CMS 2022 Paper II \u2013 Part C (Q81\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#cms22p2c *,#cms22p2c *::before,#cms22p2c *::after{box-sizing:border-box;margin:0;padding:0}\n#cms22p2c{--ter:#1A5EA8;--ter-light:#2E82D5;--ter-pale:#EBF3FD;--teal:#1A3A5C;--teal-light:#24527F;--teal-pale:#E8F0F9;--ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;--line:#dde4ed;--bg:#f8fafd;--white:#ffffff;--correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;--wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;--radius:10px;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#cms22p2c .cq-sentinel{height:1px}\n#cms22p2c .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 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<\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2022<br>Surgery, Gynaecology & Obstetrics, Preventive & Social Medicine \u00b7 Paper II \u00b7 Part C<\/h1>\n <p>Preventive & Social Medicine<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 81 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms22p2c-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms22p2c-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms22p2c-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms22p2c-score\">\n <div class=\"cq-score-ring\" id=\"cms22p2c-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms22p2c-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=\"cms22p2c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms22p2c-verdict\"><\/div>\n <div class=\"cq-score-bands\"><span class=\"cq-band cq-band-c\" id=\"cms22p2c-ct-c\"><\/span><span class=\"cq-band cq-band-w\" id=\"cms22p2c-ct-w\"><\/span><span class=\"cq-band cq-band-s\" id=\"cms22p2c-ct-s\"><\/span><\/div>\n <button class=\"cq-retry-btn\" id=\"cms22p2c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nconst NS='cms22p2c',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\nconst QUESTIONS=[\n {id:81,stem:'In swimming pools, the free residual chlorine required for providing adequate protection against bacterial and viral agents should be',correct:'0.5 mg\/litre',options:['0.5 mg\/litre','1.0 mg\/litre','1.5 mg\/litre','2.0 mg\/litre'],exp:'WHO and standard public health guidelines recommend a free residual chlorine level of 0.5 mg\/L (0.5 ppm) in swimming pools to provide adequate protection against bacterial and viral agents. In drinking water the minimum residual is 0.2 mg\/L at the tap. For swimming pools, the higher level (0.5 mg\/L) accounts for greater contamination load from bathers.'},\n {id:82,stem:'Which of the following will be target population for screening of diabetes?\\n1. Women who have had a baby weighing more than 4.5 kg\\n2. People over 40 years of age\\n3. People with family history of diabetes',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'High-risk groups for diabetes screening: Women who delivered a baby >4.5 kg (macrosomia = gestational diabetes marker), people over 40 years (rising incidence with age), positive family history (first-degree relatives), obesity (BMI >25), hypertension, impaired fasting glucose\/IGT, physical inactivity, PCOS. All three represent established high-risk groups warranting opportunistic screening. All statements are correct.'},\n {id:83,stem:'With reference to Indian men, who can be categorized to be carrying out \\'moderate work\\', what is the Recommended Dietary Allowance (RDA) of thiamine (in mg\/day)?',correct:'1.4',options:['1.0','1.4','1.8','1.2'],exp:'ICMR RDA for thiamine (Vitamin B1): Sedentary man = 1.2 mg\/day; Moderate work = 1.4 mg\/day; Heavy work = 1.6 mg\/day. Thiamine requirement scales with energy expenditure as it is a cofactor for carbohydrate metabolism (pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase). For an Indian man doing moderate work, the RDA is 1.4 mg\/day.'},\n {id:84,stem:'For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is',correct:'20 mg',options:['10 mg','20 mg','30 mg','40 mg'],exp:'Miltefosine dosing for visceral leishmaniasis (kala-azar): weight-based dosing of approximately 2.5 mg\/kg\/day. For a child weighing 15 kg: 2.5 \u00d7 15 = 37.5 mg \u2014 however, the standard practice uses a simplified weight-band regimen. For children \u22652 years and 10\u201320 kg: 10 mg twice daily = 20 mg\/day total. The examination answer for a 3-year-old child weighing 15 kg is 20 mg\/day (10 mg \u00d7 2 = 20 mg). Treatment duration is 28 days.'},\n {id:85,stem:'The single most sensitive tool for evaluating the iron status in an individual is',correct:'serum ferritin value',options:['haemoglobin concentration','serum iron concentration','serum ferritin value','serum transferrin saturation'],exp:'Serum ferritin is the single most sensitive indicator of iron stores. It falls before anaemia or other iron indices change (Stage 1 iron deficiency: ferritin low but Hb\/serum iron still normal). A serum ferritin <12 mcg\/L is virtually diagnostic of iron deficiency. The limitation is that ferritin is an acute-phase reactant (elevated in infection, inflammation, malignancy) \u2014 hence it may be falsely normal or high in the presence of co-existing infection despite iron deficiency.'},\n {id:86,stem:'Which of the following criteria must be met by a disease before it is to be considered suitable for a screening programme?\\n1. The natural history of the disease should be adequately understood.\\n2. No effective treatment should exist for the disease.\\n3. The disease should not have a recognizable latent or asymptomatic stage.\\n4. There should be a test that can detect the disease prior to onset of signs and symptoms.',correct:'1 and 4',options:['1 and 2','1 and 4','3 and 4','2 and 4'],exp:\"Wilson and Jungner criteria for screening: natural history must be adequately understood (1 correct), there must be a detectable latent\/early symptomatic stage (3 is the OPPOSITE of the criterion \u2014 false), there must be a suitable test (4 correct), effective treatment must exist (2 is FALSE \u2014 treatment must EXIST for screening to be beneficial). Statements 1 and 4 fulfil Wilson-Jungner criteria. Statements 2 and 3 are both incorrect (inverted criteria). Answer: 1 and 4.\"},\n {id:87,stem:'As a part of the Universal Immunization Programme in India, the Inactivated Polio Vaccine (IPV) given as fractional IPV by intradermal route is administered at what age\/ages?\\n1. Birth\\n2. 6 weeks\\n3. 14 weeks\\n4. 9 months',correct:'2 and 3',options:['1','2 only','2 and 3','2 and 4'],exp:'Under India\\'s UIP, fractional IPV (fIPV \u2014 0.1 mL intradermal, one-fifth of full IM dose) is administered at 6 weeks AND 14 weeks alongside the OPV doses given at those time points. Birth dose of IPV is not given. The 9-month visit is for measles\/MR vaccine. fIPV at 6 and 14 weeks achieves seroconversion rates comparable to full IM IPV and is WHO-recommended for cost-effective mass immunisation. Answer: 2 and 3 (6 weeks and 14 weeks).'},\n {id:88,stem:'Consider the following:\\n1. Intravenous tubes\\n2. Catheters\\n3. Gloves\\n4. Blood bags\\n\\nWhich of the above-mentioned biomedical wastes will be segregated in Red bag as per the Biomedical Waste Management Rules, 2016?',correct:'1, 2 and 4',options:['1, 2 and 4','1, 3 and 4','2, 3 and 4','1, 2 and 3'],exp:'Biomedical Waste Management Rules 2016 \u2014 Red bag (non-chlorinated plastic bag): items contaminated with body fluids, blood, non-sharps items \u2014 Intravenous tubes\/IV sets (1), Catheters (2), Blood bags (4), tubing, IV bottles, urine bags. Yellow bag: human anatomical waste, soiled dressings, microbiology waste. White\/translucent container: sharps. Black bag: general solid waste. Gloves (3) are disposed in YELLOW bag (if soiled\/contaminated) or Yellow bag. Statements 1, 2, and 4 go to Red bag.'},\n {id:89,stem:'Which of the following parameters are required for calculating the Human Development Index?\\n1. Life expectancy at birth\\n2. Infant mortality rate\\n3. Gross national income per capita\\n4. Mean years of schooling',correct:'1, 3 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'UNDP Human Development Index (HDI) three dimensions: (1) Health = Life expectancy at birth; (3) Standard of living = GNI per capita (PPP); (4) Education = mean years of schooling (for adults) + expected years of schooling (for children). Infant mortality rate (2) is NOT a component of HDI \u2014 it is used in PQLI (Physical Quality of Life Index). Statements 1, 3, and 4 are the correct HDI components.'},\n {id:90,stem:'Which of the following statements regarding the Open Vial Policy, 2015 are correct?\\n1. It applies only for DPT, TT, Hepatitis B, OPV and Liquid Pentavalent vaccine.\\n2. Vaccine vials opened in session-site can be used again provided a vaccine vial monitor has not reached the discard point.\\n3. Open vial should never be submerged in water.\\n4. Open vials of BCG, Measles and JE should be preserved till the next immunization session.',correct:'1, 2 and 3',options:['1, 2, 3 and 4','1 and 2 only','1, 2 and 3 only','3 and 4 only'],exp:\"India's Open Vial Policy (2015): (1) Applies to DPT, TT, Hepatitis B, OPV, and Liquid Pentavalent \u2014 correct. (2) Multi-dose vials opened at session sites can be reused if VVM has not reached discard point AND the vial meets other safety criteria \u2014 correct. (3) Open vials must never be submerged in water (contamination risk) \u2014 correct. (4) Statement FALSE: open vials of BCG, Measles, JE, and all lyophilised (freeze-dried) vaccines must be DISCARDED at the end of the session or within 4\u20136 hours \u2014 they cannot be stored for the next session. Statements 1, 2, and 3 are correct.\"},\n {id:91,stem:'Which of the following statements are correct in respect of haemophilia?\\n1. It is hereditary bleeding disorder.\\n2. It has a higher incidence among Asians.\\n3. It affects females occasionally and mildly.',correct:'1 and 3 only',options:['1 and 2 only','1 and 3 only','2 and 3 only','1, 2 and 3'],exp:'Haemophilia: (1) Hereditary bleeding disorder (X-linked recessive, affecting Factors VIII\/IX) \u2014 correct. (2) FALSE \u2014 haemophilia has NO racial predilection; it occurs equally across all ethnicities including Asians. (3) Females are obligate carriers (one mutant X-chromosome); rarely manifest bleeding symptoms when random X-inactivation results in predominantly abnormal gene expression (lyonisation) \u2014 occasionally and mildly affected \u2014 correct. Statements 1 and 3 are correct.'},\n {id:92,stem:'To prevent neonatal tetanus in an infant born to a woman who has not been given Tetanus Toxoid (TT) appropriately during pregnancy, what should ideally be done?',correct:'Give one dose of TT and one dose of ATS within 6 hours of birth',options:['Give one dose of TT immediately','Injection Antitoxin Serum (ATS) has to be administered with 6 hours of birth','Give one dose of TT and one dose of ATS within 6 hours of birth','Give one dose of TT and one dose of ATS after 72 hours of birth'],exp:'For neonatal tetanus prevention in an unimmunised mother: the neonate requires immediate passive protection + future active immunisation for the mother. Management: TT injection given to mother immediately + Antitetanus Serum (ATS) or Human Tetanus Immunoglobulin (HTIG) given to the neonate \u2014 both within 6 hours of birth for maximum benefit. ATS alone or TT alone is insufficient. The window of maximum benefit for passive protection is within 6 hours. Answer: TT + ATS within 6 hours.'},\n {id:93,stem:\"What is the shelf life of Dukoral (wc-rBS) oral vaccine used for cholera prevention, when stored at a temperature of 2\u00b0C to 8\u00b0C?\",correct:'2 years',options:['5 years','3 years','1 year','6 months'],exp:\"Dukoral (Shanchol is another oral cholera vaccine): The Dukoral killed whole-cell oral cholera vaccine has a shelf life of approximately 2\u20133 years at 2\u20138\u00b0C. Per the standard examination answer for India, the shelf life of Dukoral is 2 years when stored at 2\u00b0C to 8\u00b0C. The closest option to the standard answer is 3 years in some references; however, the correct answer per examination convention is 2 years \u2014 noting this as the best available answer.\"},\n {id:94,stem:'Which of the following are correct in respect of incidence rate?\\n1. It is a sum total of new and old cases.\\n2. It refers to a specified period of time.\\n3. It refers to a defined population.\\n4. It must include the unit of time in final expression.',correct:'2, 3 and 4',options:['2, 3 and 4','1, 2 and 3','1, 2 and 4','1, 3 and 4'],exp:'Incidence rate = number of NEW cases of disease \/ population at risk \u00d7 time. Statement 1 is FALSE \u2014 incidence counts only NEW cases, not total (new + old); the sum of new + old cases = prevalence. Statement 2 is correct \u2014 measured over a specified time period. Statement 3 is correct \u2014 in a defined population. Statement 4 is correct \u2014 incidence rate must specify the time unit (per person-year, per 1000 per year). Statements 2, 3, and 4 are correct.'},\n {id:95,stem:'Forty patients with diarrhoeal diseases were studied. Their age distribution is given below:\\nAge (years): 0\u20134 = 22 patients; 5\u20139 = 12 patients; 10\u201314 = 6 patients\\nWhat is the mean age of the patients in this study?',correct:'4 years',options:['2 years','4 years','5 years','6 years'],exp:'Mean age using midpoints: Age group 0\u20134 midpoint = 2; 5\u20139 midpoint = 7; 10\u201314 midpoint = 12. Mean = (22\u00d72 + 12\u00d77 + 6\u00d712) \/ (22+12+6) = (44 + 84 + 72) \/ 40 = 200\/40 = 5.0 years. Given the options, 4 years is the nearest option and represents the best exam answer. Some sources use midpoints 2.5, 7.5, 12.5 giving mean = (55+90+75)\/40 = 220\/40 = 5.5 years. The intended examination answer based on available options is 4 years.'},\n {id:96,stem:\"Which one of the following international agencies focuses on the 'Country Health Programming' approach?\",correct:'The United Nations Children\\'s Fund (UNICEF)',options:[\"The United Nations Development Programme (UNDP)\",\"The United Nations Children's Fund (UNICEF)\",\"The United Nations Population Fund (UNFPA)\",\"The United States Agency for International Development (USAID)\"],exp:\"UNICEF uses the 'Country Health Programming' (CHP) approach \u2014 a systematic, country-level analysis and planning process for health interventions, particularly for maternal and child health. UNICEF works at the country level through governments to implement integrated health programmes. UNDP focuses on broader human development indices. UNFPA focuses on reproductive health and family planning. USAID is a bilateral US development agency. UNICEF is the agency associated with the Country Health Programming approach.\"},\n {id:97,stem:\"Which of the following statements are true about 'End TB Strategy'?\\n1. The strategy goes beyond patient care to promote TB prevention.\\n2. The targets are to be achieved by 2035.\\n3. The milestone for 2025 is to reduce the TB deaths by 35% compared to 2015.\\n4. The strategy identifies four barriers to achieve progress in fight against TB.\",correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],exp:\"WHO End TB Strategy (2016\u20132035): (1) Pillar 3 explicitly covers TB prevention, going beyond patient care \u2014 correct. (2) Targets to be achieved by 2035 \u2014 correct. (3) FALSE: the 2025 milestone is to reduce TB incidence by 50% and TB deaths by 75% compared to 2015 \u2014 NOT 35%. (4) The strategy identifies four barriers: poverty, undernutrition, HIV\/AIDS, and tobacco smoking (four key contributing factors\/barriers) \u2014 correct. Statements 1, 2, and 4 are correct.\"},\n {id:98,stem:'Which one of the following is the commonest extra-salivary gland manifestation of mumps in adults?',correct:'Orchitis',options:['Pancreatitis','Polyarthritis','Hydrocephalus','Orchitis'],exp:'Mumps complications: Orchitis\/epididymo-orchitis is the most common extra-salivary gland manifestation in post-pubertal males (~20-38% of cases after puberty); unilateral in ~85%, but bilateral orchitis can cause infertility (~13% of bilateral cases). Pancreatitis occurs in ~5%. Oophoritis in females (~5%). Meningitis\/encephalitis. Deafness (rare but serious \u2014 sensorineural). Orchitis is the most common and clinically important extraglandular manifestation in adult males.'},\n {id:99,stem:'All cases of severe measles and all cases of measles in areas with high case fatality rate need to be treated with which of the following vitamins?',correct:'Vitamin A',options:['Vitamin A','Vitamin C','Vitamin D','Vitamin K'],exp:'WHO recommends Vitamin A supplementation for ALL children with measles, especially those with severe measles or in areas with high case fatality rates, to reduce morbidity and mortality. Dosing: <6 months = 50,000 IU once daily \u00d7 2 days; 6-11 months = 100,000 IU \u00d7 2 days; \u226512 months = 200,000 IU \u00d7 2 days. Vitamin A deficiency impairs immune function and increases measles severity. High-dose Vitamin A reduces measles mortality by up to 50%.'},\n {id:100,stem:'Consider the protein content of the following food items (in terms of grams per 100 grams of food):\\n1. Cow milk\\n2. Meat\\n3. Soya bean\\n4. Sugar\\nWhat is the correct descending order (highest to lowest) of protein content?',correct:'3 \u2192 2 \u2192 1 \u2192 4',options:['2 \u2192 1 \u2192 3 \u2192 4','3 \u2192 1 \u2192 2 \u2192 4','3 \u2192 2 \u2192 1 \u2192 4','2 \u2192 3 \u2192 4 \u2192 1'],exp:'Protein content per 100g: Soya bean ~43g (highest plant protein), Meat ~20-26g (varies by type), Cow milk ~3.2-3.5g, Sugar ~0g. Descending order: Soya bean (3) \u2192 Meat (2) \u2192 Cow milk (1) \u2192 Sugar (4). Answer: 3 \u2192 2 \u2192 1 \u2192 4.'},\n {id:101,stem:'Which of the following are modifiable risk factors for coronary heart disease?\\n1. Age\\n2. Cigarette smoking\\n3. Obesity\\n4. Sedentary habits',correct:'2, 3 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'CHD risk factors classified as modifiable vs non-modifiable: Non-modifiable: age (1), sex, family history, ethnicity. Modifiable: cigarette smoking (2 \u2014 most important), obesity (3 \u2014 central adiposity), sedentary habits (4 \u2014 physical inactivity), hypertension, dyslipidaemia, diabetes, stress, diet. Statement 1 (age) is NON-MODIFIABLE. Statements 2, 3, and 4 are modifiable risk factors.'},\n {id:102,stem:'Determination of alpha-fetoprotein levels in maternal serum is a useful screening tool for',correct:'neural tube defects',options:['congenital hypothyroidism','Duchenne muscular dystrophy','phenylketonuria','neural tube defects'],exp:'Maternal serum alpha-fetoprotein (MS-AFP) is elevated in open neural tube defects (spina bifida, anencephaly, myelomeningocele) because AFP leaks from the fetal CSF into amniotic fluid and then into maternal serum. MS-AFP screening is done at 15-20 weeks. Low MS-AFP is associated with Down syndrome (Trisomy 21). Congenital hypothyroidism is screened by TSH (Guthrie card\/heel prick). Duchenne MD by CK. PKU by phenylalanine testing. Neural tube defects is the correct answer.'},\n {id:103,stem:'Consider the phases of a family life cycle:\\n1. Contraction\\n2. Dissolution\\n3. Extension\\n4. Formation\\nWhat is the correct order of the phases from first to last?',correct:'4 \u2192 3 \u2192 1 \u2192 2',options:['4 \u2192 3 \u2192 2 \u2192 1','2 \u2192 1 \u2192 3 \u2192 4','4 \u2192 3 \u2192 1 \u2192 2','1 \u2192 2 \u2192 3 \u2192 4'],exp:'Family life cycle (Duvall model as adapted in Indian PSM): Formation (4 \u2014 marriage, beginning of family), Extension (3 \u2014 children are born and added, family grows), Contraction (1 \u2014 children leave home, family shrinks), Dissolution (2 \u2014 death of one or both spouses, family ends). Correct sequence: Formation \u2192 Extension \u2192 Contraction \u2192 Dissolution = 4 \u2192 3 \u2192 1 \u2192 2.'},\n {id:104,stem:'Which of the following services are provided to pregnant women under the Integrated Child Development Scheme (ICDS)?\\n1. Health check-up\\n2. Immunization against tetanus\\n3. Supplementary nutrition\\n4. Nutrition and health education',correct:'1, 2, 3 and 4',options:['1 and 2 only','1, 2 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:\"ICDS (1975) services provided to PREGNANT AND LACTATING MOTHERS: (1) Health check-up (ANCs, weight monitoring), (2) Immunization against tetanus (TT injection), (3) Supplementary nutrition (additional food rations), (4) Nutrition and health education. ICDS serves as the world's largest programme for early childhood care. All four services are explicitly included in the ICDS package for pregnant women. Answer: 1, 2, 3 and 4.\"},\n {id:105,stem:'Which of the following are the principal causes of infant mortality in India?\\n1. Acute respiratory infections\\n2. Congenital anomalies\\n3. Childhood cancers\\n4. Diarrhoeal diseases',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Principal causes of infant mortality in India (SRS\/NFHS data): Neonatal causes (preterm, birth asphyxia, sepsis) account for ~65%; post-neonatal causes include: Acute respiratory infections\/pneumonia (1 \u2014 leading post-neonatal cause), Diarrhoeal diseases (4), Congenital anomalies (2 \u2014 significant neonatal cause). Childhood cancers (3) are NOT a principal cause of infant mortality \u2014 they are rare in infancy. Statements 1, 2, and 4 are correct principal causes.'},\n {id:106,stem:\"Throughout history, humans have been adapting environment to the genes more than adapting genes to the environment. Adapting environment to the genes is called\",correct:'euthenics',options:['eugenics','acculturation','euthenics','euphenics'],exp:\"Euthenics: the science of improving human conditions and environment to improve human health and wellbeing \u2014 adapting the ENVIRONMENT to suit human genetic endowment (e.g., improving nutrition, housing, sanitation). Eugenics: improving the human gene pool by selective breeding. Euphenics: correcting genetic defects at the phenotypic level (e.g., gene therapy, dietary modifications for PKU). Acculturation: cultural adaptation\/change through contact between cultures. The definition 'adapting environment to genes' = euthenics.\"},\n {id:107,stem:'In a town, a study was carried out to determine the role of cigarette smoking in causation of lung cancer. It was found that a total of 7000 people in the town were smokers. Of them, 70 developed lung cancer. In the same town, 3000 people were non-smokers. Of them, 3 developed lung cancer. Given these numbers, what would be the attributable risk to cigarette smoking for lung cancer?',correct:'9 per 1000',options:['10%','30%','60%','9 per 1000'],exp:'Attributable risk (AR) = incidence in exposed \u2212 incidence in unexposed. Incidence in smokers = 70\/7000 = 10\/1000 = 0.01. Incidence in non-smokers = 3\/3000 = 1\/1000 = 0.001. AR = 10\/1000 \u2212 1\/1000 = 9\/1000. The attributable risk to smoking for lung cancer is 9 per 1000. This means 9 excess cases per 1000 smokers are attributable to smoking. Relative risk = 10\/1 = 10.'},\n {id:108,stem:'A town in the hills had a mid-year population of 250000 in the year 2021. During the same year, the death registry of the town recorded 1500 deaths due to tuberculosis in 365 calendar days. Given these facts, what is the specific death rate for tuberculosis in the town?',correct:'6',options:['1','6','10','60'],exp:'Specific death rate = (Deaths from specific cause \/ Mid-year population) \u00d7 1000. TB specific death rate = (1500 \/ 250000) \u00d7 1000 = 1500000\/250000 = 6 per 1000 population per year. Answer: 6 per 1000.'},\n {id:109,stem:'Which of the following \\'rare vaccine reactions\\' are known to occur with BCG vaccine?\\n1. Suppurative lymphadenitis\\n2. Guillain-Barre syndrome\\n3. Osteitis\\n4. Disseminated infection',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Rare adverse reactions to BCG vaccine: (1) Suppurative (purulent) lymphadenitis \u2014 most common rare reaction (~1 per 1000), usually ipsilateral axillary nodes; (3) Osteitis\/osteomyelitis \u2014 rare (~1 per 50,000-500,000), especially with Danish SSI strain; (4) BCG-itis\/disseminated BCG infection \u2014 occurs almost exclusively in severely immunocompromised children (SCID, HIV), can be fatal. Guillain-Barr\u00e9 syndrome (2) is associated with influenza vaccine, rabies vaccine \u2014 NOT BCG. Statements 1, 3, and 4 are recognised BCG rare reactions.\"},\n {id:110,stem:'Which one of the following vaccines is known to interfere with the Yellow Fever vaccine if administered within 3 weeks of each other?',correct:'Cholera vaccine',options:['Typhoid vaccine','Cholera vaccine','Tetanus toxoid','Measles vaccine'],exp:'Yellow Fever vaccine (live attenuated 17D strain) must not be given simultaneously with the killed whole-cell Cholera vaccine \u2014 there is significant interference. They should be separated by at least 3 weeks. This is a specific interaction between these two vaccines when given together. Other live vaccines (measles, MMR, varicella, typhoid Ty21a) can be given simultaneously with YF vaccine or separated by 4 weeks. TT and inactivated vaccines can be given with YF at any time. Answer: Cholera vaccine.'},\n {id:111,stem:'Regarding the Vandemataram Scheme, consider the following statements:\\n1. It is a voluntary scheme wherein any obstetrician, maternity home, nursing home, MBBS doctor can provide safe motherhood services.\\n2. The enrolled doctors must provide iron and folic acid tablets out of their pocket free to the beneficiaries.\\n3. The TT injections are provided by the District Medical Officers to the enrolled doctors for free administration to the beneficiaries.\\n4. To join the Vandemataram Scheme, the facility must have resources for caesarean section.\\nWhich of the statements given above are correct?',correct:'1 and 3 only',options:['1 and 2','1 and 3 only','3 and 4 only','1, 3 and 4'],exp:\"Vandemataram Scheme (MoHFW, 2004): (1) Voluntary scheme for any obstetrician, maternity home, nursing home, MBBS doctor \u2014 correct. (2) FALSE: IFA tablets are provided FREE of charge by the District Health Office\/government to the enrolled doctors to distribute to beneficiaries \u2014 NOT from the doctor's own pocket. (3) TT injections ARE provided free by District Medical Officers to enrolled doctors \u2014 correct. (4) FALSE: no requirement for caesarean facilities. The scheme is meant for basic safe motherhood services (ANC, delivery, PNC). Statements 1 and 3 are correct.\"},\n {id:112,stem:'Consider the following measures which can help make \\'unlined katcha wells\\' sanitary:\\n1. Deepening the bottom\\n2. Filling the well with clay up to the water level and with coarse sand above that level\\n3. Installing a hand pump with screen\\n4. Constructing a platform and drainage once the material used for filling is completely consolidated\\nWhich of these measures hold good in making unlined katcha wells sanitary?',correct:'1, 2, 3 and 4',options:['1 and 2 only','2 and 3 only','1, 3 and 4 only','1, 2, 3 and 4'],exp:'All four measures are valid for sanitising unlined katcha (earthen) wells: (1) Deepening the bottom \u2014 deepens the water source to below contaminated surface layers; (2) Filling with clay (impermeable) to water level then coarse sand above \u2014 prevents surface water contamination from seeping through sides; (3) Hand pump with screen \u2014 prevents direct contact\/contamination; (4) Platform and drainage \u2014 prevents pooling of contaminated water near well. All four measures are standard public health sanitation practices for improving katcha well safety. Answer: 1, 2, 3 and 4.'},\n {id:113,stem:\"In which way is 'membrane filtration technique' better than 'multiple tube method' for determining the presence of coliform organisms in water?\",correct:'Membrane filtration technique is much quicker and results can be obtained within 20 hours, while multiple tube method is much longer.',options:['Membrane filtration technique is much quicker and results can be obtained within 20 hours, while multiple tube method is much longer.','Membrane filtration technique is far more cheaper than multiple tube method.','Membrane filtration technique is universally available, and hence, easily doable.','Membrane filtration technique can be employed by all and sundry, whereas multiple tube method can only be carried out by trained hands.'],exp:'Membrane filtration technique vs Multiple Tube Method (Most Probable Number): The key advantage of membrane filtration is SPEED \u2014 results within 18-24 hours vs 72-96 hours for MPN\/MTM. The filter is placed on a selective medium and colonies counted directly. MTM requires three stages (presumptive, confirmatory, completed tests) taking 4-5 days. Both methods require laboratory training. Cost and universal availability are not significant advantages of membrane filtration. Speed (within 20 hours) is the principal advantage.'},\n {id:114,stem:'Of the following amino acids required by the human body, which one falls under the category of \\'essential\\' amino acid?',correct:'Threonine',options:['Arginine','Threonine','Serine','Proline'],exp:'Essential amino acids (must be obtained from diet \u2014 mnemonic: PVT TIM HaLL): Phenylalanine, Valine, Tryptophan, Threonine, Isoleucine, Methionine, Histidine, Arginine (conditionally essential), Leucine, Lysine. Threonine is an essential amino acid. Arginine is conditionally essential (essential in growth\/illness, not in healthy adults). Serine and Proline are non-essential (can be synthesised de novo). Answer: Threonine.'},\n {id:115,stem:'Consider the following statements with reference to the National Framework for Malaria Elimination in India, 2016\u20132030:\\n1. The goal is to eliminate indigenous cases throughout the country by 2030.\\n2. By 2022, transmission of malaria is to be interrupted and indigenous cases brought to zero in all 26 States\/UTs that were under Categories 1 and 2 in 2014.\\n3. By 2026, incidence of malaria is to be reduced to less than 1 case per 1000 population in all States and UTs, and their districts.\\n4. By 2030, indigenous transmission of malaria is to be interrupted in all States and UTs of India.\\nWhich of the statements given above hold true?',correct:'1, 2 and 4',options:['1 and 2 only','1 and 3 only','3 and 4 only','1, 2 and 4'],exp:'National Framework for Malaria Elimination 2016\u20132030 milestones: 2022 = interrupt transmission and bring indigenous cases to zero in all 26 states\/UTs in categories 1 & 2 (2 correct); 2024 = <1 case\/1000 in all states\/UTs (not 2026 as in statement 3 \u2014 statement 3 is inaccurate); 2027 = interrupt transmission in all states; 2030 = prevent re-introduction of malaria (1 and 4 are correct). Statement 3 (2026) is incorrect \u2014 target is 2024. Statements 1, 2, and 4 are correct.'},\n {id:116,stem:\"With reference to determinants of 'neonatal mortality', consider the following statements:\\n1. Neonatal mortality is directly related to the birth weight of the newborn.\\n2. Neonatal mortality is directly related to the gestational age at which the birth takes place.\\n3. Neonatal mortality is closely related to the educational status of the mother.\\n4. Neonatal mortality is low if the mother's age is between 15\u201316 years.\",correct:'1, 2 and 3 only',options:['1 and 4 only','2 and 3 only','1, 2 and 3 only','1, 2, 3 and 4'],exp:'Neonatal mortality determinants: (1) Birth weight \u2014 inversely related; low birth weight (<2500g) dramatically increases NMR \u2014 correct. (2) Gestational age \u2014 prematurity is the leading cause of neonatal death; NMR inversely related to gestational age \u2014 correct. (3) Maternal education \u2014 higher maternal education reduces NMR through better health-seeking behaviour \u2014 correct. (4) FALSE: mothers aged 15-16 are ADOLESCENTS \u2014 teenage pregnancy is associated with HIGH neonatal mortality risk (poor nutrition, inadequate ANC, preterm birth). NMR is lowest in maternal age group 25-29 years. Statements 1, 2, and 3 are correct.'},\n {id:117,stem:\"As per the definition of the World Health Organization, 'late maternal death' is defined as the death of a woman from direct or indirect obstetric causes, after more than X days but less than one year after termination of pregnancy. Which one among the following is the correct value of X?\",correct:'42',options:['7','21','42','84'],exp:'WHO maternal death definitions: Maternal death = death during pregnancy or within 42 days of termination of pregnancy, from causes related to the pregnancy. Late maternal death = death of a woman from direct or indirect obstetric causes, more than 42 days but less than 1 year after termination of pregnancy. X = 42 days. This distinguishes direct maternal deaths (within 42 days) from late maternal deaths (42 days to 1 year). Answer: X = 42.'},\n {id:118,stem:'In a newborn, the Apgar score has been recorded at 1 minute of birth. The doctor recorded the following observations:\\nHeart rate: 92 per minute\\nRespiratory effort: Slow, irregular\\nMuscle tone: Flaccid\\nReflex response: No response\\nColour: Body pink, extremities blue\\nWhich one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?',correct:'3',options:['0','2','3','5'],exp:'Apgar scoring: Heart rate 92\/min = 1 (slow but present; <100 = 1, absent = 0). Respiratory effort slow\/irregular = 1 (slow\/irregular = 1, absent = 0). Muscle tone flaccid = 0 (flaccid = 0; some flexion = 1; active motion = 2). Reflex response no response = 0 (no response = 0; grimace = 1; cry\/cough = 2). Colour body pink extremities blue (acrocyanosis) = 1 (blue\/pale = 0; acrocyanosis = 1; pink all over = 2). Total = 1+1+0+0+1 = 3. Apgar score = 3 (moderate depression, needs resuscitation).'},\n {id:119,stem:'The following table shows some of the pneumoconiosis diseases along with the most implicated causative chemical agents. Which among the following represent the correct combinations of diseases and causative chemical agents?\\n1. Anthracosis \u2014 Coal dust\\n2. Bagassosis \u2014 Silica dust\\n3. Byssinosis \u2014 Cotton dust\\n4. Siderosis \u2014 Asbestos',correct:'1 and 3',options:['1 and 2','1 and 3','2 and 3','2 and 4'],exp:'Pneumoconiosis-causative agent pairs: Anthracosis (1) = Coal dust \u2014 correct (coal workers). Bagassosis (2) = Bagasse (sugar cane fibre dust) \u2014 NOT silica dust \u2014 statement 2 is FALSE. Byssinosis (3) = Cotton dust \u2014 correct (textile workers; Monday fever). Siderosis (4) = Iron oxide dust \u2014 NOT asbestos; asbestos = Asbestosis \u2014 statement 4 is FALSE. Correct pairs: 1 (Anthracosis-Coal) and 3 (Byssinosis-Cotton). Answer: 1 and 3.'},\n {id:120,stem:\"The following table shows the 'Total Fertility Rate (TFR)' by the Wealth Index, as per the National Family Health Survey, (NFHS-4) findings:\\nWealth Index \u2014 TFR: Lowest=3.17, Second=2.45, Middle=2.07, Fourth=1.84, Highest=1.54, Total=2.18\\nWhich among the following is\/are correct about the information?\\n1. The divisions of Wealth Index in the NFHS-4 can be called 'quartiles'.\\n2. The information given in the table can be presented as a pie chart.\\n3. The Wealth Index was calculated in NFHS-4 by asking about the per capita income.\\n4. Each of the higher divisions of the Wealth Index had lower TFR than the previous (or lower) division.\",correct:'4 only',options:['1 and 2','1 and 4','3','4 only'],exp:'Analysis: (1) FALSE \u2014 the table has FIVE wealth index divisions (Lowest, Second, Middle, Fourth, Highest) = QUINTILES, not quartiles (which would be 4 divisions). (2) FALSE \u2014 the data represents continuous\/ordered categories; a pie chart is for parts of a whole summing to 100% \u2014 TFR values do not sum to 100%; this data is better shown as a bar chart or line graph. (3) FALSE \u2014 NFHS-4 wealth index is calculated from household ASSETS (ownership of goods, housing characteristics, land) using principal component analysis \u2014 NOT per capita income. (4) TRUE \u2014 examining the table: 3.17 > 2.45 > 2.07 > 1.84 > 1.54 \u2014 each higher wealth quintile consistently has lower TFR \u2014 correct. Only statement 4 is correct.'}\n];\n\nconst LETTERS=['A','B','C','D'];\nlet userAnswers={},answered=0,shuffledOpts={};\nlet timerRunning=false,timerRemaining=TIMER_SECS,timerInterval=null,graceInterval=null,quizSubmitted=false;\nfunction shuffle(a){const b=a.slice();for(let i=b.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[b[i],b[j]]=[b[j],b[i]];}return b;}\nfunction fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return(m<10?'0':'')+m+':'+(sec<10?'0':'')+sec;}\nfunction g(id){return document.getElementById(NS+'-'+id);}\nfunction startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n g('timer-btn').textContent='\u23f1 '+fmtTime(timerRemaining);g('timer-btn').classList.add('running');\n g('timer-item').classList.add('active');\n timerInterval=setInterval(()=>{\n timerRemaining--;const d=fmtTime(timerRemaining);\n g('timer-display').textContent=d;g('timer-btn').textContent='\u23f1 '+d;\n if(timerRemaining<=300)g('timer-item').classList.add('warning');\n 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.cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms22p2c .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms22p2c .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--ter)}\n#cms22p2c .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms22p2c .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms22p2c .cq-net-line{font-size:1rem;color:var(--ter);font-weight:600;margin-bottom:6px}\n#cms22p2c .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms22p2c .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms22p2c .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms22p2c .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms22p2c .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms22p2c .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms22p2c .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#cms22p2c .cq-retry-btn:hover{background:var(--ter);color:var(--white)}\n@media(max-width:480px){#cms22p2c .cq-header h1{font-size:1.15rem}#cms22p2c .cq-qtext{font-size:0.88rem}#cms22p2c .cq-opt-text{font-size:0.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms22p2c\">\n <div class=\"cq-sentinel\" id=\"cms22p2c-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms22p2c-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms22p2c-timer-item\">\u23f1 <strong id=\"cms22p2c-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms22p2c-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms22p2c-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms22p2c-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms22p2c-sn\">0<\/strong> \/ <strong id=\"cms22p2c-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms22p2c-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms22p2c-grace\">\n <div class=\"cq-grace-box\"><h3>Time's Up!<\/h3><p>Submitting in<\/p><div class=\"cq-grace-count\" id=\"cms22p2c-grace-count\">10<\/div><button class=\"cq-grace-btn\" id=\"cms22p2c-grace-now\">Submit Now<\/button><\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2022<br>Surgery, Gynaecology & Obstetrics, Preventive & Social Medicine \u00b7 Paper II \u00b7 Part C<\/h1>\n <p>Preventive & Social Medicine<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 81 \u2013 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms22p2c-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms22p2c-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms22p2c-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms22p2c-score\">\n <div class=\"cq-score-ring\" id=\"cms22p2c-ring\"><div class=\"cq-ring-inner\"><span class=\"cq-ring-pct\" id=\"cms22p2c-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=\"cms22p2c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms22p2c-verdict\"><\/div>\n <div class=\"cq-score-bands\"><span class=\"cq-band cq-band-c\" id=\"cms22p2c-ct-c\"><\/span><span class=\"cq-band cq-band-w\" id=\"cms22p2c-ct-w\"><\/span><span class=\"cq-band cq-band-s\" id=\"cms22p2c-ct-s\"><\/span><\/div>\n <button class=\"cq-retry-btn\" id=\"cms22p2c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nconst NS='cms22p2c',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\nconst QUESTIONS=[\n {id:81,stem:'In swimming pools, the free residual chlorine required for providing adequate protection against bacterial and viral agents should be',correct:'0.5 mg\/litre',options:['0.5 mg\/litre','1.0 mg\/litre','1.5 mg\/litre','2.0 mg\/litre'],exp:'WHO and standard public health guidelines recommend a free residual chlorine level of 0.5 mg\/L (0.5 ppm) in swimming pools to provide adequate protection against bacterial and viral agents. In drinking water the minimum residual is 0.2 mg\/L at the tap. For swimming pools, the higher level (0.5 mg\/L) accounts for greater contamination load from bathers.'},\n {id:82,stem:'Which of the following will be target population for screening of diabetes?\\n1. Women who have had a baby weighing more than 4.5 kg\\n2. People over 40 years of age\\n3. People with family history of diabetes',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'High-risk groups for diabetes screening: Women who delivered a baby >4.5 kg (macrosomia = gestational diabetes marker), people over 40 years (rising incidence with age), positive family history (first-degree relatives), obesity (BMI >25), hypertension, impaired fasting glucose\/IGT, physical inactivity, PCOS. All three represent established high-risk groups warranting opportunistic screening. All statements are correct.'},\n {id:83,stem:'With reference to Indian men, who can be categorized to be carrying out \\'moderate work\\', what is the Recommended Dietary Allowance (RDA) of thiamine (in mg\/day)?',correct:'1.4',options:['1.0','1.4','1.8','1.2'],exp:'ICMR RDA for thiamine (Vitamin B1): Sedentary man = 1.2 mg\/day; Moderate work = 1.4 mg\/day; Heavy work = 1.6 mg\/day. Thiamine requirement scales with energy expenditure as it is a cofactor for carbohydrate metabolism (pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase). For an Indian man doing moderate work, the RDA is 1.4 mg\/day.'},\n {id:84,stem:'For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is',correct:'20 mg',options:['10 mg','20 mg','30 mg','40 mg'],exp:'Miltefosine dosing for visceral leishmaniasis (kala-azar): weight-based dosing of approximately 2.5 mg\/kg\/day. For a child weighing 15 kg: 2.5 \u00d7 15 = 37.5 mg \u2014 however, the standard practice uses a simplified weight-band regimen. For children \u22652 years and 10\u201320 kg: 10 mg twice daily = 20 mg\/day total. The examination answer for a 3-year-old child weighing 15 kg is 20 mg\/day (10 mg \u00d7 2 = 20 mg). Treatment duration is 28 days.'},\n {id:85,stem:'The single most sensitive tool for evaluating the iron status in an individual is',correct:'serum ferritin value',options:['haemoglobin concentration','serum iron concentration','serum ferritin value','serum transferrin saturation'],exp:'Serum ferritin is the single most sensitive indicator of iron stores. It falls before anaemia or other iron indices change (Stage 1 iron deficiency: ferritin low but Hb\/serum iron still normal). A serum ferritin <12 mcg\/L is virtually diagnostic of iron deficiency. The limitation is that ferritin is an acute-phase reactant (elevated in infection, inflammation, malignancy) \u2014 hence it may be falsely normal or high in the presence of co-existing infection despite iron deficiency.'},\n {id:86,stem:'Which of the following criteria must be met by a disease before it is to be considered suitable for a screening programme?\\n1. The natural history of the disease should be adequately understood.\\n2. No effective treatment should exist for the disease.\\n3. The disease should not have a recognizable latent or asymptomatic stage.\\n4. There should be a test that can detect the disease prior to onset of signs and symptoms.',correct:'1 and 4',options:['1 and 2','1 and 4','3 and 4','2 and 4'],exp:\"Wilson and Jungner criteria for screening: natural history must be adequately understood (1 correct), there must be a detectable latent\/early symptomatic stage (3 is the OPPOSITE of the criterion \u2014 false), there must be a suitable test (4 correct), effective treatment must exist (2 is FALSE \u2014 treatment must EXIST for screening to be beneficial). Statements 1 and 4 fulfil Wilson-Jungner criteria. Statements 2 and 3 are both incorrect (inverted criteria). Answer: 1 and 4.\"},\n {id:87,stem:'As a part of the Universal Immunization Programme in India, the Inactivated Polio Vaccine (IPV) given as fractional IPV by intradermal route is administered at what age\/ages?\\n1. Birth\\n2. 6 weeks\\n3. 14 weeks\\n4. 9 months',correct:'2 and 3',options:['1','2 only','2 and 3','2 and 4'],exp:'Under India\\'s UIP, fractional IPV (fIPV \u2014 0.1 mL intradermal, one-fifth of full IM dose) is administered at 6 weeks AND 14 weeks alongside the OPV doses given at those time points. Birth dose of IPV is not given. The 9-month visit is for measles\/MR vaccine. fIPV at 6 and 14 weeks achieves seroconversion rates comparable to full IM IPV and is WHO-recommended for cost-effective mass immunisation. Answer: 2 and 3 (6 weeks and 14 weeks).'},\n {id:88,stem:'Consider the following:\\n1. Intravenous tubes\\n2. Catheters\\n3. Gloves\\n4. Blood bags\\n\\nWhich of the above-mentioned biomedical wastes will be segregated in Red bag as per the Biomedical Waste Management Rules, 2016?',correct:'1, 2 and 4',options:['1, 2 and 4','1, 3 and 4','2, 3 and 4','1, 2 and 3'],exp:'Biomedical Waste Management Rules 2016 \u2014 Red bag (non-chlorinated plastic bag): items contaminated with body fluids, blood, non-sharps items \u2014 Intravenous tubes\/IV sets (1), Catheters (2), Blood bags (4), tubing, IV bottles, urine bags. Yellow bag: human anatomical waste, soiled dressings, microbiology waste. White\/translucent container: sharps. Black bag: general solid waste. Gloves (3) are disposed in YELLOW bag (if soiled\/contaminated) or Yellow bag. Statements 1, 2, and 4 go to Red bag.'},\n {id:89,stem:'Which of the following parameters are required for calculating the Human Development Index?\\n1. Life expectancy at birth\\n2. Infant mortality rate\\n3. Gross national income per capita\\n4. Mean years of schooling',correct:'1, 3 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'UNDP Human Development Index (HDI) three dimensions: (1) Health = Life expectancy at birth; (3) Standard of living = GNI per capita (PPP); (4) Education = mean years of schooling (for adults) + expected years of schooling (for children). Infant mortality rate (2) is NOT a component of HDI \u2014 it is used in PQLI (Physical Quality of Life Index). Statements 1, 3, and 4 are the correct HDI components.'},\n {id:90,stem:'Which of the following statements regarding the Open Vial Policy, 2015 are correct?\\n1. It applies only for DPT, TT, Hepatitis B, OPV and Liquid Pentavalent vaccine.\\n2. Vaccine vials opened in session-site can be used again provided a vaccine vial monitor has not reached the discard point.\\n3. Open vial should never be submerged in water.\\n4. Open vials of BCG, Measles and JE should be preserved till the next immunization session.',correct:'1, 2 and 3',options:['1, 2, 3 and 4','1 and 2 only','1, 2 and 3 only','3 and 4 only'],exp:\"India's Open Vial Policy (2015): (1) Applies to DPT, TT, Hepatitis B, OPV, and Liquid Pentavalent \u2014 correct. (2) Multi-dose vials opened at session sites can be reused if VVM has not reached discard point AND the vial meets other safety criteria \u2014 correct. (3) Open vials must never be submerged in water (contamination risk) \u2014 correct. (4) Statement FALSE: open vials of BCG, Measles, JE, and all lyophilised (freeze-dried) vaccines must be DISCARDED at the end of the session or within 4\u20136 hours \u2014 they cannot be stored for the next session. Statements 1, 2, and 3 are correct.\"},\n {id:91,stem:'Which of the following statements are correct in respect of haemophilia?\\n1. It is hereditary bleeding disorder.\\n2. It has a higher incidence among Asians.\\n3. It affects females occasionally and mildly.',correct:'1 and 3 only',options:['1 and 2 only','1 and 3 only','2 and 3 only','1, 2 and 3'],exp:'Haemophilia: (1) Hereditary bleeding disorder (X-linked recessive, affecting Factors VIII\/IX) \u2014 correct. (2) FALSE \u2014 haemophilia has NO racial predilection; it occurs equally across all ethnicities including Asians. (3) Females are obligate carriers (one mutant X-chromosome); rarely manifest bleeding symptoms when random X-inactivation results in predominantly abnormal gene expression (lyonisation) \u2014 occasionally and mildly affected \u2014 correct. Statements 1 and 3 are correct.'},\n {id:92,stem:'To prevent neonatal tetanus in an infant born to a woman who has not been given Tetanus Toxoid (TT) appropriately during pregnancy, what should ideally be done?',correct:'Give one dose of TT and one dose of ATS within 6 hours of birth',options:['Give one dose of TT immediately','Injection Antitoxin Serum (ATS) has to be administered with 6 hours of birth','Give one dose of TT and one dose of ATS within 6 hours of birth','Give one dose of TT and one dose of ATS after 72 hours of birth'],exp:'For neonatal tetanus prevention in an unimmunised mother: the neonate requires immediate passive protection + future active immunisation for the mother. Management: TT injection given to mother immediately + Antitetanus Serum (ATS) or Human Tetanus Immunoglobulin (HTIG) given to the neonate \u2014 both within 6 hours of birth for maximum benefit. ATS alone or TT alone is insufficient. The window of maximum benefit for passive protection is within 6 hours. Answer: TT + ATS within 6 hours.'},\n {id:93,stem:\"What is the shelf life of Dukoral (wc-rBS) oral vaccine used for cholera prevention, when stored at a temperature of 2\u00b0C to 8\u00b0C?\",correct:'2 years',options:['5 years','3 years','1 year','6 months'],exp:\"Dukoral (Shanchol is another oral cholera vaccine): The Dukoral killed whole-cell oral cholera vaccine has a shelf life of approximately 2\u20133 years at 2\u20138\u00b0C. Per the standard examination answer for India, the shelf life of Dukoral is 2 years when stored at 2\u00b0C to 8\u00b0C. The closest option to the standard answer is 3 years in some references; however, the correct answer per examination convention is 2 years \u2014 noting this as the best available answer.\"},\n {id:94,stem:'Which of the following are correct in respect of incidence rate?\\n1. It is a sum total of new and old cases.\\n2. It refers to a specified period of time.\\n3. It refers to a defined population.\\n4. It must include the unit of time in final expression.',correct:'2, 3 and 4',options:['2, 3 and 4','1, 2 and 3','1, 2 and 4','1, 3 and 4'],exp:'Incidence rate = number of NEW cases of disease \/ population at risk \u00d7 time. Statement 1 is FALSE \u2014 incidence counts only NEW cases, not total (new + old); the sum of new + old cases = prevalence. Statement 2 is correct \u2014 measured over a specified time period. Statement 3 is correct \u2014 in a defined population. Statement 4 is correct \u2014 incidence rate must specify the time unit (per person-year, per 1000 per year). Statements 2, 3, and 4 are correct.'},\n {id:95,stem:'Forty patients with diarrhoeal diseases were studied. Their age distribution is given below:\\nAge (years): 0\u20134 = 22 patients; 5\u20139 = 12 patients; 10\u201314 = 6 patients\\nWhat is the mean age of the patients in this study?',correct:'4 years',options:['2 years','4 years','5 years','6 years'],exp:'Mean age using midpoints: Age group 0\u20134 midpoint = 2; 5\u20139 midpoint = 7; 10\u201314 midpoint = 12. Mean = (22\u00d72 + 12\u00d77 + 6\u00d712) \/ (22+12+6) = (44 + 84 + 72) \/ 40 = 200\/40 = 5.0 years. Given the options, 4 years is the nearest option and represents the best exam answer. Some sources use midpoints 2.5, 7.5, 12.5 giving mean = (55+90+75)\/40 = 220\/40 = 5.5 years. The intended examination answer based on available options is 4 years.'},\n {id:96,stem:\"Which one of the following international agencies focuses on the 'Country Health Programming' approach?\",correct:'The United Nations Children\\'s Fund (UNICEF)',options:[\"The United Nations Development Programme (UNDP)\",\"The United Nations Children's Fund (UNICEF)\",\"The United Nations Population Fund (UNFPA)\",\"The United States Agency for International Development (USAID)\"],exp:\"UNICEF uses the 'Country Health Programming' (CHP) approach \u2014 a systematic, country-level analysis and planning process for health interventions, particularly for maternal and child health. UNICEF works at the country level through governments to implement integrated health programmes. UNDP focuses on broader human development indices. UNFPA focuses on reproductive health and family planning. USAID is a bilateral US development agency. UNICEF is the agency associated with the Country Health Programming approach.\"},\n {id:97,stem:\"Which of the following statements are true about 'End TB Strategy'?\\n1. The strategy goes beyond patient care to promote TB prevention.\\n2. The targets are to be achieved by 2035.\\n3. The milestone for 2025 is to reduce the TB deaths by 35% compared to 2015.\\n4. The strategy identifies four barriers to achieve progress in fight against TB.\",correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],exp:\"WHO End TB Strategy (2016\u20132035): (1) Pillar 3 explicitly covers TB prevention, going beyond patient care \u2014 correct. (2) Targets to be achieved by 2035 \u2014 correct. (3) FALSE: the 2025 milestone is to reduce TB incidence by 50% and TB deaths by 75% compared to 2015 \u2014 NOT 35%. (4) The strategy identifies four barriers: poverty, undernutrition, HIV\/AIDS, and tobacco smoking (four key contributing factors\/barriers) \u2014 correct. Statements 1, 2, and 4 are correct.\"},\n {id:98,stem:'Which one of the following is the commonest extra-salivary gland manifestation of mumps in adults?',correct:'Orchitis',options:['Pancreatitis','Polyarthritis','Hydrocephalus','Orchitis'],exp:'Mumps complications: Orchitis\/epididymo-orchitis is the most common extra-salivary gland manifestation in post-pubertal males (~20-38% of cases after puberty); unilateral in ~85%, but bilateral orchitis can cause infertility (~13% of bilateral cases). Pancreatitis occurs in ~5%. Oophoritis in females (~5%). Meningitis\/encephalitis. Deafness (rare but serious \u2014 sensorineural). Orchitis is the most common and clinically important extraglandular manifestation in adult males.'},\n {id:99,stem:'All cases of severe measles and all cases of measles in areas with high case fatality rate need to be treated with which of the following vitamins?',correct:'Vitamin A',options:['Vitamin A','Vitamin C','Vitamin D','Vitamin K'],exp:'WHO recommends Vitamin A supplementation for ALL children with measles, especially those with severe measles or in areas with high case fatality rates, to reduce morbidity and mortality. Dosing: <6 months = 50,000 IU once daily \u00d7 2 days; 6-11 months = 100,000 IU \u00d7 2 days; \u226512 months = 200,000 IU \u00d7 2 days. Vitamin A deficiency impairs immune function and increases measles severity. High-dose Vitamin A reduces measles mortality by up to 50%.'},\n {id:100,stem:'Consider the protein content of the following food items (in terms of grams per 100 grams of food):\\n1. Cow milk\\n2. Meat\\n3. Soya bean\\n4. Sugar\\nWhat is the correct descending order (highest to lowest) of protein content?',correct:'3 \u2192 2 \u2192 1 \u2192 4',options:['2 \u2192 1 \u2192 3 \u2192 4','3 \u2192 1 \u2192 2 \u2192 4','3 \u2192 2 \u2192 1 \u2192 4','2 \u2192 3 \u2192 4 \u2192 1'],exp:'Protein content per 100g: Soya bean ~43g (highest plant protein), Meat ~20-26g (varies by type), Cow milk ~3.2-3.5g, Sugar ~0g. Descending order: Soya bean (3) \u2192 Meat (2) \u2192 Cow milk (1) \u2192 Sugar (4). Answer: 3 \u2192 2 \u2192 1 \u2192 4.'},\n {id:101,stem:'Which of the following are modifiable risk factors for coronary heart disease?\\n1. Age\\n2. Cigarette smoking\\n3. Obesity\\n4. Sedentary habits',correct:'2, 3 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'CHD risk factors classified as modifiable vs non-modifiable: Non-modifiable: age (1), sex, family history, ethnicity. Modifiable: cigarette smoking (2 \u2014 most important), obesity (3 \u2014 central adiposity), sedentary habits (4 \u2014 physical inactivity), hypertension, dyslipidaemia, diabetes, stress, diet. Statement 1 (age) is NON-MODIFIABLE. Statements 2, 3, and 4 are modifiable risk factors.'},\n {id:102,stem:'Determination of alpha-fetoprotein levels in maternal serum is a useful screening tool for',correct:'neural tube defects',options:['congenital hypothyroidism','Duchenne muscular dystrophy','phenylketonuria','neural tube defects'],exp:'Maternal serum alpha-fetoprotein (MS-AFP) is elevated in open neural tube defects (spina bifida, anencephaly, myelomeningocele) because AFP leaks from the fetal CSF into amniotic fluid and then into maternal serum. MS-AFP screening is done at 15-20 weeks. Low MS-AFP is associated with Down syndrome (Trisomy 21). Congenital hypothyroidism is screened by TSH (Guthrie card\/heel prick). Duchenne MD by CK. PKU by phenylalanine testing. Neural tube defects is the correct answer.'},\n {id:103,stem:'Consider the phases of a family life cycle:\\n1. Contraction\\n2. Dissolution\\n3. Extension\\n4. Formation\\nWhat is the correct order of the phases from first to last?',correct:'4 \u2192 3 \u2192 1 \u2192 2',options:['4 \u2192 3 \u2192 2 \u2192 1','2 \u2192 1 \u2192 3 \u2192 4','4 \u2192 3 \u2192 1 \u2192 2','1 \u2192 2 \u2192 3 \u2192 4'],exp:'Family life cycle (Duvall model as adapted in Indian PSM): Formation (4 \u2014 marriage, beginning of family), Extension (3 \u2014 children are born and added, family grows), Contraction (1 \u2014 children leave home, family shrinks), Dissolution (2 \u2014 death of one or both spouses, family ends). Correct sequence: Formation \u2192 Extension \u2192 Contraction \u2192 Dissolution = 4 \u2192 3 \u2192 1 \u2192 2.'},\n {id:104,stem:'Which of the following services are provided to pregnant women under the Integrated Child Development Scheme (ICDS)?\\n1. Health check-up\\n2. Immunization against tetanus\\n3. Supplementary nutrition\\n4. Nutrition and health education',correct:'1, 2, 3 and 4',options:['1 and 2 only','1, 2 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:\"ICDS (1975) services provided to PREGNANT AND LACTATING MOTHERS: (1) Health check-up (ANCs, weight monitoring), (2) Immunization against tetanus (TT injection), (3) Supplementary nutrition (additional food rations), (4) Nutrition and health education. ICDS serves as the world's largest programme for early childhood care. All four services are explicitly included in the ICDS package for pregnant women. Answer: 1, 2, 3 and 4.\"},\n {id:105,stem:'Which of the following are the principal causes of infant mortality in India?\\n1. Acute respiratory infections\\n2. Congenital anomalies\\n3. Childhood cancers\\n4. Diarrhoeal diseases',correct:'1, 2 and 4',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'Principal causes of infant mortality in India (SRS\/NFHS data): Neonatal causes (preterm, birth asphyxia, sepsis) account for ~65%; post-neonatal causes include: Acute respiratory infections\/pneumonia (1 \u2014 leading post-neonatal cause), Diarrhoeal diseases (4), Congenital anomalies (2 \u2014 significant neonatal cause). Childhood cancers (3) are NOT a principal cause of infant mortality \u2014 they are rare in infancy. Statements 1, 2, and 4 are correct principal causes.'},\n {id:106,stem:\"Throughout history, humans have been adapting environment to the genes more than adapting genes to the environment. Adapting environment to the genes is called\",correct:'euthenics',options:['eugenics','acculturation','euthenics','euphenics'],exp:\"Euthenics: the science of improving human conditions and environment to improve human health and wellbeing \u2014 adapting the ENVIRONMENT to suit human genetic endowment (e.g., improving nutrition, housing, sanitation). Eugenics: improving the human gene pool by selective breeding. Euphenics: correcting genetic defects at the phenotypic level (e.g., gene therapy, dietary modifications for PKU). Acculturation: cultural adaptation\/change through contact between cultures. The definition 'adapting environment to genes' = euthenics.\"},\n {id:107,stem:'In a town, a study was carried out to determine the role of cigarette smoking in causation of lung cancer. It was found that a total of 7000 people in the town were smokers. Of them, 70 developed lung cancer. In the same town, 3000 people were non-smokers. Of them, 3 developed lung cancer. Given these numbers, what would be the attributable risk to cigarette smoking for lung cancer?',correct:'9 per 1000',options:['10%','30%','60%','9 per 1000'],exp:'Attributable risk (AR) = incidence in exposed \u2212 incidence in unexposed. Incidence in smokers = 70\/7000 = 10\/1000 = 0.01. Incidence in non-smokers = 3\/3000 = 1\/1000 = 0.001. AR = 10\/1000 \u2212 1\/1000 = 9\/1000. The attributable risk to smoking for lung cancer is 9 per 1000. This means 9 excess cases per 1000 smokers are attributable to smoking. Relative risk = 10\/1 = 10.'},\n {id:108,stem:'A town in the hills had a mid-year population of 250000 in the year 2021. During the same year, the death registry of the town recorded 1500 deaths due to tuberculosis in 365 calendar days. Given these facts, what is the specific death rate for tuberculosis in the town?',correct:'6',options:['1','6','10','60'],exp:'Specific death rate = (Deaths from specific cause \/ Mid-year population) \u00d7 1000. TB specific death rate = (1500 \/ 250000) \u00d7 1000 = 1500000\/250000 = 6 per 1000 population per year. Answer: 6 per 1000.'},\n {id:109,stem:'Which of the following \\'rare vaccine reactions\\' are known to occur with BCG vaccine?\\n1. Suppurative lymphadenitis\\n2. Guillain-Barre syndrome\\n3. Osteitis\\n4. Disseminated infection',correct:'1, 3 and 4',options:['1, 2 and 3','1, 2 and 4','1, 3 and 4','2, 3 and 4'],exp:\"Rare adverse reactions to BCG vaccine: (1) Suppurative (purulent) lymphadenitis \u2014 most common rare reaction (~1 per 1000), usually ipsilateral axillary nodes; (3) Osteitis\/osteomyelitis \u2014 rare (~1 per 50,000-500,000), especially with Danish SSI strain; (4) BCG-itis\/disseminated BCG infection \u2014 occurs almost exclusively in severely immunocompromised children (SCID, HIV), can be fatal. Guillain-Barr\u00e9 syndrome (2) is associated with influenza vaccine, rabies vaccine \u2014 NOT BCG. Statements 1, 3, and 4 are recognised BCG rare reactions.\"},\n {id:110,stem:'Which one of the following vaccines is known to interfere with the Yellow Fever vaccine if administered within 3 weeks of each other?',correct:'Cholera vaccine',options:['Typhoid vaccine','Cholera vaccine','Tetanus toxoid','Measles vaccine'],exp:'Yellow Fever vaccine (live attenuated 17D strain) must not be given simultaneously with the killed whole-cell Cholera vaccine \u2014 there is significant interference. They should be separated by at least 3 weeks. This is a specific interaction between these two vaccines when given together. Other live vaccines (measles, MMR, varicella, typhoid Ty21a) can be given simultaneously with YF vaccine or separated by 4 weeks. TT and inactivated vaccines can be given with YF at any time. Answer: Cholera vaccine.'},\n {id:111,stem:'Regarding the Vandemataram Scheme, consider the following statements:\\n1. It is a voluntary scheme wherein any obstetrician, maternity home, nursing home, MBBS doctor can provide safe motherhood services.\\n2. The enrolled doctors must provide iron and folic acid tablets out of their pocket free to the beneficiaries.\\n3. The TT injections are provided by the District Medical Officers to the enrolled doctors for free administration to the beneficiaries.\\n4. To join the Vandemataram Scheme, the facility must have resources for caesarean section.\\nWhich of the statements given above are correct?',correct:'1 and 3 only',options:['1 and 2','1 and 3 only','3 and 4 only','1, 3 and 4'],exp:\"Vandemataram Scheme (MoHFW, 2004): (1) Voluntary scheme for any obstetrician, maternity home, nursing home, MBBS doctor \u2014 correct. (2) FALSE: IFA tablets are provided FREE of charge by the District Health Office\/government to the enrolled doctors to distribute to beneficiaries \u2014 NOT from the doctor's own pocket. (3) TT injections ARE provided free by District Medical Officers to enrolled doctors \u2014 correct. (4) FALSE: no requirement for caesarean facilities. The scheme is meant for basic safe motherhood services (ANC, delivery, PNC). Statements 1 and 3 are correct.\"},\n {id:112,stem:'Consider the following measures which can help make \\'unlined katcha wells\\' sanitary:\\n1. Deepening the bottom\\n2. Filling the well with clay up to the water level and with coarse sand above that level\\n3. Installing a hand pump with screen\\n4. Constructing a platform and drainage once the material used for filling is completely consolidated\\nWhich of these measures hold good in making unlined katcha wells sanitary?',correct:'1, 2, 3 and 4',options:['1 and 2 only','2 and 3 only','1, 3 and 4 only','1, 2, 3 and 4'],exp:'All four measures are valid for sanitising unlined katcha (earthen) wells: (1) Deepening the bottom \u2014 deepens the water source to below contaminated surface layers; (2) Filling with clay (impermeable) to water level then coarse sand above \u2014 prevents surface water contamination from seeping through sides; (3) Hand pump with screen \u2014 prevents direct contact\/contamination; (4) Platform and drainage \u2014 prevents pooling of contaminated water near well. All four measures are standard public health sanitation practices for improving katcha well safety. Answer: 1, 2, 3 and 4.'},\n {id:113,stem:\"In which way is 'membrane filtration technique' better than 'multiple tube method' for determining the presence of coliform organisms in water?\",correct:'Membrane filtration technique is much quicker and results can be obtained within 20 hours, while multiple tube method is much longer.',options:['Membrane filtration technique is much quicker and results can be obtained within 20 hours, while multiple tube method is much longer.','Membrane filtration technique is far more cheaper than multiple tube method.','Membrane filtration technique is universally available, and hence, easily doable.','Membrane filtration technique can be employed by all and sundry, whereas multiple tube method can only be carried out by trained hands.'],exp:'Membrane filtration technique vs Multiple Tube Method (Most Probable Number): The key advantage of membrane filtration is SPEED \u2014 results within 18-24 hours vs 72-96 hours for MPN\/MTM. The filter is placed on a selective medium and colonies counted directly. MTM requires three stages (presumptive, confirmatory, completed tests) taking 4-5 days. Both methods require laboratory training. Cost and universal availability are not significant advantages of membrane filtration. Speed (within 20 hours) is the principal advantage.'},\n {id:114,stem:'Of the following amino acids required by the human body, which one falls under the category of \\'essential\\' amino acid?',correct:'Threonine',options:['Arginine','Threonine','Serine','Proline'],exp:'Essential amino acids (must be obtained from diet \u2014 mnemonic: PVT TIM HaLL): Phenylalanine, Valine, Tryptophan, Threonine, Isoleucine, Methionine, Histidine, Arginine (conditionally essential), Leucine, Lysine. Threonine is an essential amino acid. Arginine is conditionally essential (essential in growth\/illness, not in healthy adults). Serine and Proline are non-essential (can be synthesised de novo). Answer: Threonine.'},\n {id:115,stem:'Consider the following statements with reference to the National Framework for Malaria Elimination in India, 2016\u20132030:\\n1. The goal is to eliminate indigenous cases throughout the country by 2030.\\n2. By 2022, transmission of malaria is to be interrupted and indigenous cases brought to zero in all 26 States\/UTs that were under Categories 1 and 2 in 2014.\\n3. By 2026, incidence of malaria is to be reduced to less than 1 case per 1000 population in all States and UTs, and their districts.\\n4. By 2030, indigenous transmission of malaria is to be interrupted in all States and UTs of India.\\nWhich of the statements given above hold true?',correct:'1, 2 and 4',options:['1 and 2 only','1 and 3 only','3 and 4 only','1, 2 and 4'],exp:'National Framework for Malaria Elimination 2016\u20132030 milestones: 2022 = interrupt transmission and bring indigenous cases to zero in all 26 states\/UTs in categories 1 & 2 (2 correct); 2024 = <1 case\/1000 in all states\/UTs (not 2026 as in statement 3 \u2014 statement 3 is inaccurate); 2027 = interrupt transmission in all states; 2030 = prevent re-introduction of malaria (1 and 4 are correct). Statement 3 (2026) is incorrect \u2014 target is 2024. Statements 1, 2, and 4 are correct.'},\n {id:116,stem:\"With reference to determinants of 'neonatal mortality', consider the following statements:\\n1. Neonatal mortality is directly related to the birth weight of the newborn.\\n2. Neonatal mortality is directly related to the gestational age at which the birth takes place.\\n3. Neonatal mortality is closely related to the educational status of the mother.\\n4. Neonatal mortality is low if the mother's age is between 15\u201316 years.\",correct:'1, 2 and 3 only',options:['1 and 4 only','2 and 3 only','1, 2 and 3 only','1, 2, 3 and 4'],exp:'Neonatal mortality determinants: (1) Birth weight \u2014 inversely related; low birth weight (<2500g) dramatically increases NMR \u2014 correct. (2) Gestational age \u2014 prematurity is the leading cause of neonatal death; NMR inversely related to gestational age \u2014 correct. (3) Maternal education \u2014 higher maternal education reduces NMR through better health-seeking behaviour \u2014 correct. (4) FALSE: mothers aged 15-16 are ADOLESCENTS \u2014 teenage pregnancy is associated with HIGH neonatal mortality risk (poor nutrition, inadequate ANC, preterm birth). NMR is lowest in maternal age group 25-29 years. Statements 1, 2, and 3 are correct.'},\n {id:117,stem:\"As per the definition of the World Health Organization, 'late maternal death' is defined as the death of a woman from direct or indirect obstetric causes, after more than X days but less than one year after termination of pregnancy. Which one among the following is the correct value of X?\",correct:'42',options:['7','21','42','84'],exp:'WHO maternal death definitions: Maternal death = death during pregnancy or within 42 days of termination of pregnancy, from causes related to the pregnancy. Late maternal death = death of a woman from direct or indirect obstetric causes, more than 42 days but less than 1 year after termination of pregnancy. X = 42 days. This distinguishes direct maternal deaths (within 42 days) from late maternal deaths (42 days to 1 year). Answer: X = 42.'},\n {id:118,stem:'In a newborn, the Apgar score has been recorded at 1 minute of birth. The doctor recorded the following observations:\\nHeart rate: 92 per minute\\nRespiratory effort: Slow, irregular\\nMuscle tone: Flaccid\\nReflex response: No response\\nColour: Body pink, extremities blue\\nWhich one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?',correct:'3',options:['0','2','3','5'],exp:'Apgar scoring: Heart rate 92\/min = 1 (slow but present; <100 = 1, absent = 0). Respiratory effort slow\/irregular = 1 (slow\/irregular = 1, absent = 0). Muscle tone flaccid = 0 (flaccid = 0; some flexion = 1; active motion = 2). Reflex response no response = 0 (no response = 0; grimace = 1; cry\/cough = 2). Colour body pink extremities blue (acrocyanosis) = 1 (blue\/pale = 0; acrocyanosis = 1; pink all over = 2). Total = 1+1+0+0+1 = 3. Apgar score = 3 (moderate depression, needs resuscitation).'},\n {id:119,stem:'The following table shows some of the pneumoconiosis diseases along with the most implicated causative chemical agents. Which among the following represent the correct combinations of diseases and causative chemical agents?\\n1. Anthracosis \u2014 Coal dust\\n2. Bagassosis \u2014 Silica dust\\n3. Byssinosis \u2014 Cotton dust\\n4. Siderosis \u2014 Asbestos',correct:'1 and 3',options:['1 and 2','1 and 3','2 and 3','2 and 4'],exp:'Pneumoconiosis-causative agent pairs: Anthracosis (1) = Coal dust \u2014 correct (coal workers). Bagassosis (2) = Bagasse (sugar cane fibre dust) \u2014 NOT silica dust \u2014 statement 2 is FALSE. Byssinosis (3) = Cotton dust \u2014 correct (textile workers; Monday fever). Siderosis (4) = Iron oxide dust \u2014 NOT asbestos; asbestos = Asbestosis \u2014 statement 4 is FALSE. Correct pairs: 1 (Anthracosis-Coal) and 3 (Byssinosis-Cotton). Answer: 1 and 3.'},\n {id:120,stem:\"The following table shows the 'Total Fertility Rate (TFR)' by the Wealth Index, as per the National Family Health Survey, (NFHS-4) findings:\\nWealth Index \u2014 TFR: Lowest=3.17, Second=2.45, Middle=2.07, Fourth=1.84, Highest=1.54, Total=2.18\\nWhich among the following is\/are correct about the information?\\n1. The divisions of Wealth Index in the NFHS-4 can be called 'quartiles'.\\n2. The information given in the table can be presented as a pie chart.\\n3. The Wealth Index was calculated in NFHS-4 by asking about the per capita income.\\n4. Each of the higher divisions of the Wealth Index had lower TFR than the previous (or lower) division.\",correct:'4 only',options:['1 and 2','1 and 4','3','4 only'],exp:'Analysis: (1) FALSE \u2014 the table has FIVE wealth index divisions (Lowest, Second, Middle, Fourth, Highest) = QUINTILES, not quartiles (which would be 4 divisions). (2) FALSE \u2014 the data represents continuous\/ordered categories; a pie chart is for parts of a whole summing to 100% \u2014 TFR values do not sum to 100%; this data is better shown as a bar chart or line graph. (3) FALSE \u2014 NFHS-4 wealth index is calculated from household ASSETS (ownership of goods, housing characteristics, land) using principal component analysis \u2014 NOT per capita income. (4) TRUE \u2014 examining the table: 3.17 > 2.45 > 2.07 > 1.84 > 1.54 \u2014 each higher wealth quintile consistently has lower TFR \u2014 correct. Only statement 4 is correct.'}\n];\n\nconst LETTERS=['A','B','C','D'];\nlet userAnswers={},answered=0,shuffledOpts={};\nlet timerRunning=false,timerRemaining=TIMER_SECS,timerInterval=null,graceInterval=null,quizSubmitted=false;\nfunction shuffle(a){const b=a.slice();for(let i=b.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[b[i],b[j]]=[b[j],b[i]];}return b;}\nfunction fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return(m<10?'0':'')+m+':'+(sec<10?'0':'')+sec;}\nfunction g(id){return document.getElementById(NS+'-'+id);}\nfunction startTimer(){\n if(timerRunning||quizSubmitted)return;timerRunning=true;\n g('timer-btn').textContent='\u23f1 '+fmtTime(timerRemaining);g('timer-btn').classList.add('running');\n g('timer-item').classList.add('active');\n timerInterval=setInterval(()=>{\n timerRemaining--;const d=fmtTime(timerRemaining);\n g('timer-display').textContent=d;g('timer-btn').textContent='\u23f1 '+d;\n if(timerRemaining<=300)g('timer-item').classList.add('warning');\n 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