitor. It enhances insulin secretion in a strictly glucose-dependent manner \u2014 when blood glucose normalises, the incretin effect plateaus and insulin secretion does not increase further, making hypoglycaemia extremely unlikely as monotherapy. By contrast, insulin delivers exogenous insulin regardless of glucose level; glimepiride (sulfonylurea) stimulates insulin secretion tonically; repaglinide (meglitinide) also stimulates insulin secretion with significant hypoglycaemia risk. Sitagliptin is least likely to cause hypoglycaemia.'},\n {id:40,stem:\"Which of the following constitute differential diagnosis of hypocalcaemia?\\n1. Hypomagnesaemia\\n2. Chronic alcoholism\\n3. Pseudohypoparathyroidism\\n4. Paget's disease\",correct:'1, 2 and 3',options:['1, 2 and 3','1 and 2 only','3 and 4 only','2, 3 and 4'],exp:\"Hypomagnesaemia impairs PTH secretion AND induces end-organ resistance to PTH, causing hypocalcaemia \u2014 magnesium must be repleted first. Chronic alcoholism causes renal and GI magnesium wasting, leading to hypomagnesaemia and consequent hypocalcaemia, plus direct PTH suppression. Pseudohypoparathyroidism (PHP type 1a) is end-organ resistance to PTH: PTH is high but calcium is low. Paget's disease of bone causes pathological bone resorption which during immobilisation can cause HYPERcalcaemia (not hypocalcaemia) \u2014 statement 4 is incorrect. Statements 1, 2, and 3 are correct.\"}\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 function startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');btn.textContent='\u23f1 '+fmtTime(timerRemaining);btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n timerRemaining--;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 function updateStats(){\n const c=Object.values(userAnswers).filter(v=>v==='correct').length;\n const w=Object.values(userAnswers).filter(v=>v==='wrong').length;\n const net=(c*4)-w;\n document.getElementById(NS+'-sc').textContent=c;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 function pick(qid,oi){\n if(userAnswers[qid]!==undefined||quizSubmitted)return;\n const q=QUESTIONS.find(x=>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 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');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\">'+opts.map((o,i)=>'<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('')+'<\/div>'+\n '<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((_,i)=>document.getElementById(NS+'-o'+q.id+'-'+i).addEventListener('click',()=>pick(q.id,i)));\n });\n }\n function showScore(){\n if(quizSubmitted)return;quizSubmitted=true;stopTimer();\n document.getElementById(NS+'-timer-btn').textContent='\u23f1 Submitted';document.getElementById(NS+'-timer-btn').classList.remove('running');\n const c=Object.values(userAnswers).filter(v=>v==='correct').length;\n const w=Object.values(userAnswers).filter(v=>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(--ter) '+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 function init(){\n document.getElementById(NS+'-grace-now').addEventListener('click',()=>{dismissGrace();showScore();});\n document.getElementById(NS+'-timer-btn').addEventListener('click',()=>{if(!timerRunning&&!quizSubmitted)startTimer();});\n document.getElementById(NS+'-submit').addEventListener('click',showScore);\n document.getElementById(NS+'-retry').addEventListener('click',()=>{build();window.scrollTo({top:0,behavior:'smooth'});});\n new IntersectionObserver(entries=>{document.getElementById(NS+'-statusbar').classList.toggle('visible',!entries[0].isIntersecting);},{threshold:0}).observe(document.getElementById(NS+'-sentinel'));\n build();updateStats();\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 2022 Paper I \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit… <\/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-36610","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2022 P1 Part-1 - 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\/18\/cms-2022-p1-part-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2022 P1 Part-1 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2022 Paper I \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit… \" \/>\n<meta property=\"og:url\" content=\"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/\" \/>\n<meta property=\"og:site_name\" content=\"atsixty\" \/>\n<meta property=\"article:published_time\" content=\"2026-04-18T08:13:19+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-20T00:40:58+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\\\/18\\\/cms-2022-p1-part-1\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\"},\"author\":{\"name\":\"Avi\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"headline\":\"CMS 2022 P1 Part-1\",\"datePublished\":\"2026-04-18T08:13:19+00:00\",\"dateModified\":\"2026-04-20T00:40:58+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\"},\"wordCount\":59,\"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\\\/18\\\/cms-2022-p1-part-1\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\",\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\",\"name\":\"CMS 2022 P1 Part-1 - atsixty\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\"},\"datePublished\":\"2026-04-18T08:13:19+00:00\",\"dateModified\":\"2026-04-20T00:40:58+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/04\\\/18\\\/cms-2022-p1-part-1\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/atsixty.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CMS 2022 P1 Part-1\"}]},{\"@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 2022 P1 Part-1 - 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\/18\/cms-2022-p1-part-1\/","og_locale":"en_US","og_type":"article","og_title":"CMS 2022 P1 Part-1 - atsixty","og_description":"CMS 2022 Paper I \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2022General Medicine & Paediatrics \u00b7 Paper I \u00b7 Part A Cardiology \u00b7 Respiratory Medicine \u00b7 Gastroenterology & Hepatology \u00b7 Neurology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit… ","og_url":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","og_site_name":"atsixty","article_published_time":"2026-04-18T08:13:19+00:00","article_modified_time":"2026-04-20T00:40:58+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\/18\/cms-2022-p1-part-1\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"CMS 2022 P1 Part-1","datePublished":"2026-04-18T08:13:19+00:00","dateModified":"2026-04-20T00:40:58+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/"},"wordCount":59,"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\/18\/cms-2022-p1-part-1\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","url":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/","name":"CMS 2022 P1 Part-1 - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-04-18T08:13:19+00:00","dateModified":"2026-04-20T00:40:58+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/18\/cms-2022-p1-part-1\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"CMS 2022 P1 Part-1"}]},{"@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\/36610","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=36610"}],"version-history":[{"count":3,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36610\/revisions"}],"predecessor-version":[{"id":36635,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36610\/revisions\/36635"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36610"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36610"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36610"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}