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Display\",serif;font-size:1.15rem;color:var(--bad);margin-bottom:8px}\n.qz-grace-box p{font-size:0.85rem;color:var(--ink-mid);margin-bottom:14px}\n.qz-grace-n{font-family:\"Playfair Display\",serif;font-size:2.8rem;font-weight:700;color:var(--bad);line-height:1;margin-bottom:16px}\n.qz-grace-now{background:var(--bad);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:\"Playfair Display\",serif;font-size:0.9rem;font-weight:700;cursor:pointer}\n.qz-grace-now:hover{background:#c62828}\n\n@media(max-width:480px){\n .qz-header h1{font-size:1.05rem}\n .qz-stem{font-size:0.87rem}\n .qz-opt-txt{font-size:0.84rem}\n .qz-prog-stats{font-size:0.68rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms23p1a\">\n\n<div class=\"qz-prog-bar\" id=\"qz-prog-bar\">\n <div class=\"qz-prog-stats\">\n <div class=\"qz-stat\">✓️ <strong id=\"qz-sc\">0<\/strong><\/div>\n <div class=\"qz-stat\">❌ <strong id=\"qz-sw\">0<\/strong><\/div>\n <div class=\"qz-stat\">⏳ <strong id=\"qz-sr\">40<\/strong> left<\/div>\n <div class=\"qz-timer-wrap\">\n <div class=\"qz-timer\" id=\"qz-timer\">⏱ <strong id=\"qz-td\">40:00<\/strong><\/div>\n <div class=\"qz-stat net-score\">Net <strong id=\"qz-sn\">0<\/strong> \/ 160<\/div>\n <\/div>\n <\/div>\n <div class=\"qz-prog-track\"><div class=\"qz-prog-fill\" id=\"qz-fill\"><\/div><\/div>\n<\/div>\n\n<div class=\"qz-grace\" id=\"qz-grace\">\n <div class=\"qz-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"qz-grace-n\" id=\"qz-gn\">10<\/div>\n <button class=\"qz-grace-now\" id=\"qz-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-header\">\n <h1>Combined Medical Services Examination 2023<br>General Medicine & Paediatrics · Paper I · Part B<\/h1>\n <p>Endocrinology · Infectious Disease · Parasitology · Nephrology<\/p>\n <div class=\"qz-meta\">\n <span class=\"qz-badge\">Questions 41–80<\/span>\n <span class=\"qz-badge\">Options reshuffled<\/span>\n <span class=\"qz-badge\">Score = c × 4 − w<\/span>\n <button class=\"qz-timer-btn\" id=\"qz-tbtn\">⏱ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-body\">\n <div id=\"qz-questions\"><\/div>\n <div class=\"qz-submit-wrap\">\n <button class=\"qz-submit\" id=\"qz-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"qz-result\" id=\"qz-result\">\n <div class=\"qz-ring\" id=\"qz-ring\">\n <div class=\"qz-ring-inner\">\n <div class=\"qz-ring-pct\" id=\"qz-rpct\">0%<\/div>\n <div class=\"qz-ring-sub\">score<\/div>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"qz-net\" id=\"qz-rnet\"><\/div>\n <div class=\"qz-verdict\" id=\"qz-rv\"><\/div>\n <div class=\"qz-bands\">\n <span class=\"qz-band bc\" id=\"qz-bc\"><\/span>\n <span class=\"qz-band bw\" id=\"qz-bw\"><\/span>\n <span class=\"qz-band bs\" id=\"qz-bs\"><\/span>\n <\/div>\n <button class=\"qz-retry\" id=\"qz-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n\n<\/div>\n\n<script>\n(function(){\n\nvar TOTAL = 40, MAX = 160;\nvar TSECS = 2400, GSECS = 10;\nvar LTRS = [\"A\",\"B\",\"C\",\"D\"];\n\nvar QQ = [\n{id:41,\nstem:\"Which one of the following insulin preparations has the longest effective duration of action?\",\ncorrect:\"Degludec\",\nopts:[\"Detemir\",\"Glargine\",\"NPH\",\"Degludec\"],\nexp:\"Insulin degludec (Tresiba) has the longest duration of action of all insulin preparations, approximately 42 hours, with an ultra-flat peakless profile. Insulin glargine lasts approximately 20-24 hours. Insulin detemir lasts approximately 16-20 hours. NPH (isophane) insulin lasts approximately 12-18 hours with a distinct peak. Degludec is the longest-acting insulin preparation.\"\n},\n{id:42,\nstem:\"Functioning pituitary adenoma most commonly arises from which one of the following cells?\",\ncorrect:\"Lactotroph\",\nopts:[\"Somatotroph\",\"Lactotroph\",\"Corticotroph\",\"Thyrotroph\"],\nexp:\"Lactotroph adenomas (prolactinomas) are the most common functioning pituitary adenomas, accounting for approximately 40-50% of all pituitary adenomas. They secrete prolactin and present with galactorrhoea and amenorrhoea in women, and hypogonadism in men. Somatotroph adenomas (acromegaly) are the second most common. Corticotroph adenomas (Cushing disease) are less common. Thyrotroph adenomas (TSH-secreting) are the rarest. Lactotroph is correct.\"\n},\n{id:43,\nstem:\"Low serum thyroglobulin levels are seen in\",\ncorrect:\"thyrotoxicosis factitia\",\nopts:[\"thyrotoxicosis factitia\",\"subacute thyroiditis\",\"Graves disease\",\"toxic multinodular goitre\"],\nexp:\"Thyroglobulin (Tg) is produced by thyroid follicular cells. In thyrotoxicosis factitia (exogenous thyroid hormone ingestion), excess circulating thyroid hormone suppresses TSH, which suppresses thyroid activity. No endogenous Tg is synthesised or released, resulting in undetectably low serum thyroglobulin. This low Tg distinguishes factitious thyrotoxicosis from all other causes of hyperthyroidism (subacute thyroiditis, Graves disease, toxic MNG) where Tg is elevated or normal.\"\n},\n{id:44,\nstem:\"A 45-year-old male presented with polyuria, polydipsia and polyphagia for the last 3 months. His fasting plasma glucose is 106 mg\/dL and random blood glucose is 220 mg\/dL. Which one of the following statements is correct regarding his diagnosis?\",\ncorrect:\"He has definitive diagnosis of diabetes mellitus.\",\nopts:[\"He has impaired glucose tolerance (IGT).\",\"He has definitive diagnosis of diabetes mellitus.\",\"He does not have diabetes mellitus.\",\"Diagnosis of diabetes mellitus is indeterminate as HbA1c value is not provided.\"],\nexp:\"WHO\/ADA diagnostic criteria for diabetes mellitus: any ONE of (1) FPG at least 126 mg\/dL; (2) 2-hour plasma glucose at least 200 mg\/dL during OGTT; (3) Random plasma glucose at least 200 mg\/dL WITH classic symptoms of hyperglycaemia; (4) HbA1c at least 6.5%. This patient has random blood glucose 220 mg\/dL WITH classic symptoms (polyuria, polydipsia, polyphagia) meeting criterion 3. The diagnosis of diabetes mellitus is definitive. FPG of 106 mg\/dL alone would indicate impaired fasting glucose, but the symptomatic random glucose of 220 mg\/dL is independently sufficient.\"\n},\n{id:45,\nstem:\"Which one of the following statements is true regarding the use of SGLT2 inhibitor in management of diabetes mellitus?\",\ncorrect:\"Euglycemic diabetic ketoacidosis may occur during treatment if there is a concurrent illness.\",\nopts:[\"They are used in type-1, type-2 and pancreatogenic forms of diabetes mellitus.\",\"They cause increase in blood pressure by 3-6 mm Hg and hence avoided in hypertensive patients.\",\"Their glucose-lowering effect is dependent on insulin secretion and insulin sensitivity.\",\"Euglycemic diabetic ketoacidosis may occur during treatment if there is a concurrent illness.\"],\nexp:\"SGLT2 inhibitors inhibit glucose reabsorption in the proximal tubule, causing glycosuria independent of insulin. Key points: (1) Approved primarily for type-2 DM; type-1 use is off-label. (2) They LOWER blood pressure by 3-4 mmHg (beneficial, not harmful). (3) Their glucose-lowering effect is insulin-INDEPENDENT. (4) Euglycemic DKA is a recognised risk, particularly during fasting, surgery, illness, or reduced carbohydrate intake. This is the correct statement.\"\n},\n{id:46,\nstem:\"A 50-year lady, who is a known case of rheumatoid arthritis, presents with obesity, moon facies, abdominal striae and hypertension. Overnight dexamethasone suppression test shows serum cortisol is greater than 50 nmol\/L, serum ACTH is less than 1.1 pmol\/L. The adrenal imaging and brain CT\/MRI imaging studies are unremarkable. The likely diagnosis is\",\ncorrect:\"exogenous glucocorticoid use\",\nopts:[\"Cushing disease\",\"ectopic ACTH-secreting tumour\",\"exogenous glucocorticoid use\",\"adrenal adenoma\"],\nexp:\"The key discriminating findings are: ACTH very low (ACTH-independent Cushing). However adrenal imaging is unremarkable (no adrenal adenoma or carcinoma). The patient has rheumatoid arthritis and is almost certainly on long-term glucocorticoids. Exogenous glucocorticoids suppress the HPA axis, resulting in low ACTH and low endogenous cortisol production, but the clinical picture mimics Cushing syndrome. Unremarkable adrenal and pituitary imaging confirms exogenous glucocorticoid use.\"\n},\n{id:47,\nstem:\"A 27-year lady underwent thyroidectomy for thyroid carcinoma. Post-operatively she started developing muscle cramps, perioral and peripheral paresthesia, and carpopedal spasm. Which one of the following interventions will be appropriate for this patient?\",\ncorrect:\"Measure of serum ionized calcium and to administer IV calcium gluconate\",\nopts:[\"Nerve conduction velocity in both upper and lower limbs and to administer methylcobalamin\",\"EMG of both lower limbs and to administer oral prednisolone\",\"Measure of serum ionized calcium and to administer IV calcium gluconate\",\"Measure of serum bicarbonate and to administer IV bicarbonate\"],\nexp:\"Post-thyroidectomy hypocalcaemia is the most common early complication of total thyroidectomy, caused by inadvertent damage or removal of parathyroid glands. Muscle cramps, perioral and peripheral paraesthesia, and carpopedal spasm (Trousseau sign) are classic features of hypocalcaemia. The appropriate immediate management is to confirm hypocalcaemia by measuring serum ionised calcium and administer IV calcium gluconate (10 mL of 10% solution given slowly IV) for symptomatic acute hypocalcaemia.\"\n},\n{id:48,\nstem:\"Which one of the following is an example of hypogonadotropic hypogonadism?\",\ncorrect:\"Kallmann syndrome\",\nopts:[\"Kallmann syndrome\",\"Klinefelter syndrome\",\"Turner syndrome\",\"Cryptorchidism\"],\nexp:\"Hypogonadotropic hypogonadism (HH) = low\/absent FSH and LH with resultant low sex steroids, due to hypothalamic or pituitary deficiency. Kallmann syndrome is the classic example: GnRH deficiency (hypothalamic) with anosmia. Klinefelter syndrome (47XXY) is hypergonadotropic hypogonadism (high FSH\/LH, primary testicular failure). Turner syndrome (45XO) is hypergonadotropic hypogonadism in females. Cryptorchidism is a structural anomaly. Kallmann syndrome is correct.\"\n},\n{id:49,\nstem:\"A tall thin adolescent boy is found to have gynaecomastia and small testes. His blood testosterone level is undetectable, and serum FSH and LH levels are elevated. Which one of the following is the likely karyotype pattern?\",\ncorrect:\"47 XXY\",\nopts:[\"46 XY\",\"45 XO\",\"47 XXY\",\"21 Trisomy\"],\nexp:\"The clinical features describe Klinefelter syndrome: tall thin male with small firm testes (primary testicular failure), gynaecomastia, azoospermia\/infertility, and eunuchoid body habitus. The endocrine pattern is hypergonadotropic hypogonadism: low testosterone, elevated FSH and LH. The karyotype is 47 XXY (one extra X chromosome). 45 XO is Turner syndrome (female phenotype). 21 Trisomy is Down syndrome. 47 XXY is correct.\"\n},\n{id:50,\nstem:\"Which of the following antidiabetic drugs may cause weight gain?<br>1. Glimepiride<br>2. Pioglitazone<br>3. NPH insulin<br>4. Sitagliptin<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Weight GAIN: Sulfonylureas (glimepiride) cause weight gain via insulin secretion and hypoglycaemia-driven compensatory eating. Pioglitazone (TZD) causes weight gain via fluid retention and adipogenesis. Insulin preparations including NPH cause weight gain (anabolic effect, fluid retention). Weight NEUTRAL: DPP-4 inhibitors (sitagliptin) are weight neutral; they enhance glucose-dependent insulin secretion without significant weight change. Statements 1, 2, and 3 are correct.\"\n},\n{id:51,\nstem:\"Which of the following statements is\/are correct for obesity?<br>1. Adiponectin levels are reduced in obesity.<br>2. Orlistat is a reversible inhibitor of lipase used for the treatment of obesity.<br>3. Liraglutide used for T2DM management can cause weight gain and not recommended in obese patients with T2DM.<br>4. Bariatric surgery is recommended in obese patients with BMI > 30 kg\/m² for long-term benefits.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 4\",\"1 and 2 only\",\"2, 3 and 4\",\"1 only\"],\nexp:\"Statement 1 TRUE: Adiponectin (anti-inflammatory, insulin-sensitising adipokine) is paradoxically reduced in obesity, contributing to insulin resistance. Statement 2 TRUE: Orlistat is a reversible gastric and pancreatic lipase inhibitor that reduces dietary fat absorption by approximately 30%. Statement 3 FALSE: Liraglutide (GLP-1 agonist) causes significant WEIGHT LOSS and is specifically recommended in obese patients with T2DM. Statement 4 TRUE: Bariatric surgery is recommended for BMI greater than 30 with T2DM as an established indication. Statements 1, 2, and 4 are correct.\"\n},\n{id:52,\nstem:\"Which of the following drugs are effective in preventing uric acid nephropathy in patients receiving chemotherapy?<br>1. Probenecid<br>2. Forced saline diuresis<br>3. Rasburicase<br>4. Acetazolamide<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Prevention of uric acid nephropathy in tumour lysis syndrome: Rasburicase enzymatically destroys uric acid (converts it to allantoin), the most effective drug for preventing and treating hyperuricaemia. Probenecid is a uricosuric agent that increases renal uric acid excretion. Acetazolamide alkalinises the urine (makes uric acid more soluble), preventing precipitation in tubules. Forced saline diuresis (statement 2) is important for volume expansion but is not a specific anti-uric-acid drug. Statements 1, 3, and 4 are correct.\"\n},\n{id:53,\nstem:\"Primaquine destroys hypnozoites of Plasmodium vivax for radical cure in which one of the following?\",\ncorrect:\"Liver\",\nopts:[\"Liver\",\"Peripheral blood\",\"Brain\",\"Bone marrow\"],\nexp:\"Plasmodium vivax (and P. ovale) form dormant hypnozoites in hepatocytes after initial hepatic schizogony. These hypnozoites can reactivate weeks to months later causing relapsing malaria. Primaquine is the only drug that effectively destroys these hepatic hypnozoites, providing radical cure (preventing future relapses). It acts in the LIVER where the hypnozoites reside. G6PD testing is required before primaquine administration.\"\n},\n{id:54,\nstem:\"HIV-associated neurocognitive disorder (HAND) includes which of the following?<br>1. Asymptomatic neurocognitive disorder<br>2. Minor neurocognitive disorder<br>3. HIV-associated dementia<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"HIV-associated neurocognitive disorder (HAND) is a spectrum classified into three categories (Frascati criteria 2007): (1) Asymptomatic neurocognitive impairment (ANI): objective cognitive impairment on neuropsychological testing, no functional impairment; (2) Mild neurocognitive disorder (MND): objective impairment PLUS mild functional impairment; (3) HIV-associated dementia (HAD): marked cognitive impairment with severe functional impairment. All three together constitute the HAND spectrum. All three statements are correct.\"\n},\n{id:55,\nstem:\"Consider the following statements with regard to cysticercosis:<br>1. It may present as personality change.<br>2. Subcutaneous nodule may be excised for histology.<br>3. Cerebral signs commonly do not occur until the larvae die, 5-20 years later.<br>4. Praziquantel can be given for 10 days.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2, 3 and 4\",\nopts:[\"1 and 4 only\",\"2 and 3 only\",\"1, 2 and 3 only\",\"1, 2, 3 and 4\"],\nexp:\"All four statements are correct regarding cysticercosis (Taenia solium larval infection): (1) Neurocysticercosis presents with seizures, raised ICP, hydrocephalus, and psychiatric features including personality change. (2) Subcutaneous cysticerci can be excised for histological diagnosis confirming the cyst structure with scolex. (3) Cerebral symptoms typically manifest when the larvae die (5-20 years later), triggering perilesional oedema. (4) Praziquantel 50 mg\/kg\/day for 10-28 days is a standard antiparasitic treatment. All four statements are correct.\"\n},\n{id:56,\nstem:\"Consider the following statements with regard to strongyloidiasis:<br>1. It parasitizes the mucosa of upper part of small intestine.<br>2. Larva currens is fast-moving transient rash seen across abdomen and buttocks.<br>3. Ivermectin is not an effective treatment.<br>4. Systematic strongyloidiasis is seen in immune competent state.<br>Which of the statements given above are correct?\",\ncorrect:\"1 and 2\",\nopts:[\"1 and 2\",\"2 and 3 only\",\"2, 3 and 4\",\"1 and 4\"],\nexp:\"Statement 1 TRUE: Strongyloides stercoralis adult female worms parasitise the mucosa of the duodenum and upper jejunum (upper small intestine). Statement 2 TRUE: Larva currens is a pathognomonic cutaneous feature: a rapidly migrating urticarial track (5-10 cm\/hour) across the perianal area, buttocks, and abdomen from autoinfecting filariform larvae. Statement 3 FALSE: Ivermectin is the treatment of CHOICE for strongyloidiasis (200 mcg\/kg for 2 days); highly effective. Statement 4 FALSE: Disseminated strongyloidiasis occurs in IMMUNOCOMPROMISED states, not immunocompetent individuals. Statements 1 and 2 are correct.\"\n},\n{id:57,\nstem:\"Consider the following statements with regard to cutaneous larva migrans:<br>1. It is one of the commonest linear lesions seen in travellers.<br>2. It may be associated with a recent visit to a beach.<br>3. It is non-pruritic.<br>4. Track moves across the skin at a rate of 2-3 cm\/day.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 3 and 4\",\"1, 2 and 4\",\"2, 3 and 4\"],\nexp:\"Cutaneous larva migrans (CLM) is caused by hookworm larvae (Ancylostoma braziliense) penetrating human skin but unable to complete their life cycle. Statement 1 TRUE: CLM is the most common travel-associated skin disease, presenting as serpiginous linear lesions. Statement 2 TRUE: Infection occurs by walking barefoot or lying on sand\/soil contaminated with dog or cat faeces, especially at tropical beaches. Statement 3 FALSE: CLM is intensely PRURITIC. Statement 4 TRUE: The larva advances at approximately 2-3 cm per day. Statements 1, 2, and 4 are correct.\"\n},\n{id:58,\nstem:\"Consider the following statements with regard to giardiasis:<br>1. Stools should be examined for cysts at 2-3 days interval for its diagnosis.<br>2. Colonoscopy aspirate gives the highest diagnostic yield.<br>3. Infection usually occurs by ingesting contaminated water.<br>4. Giardia has a flagellate trophozoite form.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1 and 3 only\",\"1, 2 and 4\",\"1, 3 and 4\",\"2 and 4 only\"],\nexp:\"Statement 1 TRUE: Giardia cysts are shed intermittently; examining three stool samples at 2-3 day intervals improves diagnostic sensitivity to approximately 90%. Statement 2 FALSE: Highest diagnostic yield is from DUODENAL\/JEJUNAL aspirate (small intestine), not colonoscopy (Giardia resides in the small intestine, not colon). Statement 3 TRUE: Giardia is transmitted predominantly via the faeco-oral route, most commonly by ingesting contaminated water. Statement 4 TRUE: Giardia lamblia exists as a binucleate flagellate trophozoite (pear-shaped with four pairs of flagella) and an oval cyst form. Statements 1, 3, and 4 are correct.\"\n},\n{id:59,\nstem:\"Type-2 necrotizing fasciitis is caused by\",\ncorrect:\"Vibrio vulnificus\",\nopts:[\"Group A Streptococcus\",\"Vibrio vulnificus\",\"Clostridium septicum\",\"Staphylococcus aureus\"],\nexp:\"Necrotizing fasciitis: Type 1 (polymicrobial, approximately 80%) involves mixed aerobic and anaerobic bacteria, seen in diabetics and post-surgical patients. Type 2 (monomicrobial) is caused by single virulent organisms: most classically Group A Streptococcus, but also Vibrio vulnificus (in patients with liver disease after seafood exposure or saltwater wounds). Among the options listed, Vibrio vulnificus is the Type 2 agent specifically listed as the answer in this question context.\"\n},\n{id:60,\nstem:\"Which of the following treatments for a pregnant lady who has been exposed to a patient of chicken pox are correct?<br>1. Varicella-zoster immune globulin<br>2. Varicella-zoster vaccine<br>3. Acyclovir<br>4. Prednisolone<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3 only\",\nopts:[\"1, 2 and 4\",\"2 and 3\",\"1 and 3 only\",\"1, 3 and 4\"],\nexp:\"Management of VZV exposure in a seronegative pregnant woman: Varicella-zoster immune globulin (VZIG) should be given within 96 hours of exposure to provide passive immunisation and reduce severity of maternal varicella. Acyclovir is given if the pregnant woman develops active varicella infection (particularly in 2nd\/3rd trimester) to reduce complications. Varicella-zoster vaccine is a LIVE attenuated vaccine ABSOLUTELY CONTRAINDICATED in pregnancy. Prednisolone is contraindicated as it may worsen varicella by immunosuppression. Statements 1 and 3 are correct.\"\n},\n{id:61,\nstem:\"Which of the following drugs is\/are useful in the treatment of Listeria monocytogenes infection?<br>1. Ceftriaxone<br>2. Gentamicin<br>3. Ampicillin<br>4. Sulfamethoxazole<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4 only\",\nopts:[\"1 only\",\"2, 3 and 4 only\",\"1 and 2 only\",\"1, 2, 3 and 4\"],\nexp:\"Listeria monocytogenes treatment: Ampicillin (drug of choice), often combined with gentamicin for synergistic bactericidal activity in severe infection (meningitis, bacteraemia). Trimethoprim-sulfamethoxazole (co-trimoxazole) is used in penicillin-allergic patients. Critically, Listeria is INTRINSICALLY RESISTANT to ALL cephalosporins including ceftriaxone. This is a classic exam trap: ceftriaxone empirically treats most bacterial meningitis but MUST be combined with ampicillin when Listeria is suspected (elderly, immunocompromised, neonates). Ceftriaxone alone is ineffective against Listeria. Statements 2, 3, and 4 are correct.\"\n},\n{id:62,\nstem:\"Which of the following abnormalities occur from vitamin D deficiency in children?<br>1. Craniotabes<br>2. Bossing of frontal and parietal bones<br>3. Muscle hypotonia<br>4. Shrinking of epiphysis at the lower end of radius<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Vitamin D deficiency (nutritional rickets) in children causes: Craniotabes (abnormal softening of skull bones, ping-pong ball sensation on palpation). Frontal and parietal bossing (excess osteoid deposition under periosteum). Muscle hypotonia (vitamin D essential for normal muscle function, causing delayed motor milestones). Other features: rachitic rosary, Harrison groove, genu varum\/valgum. Statement 4 is false: rickets causes WIDENING (splaying\/cupping\/fraying) of the epiphysis at the lower end of radius, not shrinking. Statements 1, 2, and 3 are correct.\"\n},\n{id:63,\nstem:\"Which one of the following is a cause of relative erythrocytosis?\",\ncorrect:\"Diuretics\",\nopts:[\"High altitude\",\"Cardiorespiratory disease\",\"High-affinity haemoglobins\",\"Diuretics\"],\nexp:\"Relative (spurious\/apparent) erythrocytosis occurs when red cell mass is normal but reduced plasma volume causes an apparent rise in haematocrit. Causes: dehydration, diuretics (plasma volume depletion), Gaisbock syndrome. Diuretics reduce plasma volume without increasing red cell mass, causing relative erythrocytosis. High altitude, cardiorespiratory disease, and high-affinity haemoglobins all cause absolute (true) secondary erythrocytosis (genuine increase in red cell mass). Diuretics is the correct answer.\"\n},\n{id:64,\nstem:\"Which of the following statements are correct regarding UTI?<br>1. Urine is an excellent culture medium for bacteria.<br>2. Atrophic urethritis in post-menopausal women is a risk factor.<br>3. Antibiotics are recommended in all cases of asymptomatic bacteriuria.<br>4. Certain strains of E. coli have a particular propensity to invade urinary tract.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1 and 4 only\",\"1, 2 and 3\",\"2, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Statement 1 TRUE: Urine is an excellent culture medium for bacteria, explaining the prevalence of UTIs. Statement 2 TRUE: Post-menopausal women lack oestrogen-dependent glycogen in vaginal epithelium, disrupting normal lactobacilli flora and promoting uropathogens; atrophic urethritis compromises local defences. Statement 3 FALSE: Antibiotics are NOT recommended for asymptomatic bacteriuria EXCEPT in pregnancy and before urological procedures. Statement 4 TRUE: Uropathogenic E. coli (UPEC) strains possess specific virulence factors (type 1 fimbriae, P-fimbriae, haemolysin) enabling them to adhere to uroepithelium and ascend the urinary tract. Statements 1, 2, and 4 are correct.\"\n},\n{id:65,\nstem:\"Which of the following statements are correct regarding scorpion stings?<br>1. Scorpion injects venom from a stinger on their tail.<br>2. Most stings are painful, but relatively harmless.<br>3. Anticholinergics can be used if antivenom is unavailable.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 2 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Statement 1 TRUE: Scorpions inject venom via a stinger (telson) located at the tip of their tail. Statement 2 TRUE: Most scorpion stings worldwide cause local pain and swelling but are self-limiting and relatively harmless. Only a few species (Buthidae family) cause life-threatening envenomation with autonomic storm. Statement 3 FALSE: Scorpion venom acts on voltage-gated sodium channels causing massive ADRENERGIC discharge. Alpha-blockers (prazosin) are used, NOT anticholinergics, which would worsen the adrenergic crisis. Statements 1 and 2 only are correct.\"\n},\n{id:66,\nstem:\"Which of the following statements are correct regarding Kyasanur forest disease?<br>1. It is commonly seen in North-Eastern States of India.<br>2. Monkeys act as reservoir of the disease.<br>3. Transmission happens through tick bite.<br>4. Inactivated vaccine is available for its prevention.<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1 and 4 only\",\"2 and 3 only\",\"1, 2 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 FALSE: KFD is endemic to the Kyasanur Forest area of KARNATAKA (Western Ghats region of South India), specifically Shimoga, Uttara Kannada, and Udupi districts. NOT north-eastern India. Statement 2 TRUE: Bonnet monkeys (Macaca radiata) serve as amplifying hosts\/reservoirs; dead monkeys alert health authorities to outbreaks. Statement 3 TRUE: Hard ticks (Haemaphysalis spinigera) are the primary vectors. Statement 4 TRUE: A formalin-inactivated vaccine is available for populations in endemic areas of Karnataka. Statements 2, 3, and 4 are correct.\"\n},\n{id:67,\nstem:\"Which of the following statements are correct regarding brucellosis?<br>1. Fever may develop into an undulating pattern that persists for weeks.<br>2. Associated musculoskeletal symptoms are a feature of the disease.<br>3. Brucellae behave as facultative intracellular parasites.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"All three statements are correct. Statement 1 TRUE: The classic undulating fever pattern (fever rising and falling in waves over weeks) gives brucellosis its alternative name undulant fever. Statement 2 TRUE: Musculoskeletal complications including arthritis, sacroiliitis, spondylitis, and osteomyelitis are the most common complications (up to 40% of cases). Statement 3 TRUE: Brucellae are classic facultative intracellular parasites; they survive and replicate within macrophages, evading killing by inhibiting phagolysosome fusion. This explains the need for combination antibiotic therapy with intracellular-penetrating agents. All three statements are correct.\"\n},\n{id:68,\nstem:\"A 60-year-old diabetic female presents with acute myocardial infarction. ECG changes include ST elevation greater than 1 mm in lead aVR. The likely localization of thrombosis is in\",\ncorrect:\"left main or proximal LAD\",\nopts:[\"right coronary artery\",\"distal LAD\",\"left circumflex artery\",\"left main or proximal LAD\"],\nexp:\"ST elevation in lead aVR (more than 0.5-1 mm) is a specific ECG finding indicating acute occlusion of the left main coronary artery (LMCA) or the proximal left anterior descending (LAD) artery. LMCA or proximal LAD occlusion causes diffuse ST depression in lateral and inferior leads with reciprocal ST elevation in aVR. This is a high-risk ECG finding associated with cardiogenic shock and high mortality. Right coronary artery occlusion causes inferior STEMI (II, III, aVF). Left circumflex causes lateral or posterior MI. Distal LAD causes anterior MI without prominent aVR changes.\"\n},\n{id:69,\nstem:\"Which one of the following antidiabetic drugs is recommended for weight loss in obese patients?\",\ncorrect:\"Liraglutide\",\nopts:[\"Glimepiride\",\"Liraglutide\",\"Sitagliptin\",\"Insulin\"],\nexp:\"Liraglutide (Victoza for T2DM; Saxenda at higher dose for obesity) is a GLP-1 receptor agonist that causes significant weight loss (typically 5-10% of body weight) through delayed gastric emptying, increased satiety, and reduced food intake. It is specifically FDA-approved for chronic weight management. Glimepiride (sulfonylurea) causes weight gain. Sitagliptin (DPP-4 inhibitor) is weight neutral. Insulin causes weight gain. Liraglutide is the recommended antidiabetic drug for weight loss in obese patients.\"\n},\n{id:70,\nstem:\"Consider the following statements regarding inflammatory bowel disease:<br>1. Ulcerative colitis (UC) involves terminal ileum and rarely causes proctitis.<br>2. Cobblestone appearance of bowel is seen in Crohn's disease.<br>3. Skip lesions are a characteristic of ulcerative colitis but never seen in Crohn's disease.<br>4. Ulcerative colitis is more common in smokers than non-smokers.<br>Which of the statements given above is\/are correct?\",\ncorrect:\"2 only\",\nopts:[\"1, 2 and 3\",\"2, 3 and 4\",\"3 and 4 only\",\"2 only\"],\nexp:\"Statement 1 FALSE: UC involves the rectum almost always (proctitis is a common presentation) and extends proximally in a continuous pattern. Statement 2 TRUE: Cobblestone mucosa (islands of intact mucosa surrounded by deep linear ulcers) is a classic feature of Crohn's disease due to transmural inflammation with deep fissuring ulcers. Statement 3 FALSE: Skip lesions (discontinuous disease) are characteristic of CROHN's disease, NOT ulcerative colitis. UC is a continuous disease. Statement 4 FALSE: UC is actually more common in NON-smokers and ex-smokers; smoking appears paradoxically protective in UC. Only statement 2 is correct.\"\n},\n{id:71,\nstem:\"Which of the following are typical physical findings in pericardial effusion?<br>1. Raised JVP<br>2. Hypotension<br>3. Oliguria<br>4. Water hammer pulse<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Cardiac tamponade (haemodynamically significant pericardial effusion) produces obstructive shock: (1) Raised JVP (elevated venous pressure as cardiac filling is restricted). (2) Hypotension (reduced cardiac output due to impaired ventricular filling). (3) Oliguria (reduced renal perfusion from low cardiac output). These three plus muffled heart sounds constitute Beck's triad. Water hammer (Corrigan) pulse is the bounding, collapsing pulse of aortic regurgitation; it is NOT a feature of tamponade. Tamponade produces pulsus paradoxus. Statements 1, 2, and 3 are correct.\"\n},\n{id:72,\nstem:\"Which of the following conditions can produce a third heart sound (S3) on auscultation?<br>1. Young age<br>2. Pregnancy<br>3. Left ventricular failure<br>4. Mitral stenosis<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"S3 (ventricular gallop) occurs in early diastole during rapid ventricular filling. Physiological S3: young adults (under 40 years) and during pregnancy (high cardiac output with rapid ventricular filling). Pathological S3: left ventricular failure, dilated cardiomyopathy, significant mitral regurgitation (volume overload). Mitral STENOSIS does NOT produce S3; it produces a loud S1, opening snap, and mid-diastolic rumble. Mitral stenosis restricts filling, making S3 unlikely. S3 requires rapid early filling. Statements 1, 2, and 3 are correct.\"\n},\n{id:73,\nstem:\"Which of the following statements are true about PR interval?<br>1. It denotes atrial depolarization.<br>2. Normal duration is 0.12 second-0.20 second.<br>3. Prolongation denotes impaired AV nodal conduction.<br>4. A short PR interval occurs in WPW syndrome.<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 FALSE: The PR interval represents conduction from onset of atrial depolarization to onset of ventricular depolarization, reflecting conduction through the atria, AV node, His bundle, and bundle branches. It is NOT just atrial depolarization alone (that is the P wave itself). Statement 2 TRUE: Normal PR interval is 0.12-0.20 seconds. Statement 3 TRUE: Prolonged PR (greater than 0.20 sec) = first-degree AV block, indicating impaired AV nodal conduction. Statement 4 TRUE: WPW syndrome: the accessory pathway (Bundle of Kent) bypasses the AV node causing pre-excitation (delta wave) with a SHORT PR interval (less than 0.12 sec). Statements 2, 3, and 4 are correct.\"\n},\n{id:74,\nstem:\"Which one of the following is the drug of choice for the treatment of schistosomiasis?\",\ncorrect:\"Praziquantel\",\nopts:[\"Doxycycline\",\"Praziquantel\",\"Albendazole\",\"Ivermectin\"],\nexp:\"Praziquantel is the drug of choice for all forms of schistosomiasis (S. mansoni, S. haematobium, S. japonicum). It is an isoquinoline-pyrazine compound causing rapid muscle contraction, tegument disruption, and death of adult worms. Single oral dose of 40 mg\/kg (S. haematobium, S. mansoni) or 60 mg\/kg in three divided doses (S. japonicum) achieves cure rates greater than 85-95%. Doxycycline is for rickettsial infections. Albendazole is for nematodes and some cestodes. Ivermectin is for strongyloidiasis, onchocerciasis. Praziquantel is correct.\"\n},\n{id:75,\nstem:\"Which of the following opportunistic systemic mycoses is characterized by rapid development of severe tissue necrosis and emerged as a specific complication associated with COVID-19 infection in India?\",\ncorrect:\"Mucormycosis\",\nopts:[\"Histoplasmosis\",\"Mucormycosis\",\"Coccidioidomycosis\",\"Sporotrichosis\"],\nexp:\"Mucormycosis (caused by Mucorales: Rhizopus, Mucor) emerged as a devastating complication of COVID-19 in India during the second wave (2021), primarily in patients with uncontrolled diabetes mellitus or those receiving high-dose corticosteroids. Rhino-orbito-cerebral mucormycosis was the most common form. India reported thousands of cases ('black fungus'). The condition is characterised by angioinvasion causing rapid tissue necrosis and infarction. Treatment requires aggressive surgical debridement plus liposomal amphotericin B. Mucormycosis is correct.\"\n},\n{id:76,\nstem:\"Which of the following fungal infections is caused by dermal inoculation of the fungal agent, usually from a thorn?\",\ncorrect:\"Sporotrichosis\",\nopts:[\"Mycetoma\",\"Aspergillosis\",\"Mucormycosis\",\"Sporotrichosis\"],\nexp:\"Sporotrichosis (Rose thorn disease) is caused by Sporothrix schenckii, a dimorphic fungus living in soil, decaying vegetation, and plant materials. Infection typically occurs via traumatic inoculation through thorn pricks, splinters, or plant material (roses, barberry, sphagnum moss). Classic presentation: a primary cutaneous nodule at the inoculation site followed by secondary nodules along lymphatic channels (lymphocutaneous sporotrichosis). Treatment: itraconazole for cutaneous\/lymphocutaneous forms; amphotericin B for disseminated forms. Sporotrichosis is correct for thorn inoculation.\"\n},\n{id:77,\nstem:\"Consider the following statements with regard to coccidioidomycosis:<br>1. It is a primary systemic mycosis caused by dimorphic fungi Coccidioides immitis and Coccidioides posadasii.<br>2. Primary pulmonary coccidioidomycosis presents with cough, fever, chest pain and arthritis.<br>3. Progressive pulmonary coccidioidomycosis presents with constitutional symptoms like fever, weight loss, anorexia and features of lobar pneumonia.<br>4. Coccidioides meningitis is a mild disease, not warranting any treatment.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 TRUE: Coccidioidomycosis is caused by the dimorphic fungi C. immitis (California) and C. posadasii (other regions), endemic to the southwestern USA, Mexico, and parts of Latin America. Statement 2 TRUE: Primary pulmonary coccidioidomycosis (San Joaquin valley fever) presents 1-3 weeks after inhalation with cough, fever, chest pain, fatigue, and classic desert rheumatism (arthritis\/arthralgias). Statement 3 TRUE: Progressive\/disseminated disease presents with constitutional symptoms, chronic pneumonia, and systemic spread. Statement 4 FALSE: Coccidioidal meningitis is a SEVERE and CHRONIC disease requiring lifelong treatment with fluconazole (400-800 mg\/day indefinitely). Untreated, it is uniformly fatal. Statements 1, 2, and 3 are correct.\"\n},\n{id:78,\nstem:\"Consider the following statements with regard to elapid snakebite:<br>1. Regardless of the anatomic site of bite, walking of victim should be discouraged.<br>2. Pressure immobilization should be used, wherever possible.<br>3. Ptosis can be present after the elapid bite.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"All three statements are correct regarding elapid (cobra, krait, mamba) snakebite. Statement 1 TRUE: Activity increases venom absorption via lymphatic spread; the victim should be kept still regardless of bite site. Statement 2 TRUE: Pressure immobilisation (bandaging the entire limb from bite site upward with a crepe bandage, then splinting) is recommended for elapid bites (neurotoxic venom) to retard lymphatic spread; contraindicated for viper bites. Statement 3 TRUE: Elapid neurotoxins block neuromuscular transmission causing descending flaccid paralysis starting with ptosis (cranial nerve involvement) followed by ophthalmoplegia, dysphagia, and respiratory failure. All three are correct.\"\n},\n{id:79,\nstem:\"Which one of the following hormones is responsible for gallbladder contraction and release of bile into duodenum?\",\ncorrect:\"Cholecystokinin\",\nopts:[\"Secretin\",\"Gastrin\",\"Cholecystokinin\",\"Vasoactive intestinal peptide\"],\nexp:\"Cholecystokinin (CCK) is released from I cells in the duodenal and jejunal mucosa in response to fats and proteins in the duodenum. CCK stimulates: (1) Gallbladder contraction (via CCK-A receptors on gallbladder smooth muscle); (2) Relaxation of the sphincter of Oddi, releasing bile into the duodenum; (3) Pancreatic enzyme secretion. Secretin (from S cells) stimulates pancreatic bicarbonate secretion. Gastrin (from G cells) stimulates gastric acid secretion. VIP causes smooth muscle relaxation. Cholecystokinin is the correct answer.\"\n},\n{id:80,\nstem:\"Consider the following statements regarding radiation enteritis and proctocolitis:<br>1. Diarrhoea in the acute phase should be treated with codeine or loperamide.<br>2. Surgery is the treatment of choice and involves resection of the injured intestine.<br>3. Sucralfate enemas and hyperbaric oxygen are effective treatments.<br>4. Small bowel strictures and rectovaginal fistulae may develop as chronic complications.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1 and 3 only\",\"2 and 4 only\",\"1, 2 and 4\",\"1, 3 and 4\"],\nexp:\"Statement 1 TRUE: Acute radiation diarrhoea is managed symptomatically with antimotility agents (codeine, loperamide), low-residue diet, and antispasmodics. Statement 2 FALSE: Surgery is NOT the treatment of choice; it is a last resort for complications. The injured irradiated bowel heals poorly and surgery carries high morbidity. Statement 3 TRUE: Sucralfate enemas (for radiation proctitis) reduce mucosal inflammation. Hyperbaric oxygen promotes neovascularisation of ischaemic irradiated tissue. Statement 4 TRUE: Chronic radiation injury causes progressive fibrosis leading to small bowel strictures, malabsorption, and rectovaginal fistulae. 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Display\",serif;font-size:1.15rem;color:var(--bad);margin-bottom:8px}\n.qz-grace-box p{font-size:0.85rem;color:var(--ink-mid);margin-bottom:14px}\n.qz-grace-n{font-family:\"Playfair Display\",serif;font-size:2.8rem;font-weight:700;color:var(--bad);line-height:1;margin-bottom:16px}\n.qz-grace-now{background:var(--bad);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:\"Playfair Display\",serif;font-size:0.9rem;font-weight:700;cursor:pointer}\n.qz-grace-now:hover{background:#c62828}\n\n@media(max-width:480px){\n .qz-header h1{font-size:1.05rem}\n .qz-stem{font-size:0.87rem}\n .qz-opt-txt{font-size:0.84rem}\n .qz-prog-stats{font-size:0.68rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms23p1a\">\n\n<div class=\"qz-prog-bar\" id=\"qz-prog-bar\">\n <div class=\"qz-prog-stats\">\n <div class=\"qz-stat\">✓️ <strong id=\"qz-sc\">0<\/strong><\/div>\n <div class=\"qz-stat\">❌ <strong id=\"qz-sw\">0<\/strong><\/div>\n <div class=\"qz-stat\">⏳ <strong id=\"qz-sr\">40<\/strong> left<\/div>\n <div class=\"qz-timer-wrap\">\n <div class=\"qz-timer\" id=\"qz-timer\">⏱ <strong id=\"qz-td\">40:00<\/strong><\/div>\n <div class=\"qz-stat net-score\">Net <strong id=\"qz-sn\">0<\/strong> \/ 160<\/div>\n <\/div>\n <\/div>\n <div class=\"qz-prog-track\"><div class=\"qz-prog-fill\" id=\"qz-fill\"><\/div><\/div>\n<\/div>\n\n<div class=\"qz-grace\" id=\"qz-grace\">\n <div class=\"qz-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"qz-grace-n\" id=\"qz-gn\">10<\/div>\n <button class=\"qz-grace-now\" id=\"qz-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-header\">\n <h1>Combined Medical Services Examination 2023<br>General Medicine & Paediatrics · Paper I · Part B<\/h1>\n <p>Endocrinology · Infectious Disease · Parasitology · Nephrology<\/p>\n <div class=\"qz-meta\">\n <span class=\"qz-badge\">Questions 41–80<\/span>\n <span class=\"qz-badge\">Options reshuffled<\/span>\n <span class=\"qz-badge\">Score = c × 4 − w<\/span>\n <button class=\"qz-timer-btn\" id=\"qz-tbtn\">⏱ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-body\">\n <div id=\"qz-questions\"><\/div>\n <div class=\"qz-submit-wrap\">\n <button class=\"qz-submit\" id=\"qz-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"qz-result\" id=\"qz-result\">\n <div class=\"qz-ring\" id=\"qz-ring\">\n <div class=\"qz-ring-inner\">\n <div class=\"qz-ring-pct\" id=\"qz-rpct\">0%<\/div>\n <div class=\"qz-ring-sub\">score<\/div>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"qz-net\" id=\"qz-rnet\"><\/div>\n <div class=\"qz-verdict\" id=\"qz-rv\"><\/div>\n <div class=\"qz-bands\">\n <span class=\"qz-band bc\" id=\"qz-bc\"><\/span>\n <span class=\"qz-band bw\" id=\"qz-bw\"><\/span>\n <span class=\"qz-band bs\" id=\"qz-bs\"><\/span>\n <\/div>\n <button class=\"qz-retry\" id=\"qz-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n\n<\/div>\n\n<script>\n(function(){\n\nvar TOTAL = 40, MAX = 160;\nvar TSECS = 2400, GSECS = 10;\nvar LTRS = [\"A\",\"B\",\"C\",\"D\"];\n\nvar QQ = [\n{id:41,\nstem:\"Which one of the following insulin preparations has the longest effective duration of action?\",\ncorrect:\"Degludec\",\nopts:[\"Detemir\",\"Glargine\",\"NPH\",\"Degludec\"],\nexp:\"Insulin degludec (Tresiba) has the longest duration of action of all insulin preparations, approximately 42 hours, with an ultra-flat peakless profile. Insulin glargine lasts approximately 20-24 hours. Insulin detemir lasts approximately 16-20 hours. NPH (isophane) insulin lasts approximately 12-18 hours with a distinct peak. Degludec is the longest-acting insulin preparation.\"\n},\n{id:42,\nstem:\"Functioning pituitary adenoma most commonly arises from which one of the following cells?\",\ncorrect:\"Lactotroph\",\nopts:[\"Somatotroph\",\"Lactotroph\",\"Corticotroph\",\"Thyrotroph\"],\nexp:\"Lactotroph adenomas (prolactinomas) are the most common functioning pituitary adenomas, accounting for approximately 40-50% of all pituitary adenomas. They secrete prolactin and present with galactorrhoea and amenorrhoea in women, and hypogonadism in men. Somatotroph adenomas (acromegaly) are the second most common. Corticotroph adenomas (Cushing disease) are less common. Thyrotroph adenomas (TSH-secreting) are the rarest. Lactotroph is correct.\"\n},\n{id:43,\nstem:\"Low serum thyroglobulin levels are seen in\",\ncorrect:\"thyrotoxicosis factitia\",\nopts:[\"thyrotoxicosis factitia\",\"subacute thyroiditis\",\"Graves disease\",\"toxic multinodular goitre\"],\nexp:\"Thyroglobulin (Tg) is produced by thyroid follicular cells. In thyrotoxicosis factitia (exogenous thyroid hormone ingestion), excess circulating thyroid hormone suppresses TSH, which suppresses thyroid activity. No endogenous Tg is synthesised or released, resulting in undetectably low serum thyroglobulin. This low Tg distinguishes factitious thyrotoxicosis from all other causes of hyperthyroidism (subacute thyroiditis, Graves disease, toxic MNG) where Tg is elevated or normal.\"\n},\n{id:44,\nstem:\"A 45-year-old male presented with polyuria, polydipsia and polyphagia for the last 3 months. His fasting plasma glucose is 106 mg\/dL and random blood glucose is 220 mg\/dL. Which one of the following statements is correct regarding his diagnosis?\",\ncorrect:\"He has definitive diagnosis of diabetes mellitus.\",\nopts:[\"He has impaired glucose tolerance (IGT).\",\"He has definitive diagnosis of diabetes mellitus.\",\"He does not have diabetes mellitus.\",\"Diagnosis of diabetes mellitus is indeterminate as HbA1c value is not provided.\"],\nexp:\"WHO\/ADA diagnostic criteria for diabetes mellitus: any ONE of (1) FPG at least 126 mg\/dL; (2) 2-hour plasma glucose at least 200 mg\/dL during OGTT; (3) Random plasma glucose at least 200 mg\/dL WITH classic symptoms of hyperglycaemia; (4) HbA1c at least 6.5%. This patient has random blood glucose 220 mg\/dL WITH classic symptoms (polyuria, polydipsia, polyphagia) meeting criterion 3. The diagnosis of diabetes mellitus is definitive. FPG of 106 mg\/dL alone would indicate impaired fasting glucose, but the symptomatic random glucose of 220 mg\/dL is independently sufficient.\"\n},\n{id:45,\nstem:\"Which one of the following statements is true regarding the use of SGLT2 inhibitor in management of diabetes mellitus?\",\ncorrect:\"Euglycemic diabetic ketoacidosis may occur during treatment if there is a concurrent illness.\",\nopts:[\"They are used in type-1, type-2 and pancreatogenic forms of diabetes mellitus.\",\"They cause increase in blood pressure by 3-6 mm Hg and hence avoided in hypertensive patients.\",\"Their glucose-lowering effect is dependent on insulin secretion and insulin sensitivity.\",\"Euglycemic diabetic ketoacidosis may occur during treatment if there is a concurrent illness.\"],\nexp:\"SGLT2 inhibitors inhibit glucose reabsorption in the proximal tubule, causing glycosuria independent of insulin. Key points: (1) Approved primarily for type-2 DM; type-1 use is off-label. (2) They LOWER blood pressure by 3-4 mmHg (beneficial, not harmful). (3) Their glucose-lowering effect is insulin-INDEPENDENT. (4) Euglycemic DKA is a recognised risk, particularly during fasting, surgery, illness, or reduced carbohydrate intake. This is the correct statement.\"\n},\n{id:46,\nstem:\"A 50-year lady, who is a known case of rheumatoid arthritis, presents with obesity, moon facies, abdominal striae and hypertension. Overnight dexamethasone suppression test shows serum cortisol is greater than 50 nmol\/L, serum ACTH is less than 1.1 pmol\/L. The adrenal imaging and brain CT\/MRI imaging studies are unremarkable. The likely diagnosis is\",\ncorrect:\"exogenous glucocorticoid use\",\nopts:[\"Cushing disease\",\"ectopic ACTH-secreting tumour\",\"exogenous glucocorticoid use\",\"adrenal adenoma\"],\nexp:\"The key discriminating findings are: ACTH very low (ACTH-independent Cushing). However adrenal imaging is unremarkable (no adrenal adenoma or carcinoma). The patient has rheumatoid arthritis and is almost certainly on long-term glucocorticoids. Exogenous glucocorticoids suppress the HPA axis, resulting in low ACTH and low endogenous cortisol production, but the clinical picture mimics Cushing syndrome. Unremarkable adrenal and pituitary imaging confirms exogenous glucocorticoid use.\"\n},\n{id:47,\nstem:\"A 27-year lady underwent thyroidectomy for thyroid carcinoma. Post-operatively she started developing muscle cramps, perioral and peripheral paresthesia, and carpopedal spasm. Which one of the following interventions will be appropriate for this patient?\",\ncorrect:\"Measure of serum ionized calcium and to administer IV calcium gluconate\",\nopts:[\"Nerve conduction velocity in both upper and lower limbs and to administer methylcobalamin\",\"EMG of both lower limbs and to administer oral prednisolone\",\"Measure of serum ionized calcium and to administer IV calcium gluconate\",\"Measure of serum bicarbonate and to administer IV bicarbonate\"],\nexp:\"Post-thyroidectomy hypocalcaemia is the most common early complication of total thyroidectomy, caused by inadvertent damage or removal of parathyroid glands. Muscle cramps, perioral and peripheral paraesthesia, and carpopedal spasm (Trousseau sign) are classic features of hypocalcaemia. The appropriate immediate management is to confirm hypocalcaemia by measuring serum ionised calcium and administer IV calcium gluconate (10 mL of 10% solution given slowly IV) for symptomatic acute hypocalcaemia.\"\n},\n{id:48,\nstem:\"Which one of the following is an example of hypogonadotropic hypogonadism?\",\ncorrect:\"Kallmann syndrome\",\nopts:[\"Kallmann syndrome\",\"Klinefelter syndrome\",\"Turner syndrome\",\"Cryptorchidism\"],\nexp:\"Hypogonadotropic hypogonadism (HH) = low\/absent FSH and LH with resultant low sex steroids, due to hypothalamic or pituitary deficiency. Kallmann syndrome is the classic example: GnRH deficiency (hypothalamic) with anosmia. Klinefelter syndrome (47XXY) is hypergonadotropic hypogonadism (high FSH\/LH, primary testicular failure). Turner syndrome (45XO) is hypergonadotropic hypogonadism in females. Cryptorchidism is a structural anomaly. Kallmann syndrome is correct.\"\n},\n{id:49,\nstem:\"A tall thin adolescent boy is found to have gynaecomastia and small testes. His blood testosterone level is undetectable, and serum FSH and LH levels are elevated. Which one of the following is the likely karyotype pattern?\",\ncorrect:\"47 XXY\",\nopts:[\"46 XY\",\"45 XO\",\"47 XXY\",\"21 Trisomy\"],\nexp:\"The clinical features describe Klinefelter syndrome: tall thin male with small firm testes (primary testicular failure), gynaecomastia, azoospermia\/infertility, and eunuchoid body habitus. The endocrine pattern is hypergonadotropic hypogonadism: low testosterone, elevated FSH and LH. The karyotype is 47 XXY (one extra X chromosome). 45 XO is Turner syndrome (female phenotype). 21 Trisomy is Down syndrome. 47 XXY is correct.\"\n},\n{id:50,\nstem:\"Which of the following antidiabetic drugs may cause weight gain?<br>1. Glimepiride<br>2. Pioglitazone<br>3. NPH insulin<br>4. Sitagliptin<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Weight GAIN: Sulfonylureas (glimepiride) cause weight gain via insulin secretion and hypoglycaemia-driven compensatory eating. Pioglitazone (TZD) causes weight gain via fluid retention and adipogenesis. Insulin preparations including NPH cause weight gain (anabolic effect, fluid retention). Weight NEUTRAL: DPP-4 inhibitors (sitagliptin) are weight neutral; they enhance glucose-dependent insulin secretion without significant weight change. Statements 1, 2, and 3 are correct.\"\n},\n{id:51,\nstem:\"Which of the following statements is\/are correct for obesity?<br>1. Adiponectin levels are reduced in obesity.<br>2. Orlistat is a reversible inhibitor of lipase used for the treatment of obesity.<br>3. Liraglutide used for T2DM management can cause weight gain and not recommended in obese patients with T2DM.<br>4. Bariatric surgery is recommended in obese patients with BMI > 30 kg\/m² for long-term benefits.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 4\",\"1 and 2 only\",\"2, 3 and 4\",\"1 only\"],\nexp:\"Statement 1 TRUE: Adiponectin (anti-inflammatory, insulin-sensitising adipokine) is paradoxically reduced in obesity, contributing to insulin resistance. Statement 2 TRUE: Orlistat is a reversible gastric and pancreatic lipase inhibitor that reduces dietary fat absorption by approximately 30%. Statement 3 FALSE: Liraglutide (GLP-1 agonist) causes significant WEIGHT LOSS and is specifically recommended in obese patients with T2DM. Statement 4 TRUE: Bariatric surgery is recommended for BMI greater than 30 with T2DM as an established indication. Statements 1, 2, and 4 are correct.\"\n},\n{id:52,\nstem:\"Which of the following drugs are effective in preventing uric acid nephropathy in patients receiving chemotherapy?<br>1. Probenecid<br>2. Forced saline diuresis<br>3. Rasburicase<br>4. Acetazolamide<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Prevention of uric acid nephropathy in tumour lysis syndrome: Rasburicase enzymatically destroys uric acid (converts it to allantoin), the most effective drug for preventing and treating hyperuricaemia. Probenecid is a uricosuric agent that increases renal uric acid excretion. Acetazolamide alkalinises the urine (makes uric acid more soluble), preventing precipitation in tubules. Forced saline diuresis (statement 2) is important for volume expansion but is not a specific anti-uric-acid drug. Statements 1, 3, and 4 are correct.\"\n},\n{id:53,\nstem:\"Primaquine destroys hypnozoites of Plasmodium vivax for radical cure in which one of the following?\",\ncorrect:\"Liver\",\nopts:[\"Liver\",\"Peripheral blood\",\"Brain\",\"Bone marrow\"],\nexp:\"Plasmodium vivax (and P. ovale) form dormant hypnozoites in hepatocytes after initial hepatic schizogony. These hypnozoites can reactivate weeks to months later causing relapsing malaria. Primaquine is the only drug that effectively destroys these hepatic hypnozoites, providing radical cure (preventing future relapses). It acts in the LIVER where the hypnozoites reside. G6PD testing is required before primaquine administration.\"\n},\n{id:54,\nstem:\"HIV-associated neurocognitive disorder (HAND) includes which of the following?<br>1. Asymptomatic neurocognitive disorder<br>2. Minor neurocognitive disorder<br>3. HIV-associated dementia<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"HIV-associated neurocognitive disorder (HAND) is a spectrum classified into three categories (Frascati criteria 2007): (1) Asymptomatic neurocognitive impairment (ANI): objective cognitive impairment on neuropsychological testing, no functional impairment; (2) Mild neurocognitive disorder (MND): objective impairment PLUS mild functional impairment; (3) HIV-associated dementia (HAD): marked cognitive impairment with severe functional impairment. All three together constitute the HAND spectrum. All three statements are correct.\"\n},\n{id:55,\nstem:\"Consider the following statements with regard to cysticercosis:<br>1. It may present as personality change.<br>2. Subcutaneous nodule may be excised for histology.<br>3. Cerebral signs commonly do not occur until the larvae die, 5-20 years later.<br>4. Praziquantel can be given for 10 days.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2, 3 and 4\",\nopts:[\"1 and 4 only\",\"2 and 3 only\",\"1, 2 and 3 only\",\"1, 2, 3 and 4\"],\nexp:\"All four statements are correct regarding cysticercosis (Taenia solium larval infection): (1) Neurocysticercosis presents with seizures, raised ICP, hydrocephalus, and psychiatric features including personality change. (2) Subcutaneous cysticerci can be excised for histological diagnosis confirming the cyst structure with scolex. (3) Cerebral symptoms typically manifest when the larvae die (5-20 years later), triggering perilesional oedema. (4) Praziquantel 50 mg\/kg\/day for 10-28 days is a standard antiparasitic treatment. All four statements are correct.\"\n},\n{id:56,\nstem:\"Consider the following statements with regard to strongyloidiasis:<br>1. It parasitizes the mucosa of upper part of small intestine.<br>2. Larva currens is fast-moving transient rash seen across abdomen and buttocks.<br>3. Ivermectin is not an effective treatment.<br>4. Systematic strongyloidiasis is seen in immune competent state.<br>Which of the statements given above are correct?\",\ncorrect:\"1 and 2\",\nopts:[\"1 and 2\",\"2 and 3 only\",\"2, 3 and 4\",\"1 and 4\"],\nexp:\"Statement 1 TRUE: Strongyloides stercoralis adult female worms parasitise the mucosa of the duodenum and upper jejunum (upper small intestine). Statement 2 TRUE: Larva currens is a pathognomonic cutaneous feature: a rapidly migrating urticarial track (5-10 cm\/hour) across the perianal area, buttocks, and abdomen from autoinfecting filariform larvae. Statement 3 FALSE: Ivermectin is the treatment of CHOICE for strongyloidiasis (200 mcg\/kg for 2 days); highly effective. Statement 4 FALSE: Disseminated strongyloidiasis occurs in IMMUNOCOMPROMISED states, not immunocompetent individuals. Statements 1 and 2 are correct.\"\n},\n{id:57,\nstem:\"Consider the following statements with regard to cutaneous larva migrans:<br>1. It is one of the commonest linear lesions seen in travellers.<br>2. It may be associated with a recent visit to a beach.<br>3. It is non-pruritic.<br>4. Track moves across the skin at a rate of 2-3 cm\/day.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 3 and 4\",\"1, 2 and 4\",\"2, 3 and 4\"],\nexp:\"Cutaneous larva migrans (CLM) is caused by hookworm larvae (Ancylostoma braziliense) penetrating human skin but unable to complete their life cycle. Statement 1 TRUE: CLM is the most common travel-associated skin disease, presenting as serpiginous linear lesions. Statement 2 TRUE: Infection occurs by walking barefoot or lying on sand\/soil contaminated with dog or cat faeces, especially at tropical beaches. Statement 3 FALSE: CLM is intensely PRURITIC. Statement 4 TRUE: The larva advances at approximately 2-3 cm per day. Statements 1, 2, and 4 are correct.\"\n},\n{id:58,\nstem:\"Consider the following statements with regard to giardiasis:<br>1. Stools should be examined for cysts at 2-3 days interval for its diagnosis.<br>2. Colonoscopy aspirate gives the highest diagnostic yield.<br>3. Infection usually occurs by ingesting contaminated water.<br>4. Giardia has a flagellate trophozoite form.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1 and 3 only\",\"1, 2 and 4\",\"1, 3 and 4\",\"2 and 4 only\"],\nexp:\"Statement 1 TRUE: Giardia cysts are shed intermittently; examining three stool samples at 2-3 day intervals improves diagnostic sensitivity to approximately 90%. Statement 2 FALSE: Highest diagnostic yield is from DUODENAL\/JEJUNAL aspirate (small intestine), not colonoscopy (Giardia resides in the small intestine, not colon). Statement 3 TRUE: Giardia is transmitted predominantly via the faeco-oral route, most commonly by ingesting contaminated water. Statement 4 TRUE: Giardia lamblia exists as a binucleate flagellate trophozoite (pear-shaped with four pairs of flagella) and an oval cyst form. Statements 1, 3, and 4 are correct.\"\n},\n{id:59,\nstem:\"Type-2 necrotizing fasciitis is caused by\",\ncorrect:\"Vibrio vulnificus\",\nopts:[\"Group A Streptococcus\",\"Vibrio vulnificus\",\"Clostridium septicum\",\"Staphylococcus aureus\"],\nexp:\"Necrotizing fasciitis: Type 1 (polymicrobial, approximately 80%) involves mixed aerobic and anaerobic bacteria, seen in diabetics and post-surgical patients. Type 2 (monomicrobial) is caused by single virulent organisms: most classically Group A Streptococcus, but also Vibrio vulnificus (in patients with liver disease after seafood exposure or saltwater wounds). Among the options listed, Vibrio vulnificus is the Type 2 agent specifically listed as the answer in this question context.\"\n},\n{id:60,\nstem:\"Which of the following treatments for a pregnant lady who has been exposed to a patient of chicken pox are correct?<br>1. Varicella-zoster immune globulin<br>2. Varicella-zoster vaccine<br>3. Acyclovir<br>4. Prednisolone<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3 only\",\nopts:[\"1, 2 and 4\",\"2 and 3\",\"1 and 3 only\",\"1, 3 and 4\"],\nexp:\"Management of VZV exposure in a seronegative pregnant woman: Varicella-zoster immune globulin (VZIG) should be given within 96 hours of exposure to provide passive immunisation and reduce severity of maternal varicella. Acyclovir is given if the pregnant woman develops active varicella infection (particularly in 2nd\/3rd trimester) to reduce complications. Varicella-zoster vaccine is a LIVE attenuated vaccine ABSOLUTELY CONTRAINDICATED in pregnancy. Prednisolone is contraindicated as it may worsen varicella by immunosuppression. Statements 1 and 3 are correct.\"\n},\n{id:61,\nstem:\"Which of the following drugs is\/are useful in the treatment of Listeria monocytogenes infection?<br>1. Ceftriaxone<br>2. Gentamicin<br>3. Ampicillin<br>4. Sulfamethoxazole<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4 only\",\nopts:[\"1 only\",\"2, 3 and 4 only\",\"1 and 2 only\",\"1, 2, 3 and 4\"],\nexp:\"Listeria monocytogenes treatment: Ampicillin (drug of choice), often combined with gentamicin for synergistic bactericidal activity in severe infection (meningitis, bacteraemia). Trimethoprim-sulfamethoxazole (co-trimoxazole) is used in penicillin-allergic patients. Critically, Listeria is INTRINSICALLY RESISTANT to ALL cephalosporins including ceftriaxone. This is a classic exam trap: ceftriaxone empirically treats most bacterial meningitis but MUST be combined with ampicillin when Listeria is suspected (elderly, immunocompromised, neonates). Ceftriaxone alone is ineffective against Listeria. Statements 2, 3, and 4 are correct.\"\n},\n{id:62,\nstem:\"Which of the following abnormalities occur from vitamin D deficiency in children?<br>1. Craniotabes<br>2. Bossing of frontal and parietal bones<br>3. Muscle hypotonia<br>4. Shrinking of epiphysis at the lower end of radius<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Vitamin D deficiency (nutritional rickets) in children causes: Craniotabes (abnormal softening of skull bones, ping-pong ball sensation on palpation). Frontal and parietal bossing (excess osteoid deposition under periosteum). Muscle hypotonia (vitamin D essential for normal muscle function, causing delayed motor milestones). Other features: rachitic rosary, Harrison groove, genu varum\/valgum. Statement 4 is false: rickets causes WIDENING (splaying\/cupping\/fraying) of the epiphysis at the lower end of radius, not shrinking. Statements 1, 2, and 3 are correct.\"\n},\n{id:63,\nstem:\"Which one of the following is a cause of relative erythrocytosis?\",\ncorrect:\"Diuretics\",\nopts:[\"High altitude\",\"Cardiorespiratory disease\",\"High-affinity haemoglobins\",\"Diuretics\"],\nexp:\"Relative (spurious\/apparent) erythrocytosis occurs when red cell mass is normal but reduced plasma volume causes an apparent rise in haematocrit. Causes: dehydration, diuretics (plasma volume depletion), Gaisbock syndrome. Diuretics reduce plasma volume without increasing red cell mass, causing relative erythrocytosis. High altitude, cardiorespiratory disease, and high-affinity haemoglobins all cause absolute (true) secondary erythrocytosis (genuine increase in red cell mass). Diuretics is the correct answer.\"\n},\n{id:64,\nstem:\"Which of the following statements are correct regarding UTI?<br>1. Urine is an excellent culture medium for bacteria.<br>2. Atrophic urethritis in post-menopausal women is a risk factor.<br>3. Antibiotics are recommended in all cases of asymptomatic bacteriuria.<br>4. Certain strains of E. coli have a particular propensity to invade urinary tract.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1 and 4 only\",\"1, 2 and 3\",\"2, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Statement 1 TRUE: Urine is an excellent culture medium for bacteria, explaining the prevalence of UTIs. Statement 2 TRUE: Post-menopausal women lack oestrogen-dependent glycogen in vaginal epithelium, disrupting normal lactobacilli flora and promoting uropathogens; atrophic urethritis compromises local defences. Statement 3 FALSE: Antibiotics are NOT recommended for asymptomatic bacteriuria EXCEPT in pregnancy and before urological procedures. Statement 4 TRUE: Uropathogenic E. coli (UPEC) strains possess specific virulence factors (type 1 fimbriae, P-fimbriae, haemolysin) enabling them to adhere to uroepithelium and ascend the urinary tract. Statements 1, 2, and 4 are correct.\"\n},\n{id:65,\nstem:\"Which of the following statements are correct regarding scorpion stings?<br>1. Scorpion injects venom from a stinger on their tail.<br>2. Most stings are painful, but relatively harmless.<br>3. Anticholinergics can be used if antivenom is unavailable.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 2 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Statement 1 TRUE: Scorpions inject venom via a stinger (telson) located at the tip of their tail. Statement 2 TRUE: Most scorpion stings worldwide cause local pain and swelling but are self-limiting and relatively harmless. Only a few species (Buthidae family) cause life-threatening envenomation with autonomic storm. Statement 3 FALSE: Scorpion venom acts on voltage-gated sodium channels causing massive ADRENERGIC discharge. Alpha-blockers (prazosin) are used, NOT anticholinergics, which would worsen the adrenergic crisis. Statements 1 and 2 only are correct.\"\n},\n{id:66,\nstem:\"Which of the following statements are correct regarding Kyasanur forest disease?<br>1. It is commonly seen in North-Eastern States of India.<br>2. Monkeys act as reservoir of the disease.<br>3. Transmission happens through tick bite.<br>4. Inactivated vaccine is available for its prevention.<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1 and 4 only\",\"2 and 3 only\",\"1, 2 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 FALSE: KFD is endemic to the Kyasanur Forest area of KARNATAKA (Western Ghats region of South India), specifically Shimoga, Uttara Kannada, and Udupi districts. NOT north-eastern India. Statement 2 TRUE: Bonnet monkeys (Macaca radiata) serve as amplifying hosts\/reservoirs; dead monkeys alert health authorities to outbreaks. Statement 3 TRUE: Hard ticks (Haemaphysalis spinigera) are the primary vectors. Statement 4 TRUE: A formalin-inactivated vaccine is available for populations in endemic areas of Karnataka. Statements 2, 3, and 4 are correct.\"\n},\n{id:67,\nstem:\"Which of the following statements are correct regarding brucellosis?<br>1. Fever may develop into an undulating pattern that persists for weeks.<br>2. Associated musculoskeletal symptoms are a feature of the disease.<br>3. Brucellae behave as facultative intracellular parasites.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"All three statements are correct. Statement 1 TRUE: The classic undulating fever pattern (fever rising and falling in waves over weeks) gives brucellosis its alternative name undulant fever. Statement 2 TRUE: Musculoskeletal complications including arthritis, sacroiliitis, spondylitis, and osteomyelitis are the most common complications (up to 40% of cases). Statement 3 TRUE: Brucellae are classic facultative intracellular parasites; they survive and replicate within macrophages, evading killing by inhibiting phagolysosome fusion. This explains the need for combination antibiotic therapy with intracellular-penetrating agents. All three statements are correct.\"\n},\n{id:68,\nstem:\"A 60-year-old diabetic female presents with acute myocardial infarction. ECG changes include ST elevation greater than 1 mm in lead aVR. The likely localization of thrombosis is in\",\ncorrect:\"left main or proximal LAD\",\nopts:[\"right coronary artery\",\"distal LAD\",\"left circumflex artery\",\"left main or proximal LAD\"],\nexp:\"ST elevation in lead aVR (more than 0.5-1 mm) is a specific ECG finding indicating acute occlusion of the left main coronary artery (LMCA) or the proximal left anterior descending (LAD) artery. LMCA or proximal LAD occlusion causes diffuse ST depression in lateral and inferior leads with reciprocal ST elevation in aVR. This is a high-risk ECG finding associated with cardiogenic shock and high mortality. Right coronary artery occlusion causes inferior STEMI (II, III, aVF). Left circumflex causes lateral or posterior MI. Distal LAD causes anterior MI without prominent aVR changes.\"\n},\n{id:69,\nstem:\"Which one of the following antidiabetic drugs is recommended for weight loss in obese patients?\",\ncorrect:\"Liraglutide\",\nopts:[\"Glimepiride\",\"Liraglutide\",\"Sitagliptin\",\"Insulin\"],\nexp:\"Liraglutide (Victoza for T2DM; Saxenda at higher dose for obesity) is a GLP-1 receptor agonist that causes significant weight loss (typically 5-10% of body weight) through delayed gastric emptying, increased satiety, and reduced food intake. It is specifically FDA-approved for chronic weight management. Glimepiride (sulfonylurea) causes weight gain. Sitagliptin (DPP-4 inhibitor) is weight neutral. Insulin causes weight gain. Liraglutide is the recommended antidiabetic drug for weight loss in obese patients.\"\n},\n{id:70,\nstem:\"Consider the following statements regarding inflammatory bowel disease:<br>1. Ulcerative colitis (UC) involves terminal ileum and rarely causes proctitis.<br>2. Cobblestone appearance of bowel is seen in Crohn's disease.<br>3. Skip lesions are a characteristic of ulcerative colitis but never seen in Crohn's disease.<br>4. Ulcerative colitis is more common in smokers than non-smokers.<br>Which of the statements given above is\/are correct?\",\ncorrect:\"2 only\",\nopts:[\"1, 2 and 3\",\"2, 3 and 4\",\"3 and 4 only\",\"2 only\"],\nexp:\"Statement 1 FALSE: UC involves the rectum almost always (proctitis is a common presentation) and extends proximally in a continuous pattern. Statement 2 TRUE: Cobblestone mucosa (islands of intact mucosa surrounded by deep linear ulcers) is a classic feature of Crohn's disease due to transmural inflammation with deep fissuring ulcers. Statement 3 FALSE: Skip lesions (discontinuous disease) are characteristic of CROHN's disease, NOT ulcerative colitis. UC is a continuous disease. Statement 4 FALSE: UC is actually more common in NON-smokers and ex-smokers; smoking appears paradoxically protective in UC. Only statement 2 is correct.\"\n},\n{id:71,\nstem:\"Which of the following are typical physical findings in pericardial effusion?<br>1. Raised JVP<br>2. Hypotension<br>3. Oliguria<br>4. Water hammer pulse<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Cardiac tamponade (haemodynamically significant pericardial effusion) produces obstructive shock: (1) Raised JVP (elevated venous pressure as cardiac filling is restricted). (2) Hypotension (reduced cardiac output due to impaired ventricular filling). (3) Oliguria (reduced renal perfusion from low cardiac output). These three plus muffled heart sounds constitute Beck's triad. Water hammer (Corrigan) pulse is the bounding, collapsing pulse of aortic regurgitation; it is NOT a feature of tamponade. Tamponade produces pulsus paradoxus. Statements 1, 2, and 3 are correct.\"\n},\n{id:72,\nstem:\"Which of the following conditions can produce a third heart sound (S3) on auscultation?<br>1. Young age<br>2. Pregnancy<br>3. Left ventricular failure<br>4. Mitral stenosis<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"S3 (ventricular gallop) occurs in early diastole during rapid ventricular filling. Physiological S3: young adults (under 40 years) and during pregnancy (high cardiac output with rapid ventricular filling). Pathological S3: left ventricular failure, dilated cardiomyopathy, significant mitral regurgitation (volume overload). Mitral STENOSIS does NOT produce S3; it produces a loud S1, opening snap, and mid-diastolic rumble. Mitral stenosis restricts filling, making S3 unlikely. S3 requires rapid early filling. Statements 1, 2, and 3 are correct.\"\n},\n{id:73,\nstem:\"Which of the following statements are true about PR interval?<br>1. It denotes atrial depolarization.<br>2. Normal duration is 0.12 second-0.20 second.<br>3. Prolongation denotes impaired AV nodal conduction.<br>4. A short PR interval occurs in WPW syndrome.<br>Select the correct answer using the code given below.\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 FALSE: The PR interval represents conduction from onset of atrial depolarization to onset of ventricular depolarization, reflecting conduction through the atria, AV node, His bundle, and bundle branches. It is NOT just atrial depolarization alone (that is the P wave itself). Statement 2 TRUE: Normal PR interval is 0.12-0.20 seconds. Statement 3 TRUE: Prolonged PR (greater than 0.20 sec) = first-degree AV block, indicating impaired AV nodal conduction. Statement 4 TRUE: WPW syndrome: the accessory pathway (Bundle of Kent) bypasses the AV node causing pre-excitation (delta wave) with a SHORT PR interval (less than 0.12 sec). Statements 2, 3, and 4 are correct.\"\n},\n{id:74,\nstem:\"Which one of the following is the drug of choice for the treatment of schistosomiasis?\",\ncorrect:\"Praziquantel\",\nopts:[\"Doxycycline\",\"Praziquantel\",\"Albendazole\",\"Ivermectin\"],\nexp:\"Praziquantel is the drug of choice for all forms of schistosomiasis (S. mansoni, S. haematobium, S. japonicum). It is an isoquinoline-pyrazine compound causing rapid muscle contraction, tegument disruption, and death of adult worms. Single oral dose of 40 mg\/kg (S. haematobium, S. mansoni) or 60 mg\/kg in three divided doses (S. japonicum) achieves cure rates greater than 85-95%. Doxycycline is for rickettsial infections. Albendazole is for nematodes and some cestodes. Ivermectin is for strongyloidiasis, onchocerciasis. Praziquantel is correct.\"\n},\n{id:75,\nstem:\"Which of the following opportunistic systemic mycoses is characterized by rapid development of severe tissue necrosis and emerged as a specific complication associated with COVID-19 infection in India?\",\ncorrect:\"Mucormycosis\",\nopts:[\"Histoplasmosis\",\"Mucormycosis\",\"Coccidioidomycosis\",\"Sporotrichosis\"],\nexp:\"Mucormycosis (caused by Mucorales: Rhizopus, Mucor) emerged as a devastating complication of COVID-19 in India during the second wave (2021), primarily in patients with uncontrolled diabetes mellitus or those receiving high-dose corticosteroids. Rhino-orbito-cerebral mucormycosis was the most common form. India reported thousands of cases ('black fungus'). The condition is characterised by angioinvasion causing rapid tissue necrosis and infarction. Treatment requires aggressive surgical debridement plus liposomal amphotericin B. Mucormycosis is correct.\"\n},\n{id:76,\nstem:\"Which of the following fungal infections is caused by dermal inoculation of the fungal agent, usually from a thorn?\",\ncorrect:\"Sporotrichosis\",\nopts:[\"Mycetoma\",\"Aspergillosis\",\"Mucormycosis\",\"Sporotrichosis\"],\nexp:\"Sporotrichosis (Rose thorn disease) is caused by Sporothrix schenckii, a dimorphic fungus living in soil, decaying vegetation, and plant materials. Infection typically occurs via traumatic inoculation through thorn pricks, splinters, or plant material (roses, barberry, sphagnum moss). Classic presentation: a primary cutaneous nodule at the inoculation site followed by secondary nodules along lymphatic channels (lymphocutaneous sporotrichosis). Treatment: itraconazole for cutaneous\/lymphocutaneous forms; amphotericin B for disseminated forms. Sporotrichosis is correct for thorn inoculation.\"\n},\n{id:77,\nstem:\"Consider the following statements with regard to coccidioidomycosis:<br>1. It is a primary systemic mycosis caused by dimorphic fungi Coccidioides immitis and Coccidioides posadasii.<br>2. Primary pulmonary coccidioidomycosis presents with cough, fever, chest pain and arthritis.<br>3. Progressive pulmonary coccidioidomycosis presents with constitutional symptoms like fever, weight loss, anorexia and features of lobar pneumonia.<br>4. Coccidioides meningitis is a mild disease, not warranting any treatment.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Statement 1 TRUE: Coccidioidomycosis is caused by the dimorphic fungi C. immitis (California) and C. posadasii (other regions), endemic to the southwestern USA, Mexico, and parts of Latin America. Statement 2 TRUE: Primary pulmonary coccidioidomycosis (San Joaquin valley fever) presents 1-3 weeks after inhalation with cough, fever, chest pain, fatigue, and classic desert rheumatism (arthritis\/arthralgias). Statement 3 TRUE: Progressive\/disseminated disease presents with constitutional symptoms, chronic pneumonia, and systemic spread. Statement 4 FALSE: Coccidioidal meningitis is a SEVERE and CHRONIC disease requiring lifelong treatment with fluconazole (400-800 mg\/day indefinitely). Untreated, it is uniformly fatal. Statements 1, 2, and 3 are correct.\"\n},\n{id:78,\nstem:\"Consider the following statements with regard to elapid snakebite:<br>1. Regardless of the anatomic site of bite, walking of victim should be discouraged.<br>2. Pressure immobilization should be used, wherever possible.<br>3. Ptosis can be present after the elapid bite.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"All three statements are correct regarding elapid (cobra, krait, mamba) snakebite. Statement 1 TRUE: Activity increases venom absorption via lymphatic spread; the victim should be kept still regardless of bite site. Statement 2 TRUE: Pressure immobilisation (bandaging the entire limb from bite site upward with a crepe bandage, then splinting) is recommended for elapid bites (neurotoxic venom) to retard lymphatic spread; contraindicated for viper bites. Statement 3 TRUE: Elapid neurotoxins block neuromuscular transmission causing descending flaccid paralysis starting with ptosis (cranial nerve involvement) followed by ophthalmoplegia, dysphagia, and respiratory failure. All three are correct.\"\n},\n{id:79,\nstem:\"Which one of the following hormones is responsible for gallbladder contraction and release of bile into duodenum?\",\ncorrect:\"Cholecystokinin\",\nopts:[\"Secretin\",\"Gastrin\",\"Cholecystokinin\",\"Vasoactive intestinal peptide\"],\nexp:\"Cholecystokinin (CCK) is released from I cells in the duodenal and jejunal mucosa in response to fats and proteins in the duodenum. CCK stimulates: (1) Gallbladder contraction (via CCK-A receptors on gallbladder smooth muscle); (2) Relaxation of the sphincter of Oddi, releasing bile into the duodenum; (3) Pancreatic enzyme secretion. Secretin (from S cells) stimulates pancreatic bicarbonate secretion. Gastrin (from G cells) stimulates gastric acid secretion. VIP causes smooth muscle relaxation. Cholecystokinin is the correct answer.\"\n},\n{id:80,\nstem:\"Consider the following statements regarding radiation enteritis and proctocolitis:<br>1. Diarrhoea in the acute phase should be treated with codeine or loperamide.<br>2. Surgery is the treatment of choice and involves resection of the injured intestine.<br>3. Sucralfate enemas and hyperbaric oxygen are effective treatments.<br>4. Small bowel strictures and rectovaginal fistulae may develop as chronic complications.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1 and 3 only\",\"2 and 4 only\",\"1, 2 and 4\",\"1, 3 and 4\"],\nexp:\"Statement 1 TRUE: Acute radiation diarrhoea is managed symptomatically with antimotility agents (codeine, loperamide), low-residue diet, and antispasmodics. Statement 2 FALSE: Surgery is NOT the treatment of choice; it is a last resort for complications. The injured irradiated bowel heals poorly and surgery carries high morbidity. Statement 3 TRUE: Sucralfate enemas (for radiation proctitis) reduce mucosal inflammation. Hyperbaric oxygen promotes neovascularisation of ischaemic irradiated tissue. Statement 4 TRUE: Chronic radiation injury causes progressive fibrosis leading to small bowel strictures, malabsorption, and rectovaginal fistulae. 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