CMS 2023 | General Medicine & Paediatrics | Paper I | Part A<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n*,*::before,*::after{box-sizing:border-box;margin:0;padding:0}\n:root{\n --blue:#1A5EA8;--blue-lt:#2E82D5;--blue-pale:#EBF3FD;\n --navy:#1A3A5C;--navy-lt:#24527F;--navy-pale:#E8F0F9;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#dde4ed;--bg:#f8fafd;--white:#ffffff;\n --ok:#1e6f46;--ok-bg:#eaf7ef;--ok-bd:#43a047;\n --bad:#b83232;--bad-bg:#fdf0f0;--bad-bd:#e53935;\n --rad:10px;\n}\nbody{font-family:\"Source Serif 4\",Georgia,serif;font-size:16px;background:var(--bg);color:var(--ink);line-height:1.7;min-height:100vh}\n#cms23p2c{max-width:780px;margin:0 auto;padding:0 0 60px}\n\n\/* \u2500\u2500 progress strip (sticky within page, below any WP header) \u2500\u2500 *\/\n.qz-prog-bar{\n position:sticky;top:0;z-index:200;\n 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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>Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part C<\/h1>\n <p>Preventive & Social Medicine · Epidemiology · Health Programmes · Biostatistics<\/p>\n <div class=\"qz-meta\">\n <span class=\"qz-badge\">Questions 81–120<\/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:81,\nstem:\"Which one of the following is defined as the average number of children a woman would have if she were to pass through her reproductive years, bearing children at the same rates as the women now in each age group?\",\ncorrect:\"Total Fertility Rate (TFR)\",\nopts:[\"Age-Specific Fertility Rate (ASFR)\",\"General Fertility Rate (GFR)\",\"Net Reproduction Rate (NRR)\",\"Total Fertility Rate (TFR)\"],\nexp:\"Total Fertility Rate (TFR) is defined as the average number of children a woman would have over her entire reproductive lifetime (ages 15-49) if she experienced the current age-specific fertility rates throughout her reproductive years. It is a synthetic cohort measure (no real cohort is followed). TFR of 2.1 = replacement level fertility. India's TFR was approximately 2.0 (NFHS-5, 2019-21). ASFR is the fertility rate for a specific age group. GFR (General Fertility Rate) is the number of live births per 1000 women of reproductive age (15-49). NRR accounts for female births and mortality; NRR of 1.0 = replacement level. TFR is the correct answer.\"\n},\n{id:82,\nstem:\"Which among the following is correct about yellow fever vaccination requirement for international travellers?<br>1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person, some years ago.<br>2. Lifetime validity of the certificate applies automatically to all existing and new certificates.<br>3. Validity of the certificate begins 4 days after vaccination.<br>4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3\",\nopts:[\"1 and 2\",\"1 and 3\",\"2 and 3\",\"2 and 4\"],\nexp:\"Yellow fever vaccination international certificate: Statement 1 TRUE: WHO amended the International Health Regulations in 2014; the validity of yellow fever vaccination certificates was extended from 10 years to LIFETIME (duration of the life of the vaccinated person), effective from 11 July 2016. A single dose of yellow fever vaccine is now considered to provide lifelong protection. Statement 2 FALSE: Lifetime validity does NOT apply automatically to all EXISTING certificates issued before 11 July 2016. Certificates issued before that date remain valid for 10 years from the date of vaccination (i.e., they expire on their original expiry date), unless reissued. Statement 3 TRUE: The certificate of vaccination becomes valid 10 days after primary vaccination (not 4 days - this statement says 4 days which is INCORRECT, but per the exam answer key, statements 1 and 3 are selected). Statement 4: India does not require a booster for certificates prior to 2016 per current guidelines. Per the UPSC CMS answer key, statements 1 and 3 are correct.\"\n},\n{id:83,\nstem:\"Regarding active immunization against Typhoid fever, consider the following statements:<br>1. The typhoid polysaccharide vaccine is injectable and can be given subcutaneously or intramuscularly.<br>2. The typhoid polysaccharide vaccine is required to be given in two doses and administered on 0 and 7th day.<br>3. The typhoid oral Ty21a vaccine requires to be given in three doses on 0, 3rd and 7th days.<br>4. Protective immunity with typhoid vaccines is achieved immediately after the vaccine is received.<br>Which of the statements given above is\/are correct?\",\ncorrect:\"1 only\",\nopts:[\"1 only\",\"1, 3 and 4\",\"1 and 2 only\",\"2 only\"],\nexp:\"Typhoid vaccines: (1) Vi capsular polysaccharide (ViCPS) vaccine (Typhim Vi, Typherix): Injectable (IM or SC), single dose, provides protection for 2-3 years - statement 1 CORRECT. (2) ViCPS is given as a SINGLE dose (not two doses on days 0 and 7) - statement 2 INCORRECT. Two-dose schedules apply to some other vaccines (e.g., hepatitis A). (3) Ty21a oral typhoid vaccine (Vivotif): given in 3 capsules on alternate days (days 1, 3, 5 - i.e., day 0, day 2, day 4 or similar alternate-day schedule), NOT on days 0, 3, 7. Some regimens state days 0, 2, 4 (3 doses on alternate days) - statement 3 INCORRECT as stated. (4) Protective immunity is NOT achieved immediately; it takes approximately 7-10 days after injectable vaccine and longer after oral - statement 4 INCORRECT. Only statement 1 is correct.\"\n},\n{id:84,\nstem:\"Which of the following statements are correct regarding Mantoux test for tuberculosis?<br>1. It entails injecting 1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative) in 0.1 mL intradermally.<br>2. The injection should be given with the needle bevel facing downward.<br>3. When placed correctly, the injection should produce a pale wheal of the skin, 1-2 mm in diameter.<br>4. The injection should be given with a tuberculin syringe.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 4\",\nopts:[\"1 and 2\",\"1 and 4\",\"2 and 3\",\"2 and 4\"],\nexp:\"Mantoux tuberculin skin test (TST): Statement 1 TRUE: The standard Mantoux test uses 2 TU (Tuberculin Units) of PPD RT-23 in 0.1 mL injected intradermally on the volar surface of the forearm. However, in some countries\/references, 1 TU (Siebert preparation) or 5 TU (US standard) is used. Per Indian guidelines (RNTCP), 1 TU of PPD RT-23 in 0.1 mL is used - statement 1 is considered correct in this context. Statement 2 FALSE: The needle bevel should face UPWARD (not downward) to ensure intradermal injection - a raised wheal forms when the bevel faces up. Statement 3 FALSE: Correct intradermal injection produces a pale wheal (bleb) of 6-10 mm diameter, NOT 1-2 mm (which is too small and suggests subcutaneous injection). Statement 4 TRUE: A 1 mL tuberculin syringe with a short (10 mm) 26-27 gauge needle is used for the Mantoux test to ensure accurate 0.1 mL dosing. Statements 1 and 4 are correct.\"\n},\n{id:85,\nstem:\"Which one among the following types of ventilation, best fits the following description: A system of ventilation in which fresh air is blown into the room by centrifugal fans so as to create a positive pressure, and displace the vitiated air?\",\ncorrect:\"Plenum ventilation\",\nopts:[\"Exhaust ventilation\",\"Balanced ventilation\",\"Natural ventilation\",\"Plenum ventilation\"],\nexp:\"Types of mechanical ventilation: (1) Plenum (Plenum-pressure) ventilation: Fresh air is BLOWN INTO the room by fans, creating POSITIVE PRESSURE inside; the vitiated (stale) air is displaced and exits through outlets\/cracks. This is the description given in the question. Used in operating theatres, clean rooms. (2) Exhaust ventilation: Stale air is EXTRACTED from the room by fans, creating NEGATIVE PRESSURE inside; fresh air enters through inlets. Used in kitchens, laboratories, toilets. (3) Balanced ventilation: Both supply fans (fresh air in) and exhaust fans (stale air out) operate simultaneously, maintaining neutral pressure. (4) Natural ventilation: Driven by wind and thermal buoyancy, no mechanical fans. The description (fresh air blown in by centrifugal fans, positive pressure, displacing vitiated air) exactly matches Plenum ventilation.\"\n},\n{id:86,\nstem:\"The Nalgonda Technique developed by the National Environmental Engineering Research Institute (NEERI) was developed primarily for the removal of which one of the following from water?\",\ncorrect:\"Fluorine\",\nopts:[\"Asbestos\",\"Fluorine\",\"Chlorine\",\"Iron\"],\nexp:\"The Nalgonda Technique was developed by the National Environmental Engineering Research Institute (NEERI), Nagpur, India, specifically for the removal of FLUORIDE (fluorine\/fluoride ions) from drinking water in endemic fluorosis areas. The technique (named after Nalgonda district of Andhra Pradesh where fluorosis was endemic) involves addition of alum (aluminium sulphate) and lime to water, followed by rapid mixing, flocculation, sedimentation, and filtration. The aluminium hydroxide floc adsorbs and co-precipitates fluoride ions, reducing water fluoride levels from above 3-4 mg\/L to below the permissible limit of 1 mg\/L. This is a community-level defluoridation technique suitable for India's rural settings. Fluorine\/fluoride is the correct answer.\"\n},\n{id:87,\nstem:\"Smoking is considered to be a modifiable risk factor for Coronary Heart Disease. Consider the following statements with regard to possible mechanisms on the basis of which it acts as a risk factor:<br>1. Nicotine stimulation of adrenergic drive raises the blood pressure and myocardial oxygen demand.<br>2. It increases carbon monoxide and induces atherogenesis.<br>3. It leads to fall in protective high density lipoproteins.<br>4. It reduces the apolipoprotein-B plasma levels.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"1 and 3 only\",\"1, 2 and 3\",\"2, 3 and 4\"],\nexp:\"Mechanisms by which smoking causes coronary heart disease: Statement 1 TRUE: Nicotine stimulates catecholamine release (adrenergic activation), causing tachycardia, hypertension, and increased myocardial oxygen demand while simultaneously causing coronary vasoconstriction, creating an oxygen supply-demand mismatch. Statement 2 TRUE: Carbon monoxide (CO) from cigarette smoke binds haemoglobin with 200x greater affinity than oxygen (forming carboxyhaemoglobin), reducing oxygen delivery; CO also directly damages endothelium and induces atherogenesis by promoting lipid deposition. Statement 3 TRUE: Smoking reduces HDL cholesterol (protective lipoprotein), shifting the lipid profile towards a more atherogenic pattern with lower HDL and potentially higher LDL. Statement 4 FALSE: Smoking INCREASES apolipoprotein-B (apo-B) levels (apo-B is the main protein of LDL and VLDL, the atherogenic lipoproteins); it does NOT reduce apo-B. Statements 1, 2, and 3 are correct.\"\n},\n{id:88,\nstem:\"The expected outcome of Government of India's initiative SUMAN is\",\ncorrect:\"Zero preventable maternal and newborn deaths\",\nopts:[\"Zero preventable maternal and newborn deaths\",\"Limit preventable maternal and newborn deaths to between 0.5-1%\",\"Limit preventable maternal and newborn deaths to between 1-2%\",\"Limit preventable maternal and newborn deaths to between 2-5%\"],\nexp:\"SUMAN (Surakshit Matritva Aashwasan) is a Government of India initiative launched in October 2019 under the National Health Mission. SUMAN aims to provide: assured, dignified, respectful, and quality healthcare at no cost, with zero tolerance for denial of services, to every woman and newborn visiting public health facilities. The stated expected outcome of SUMAN is: ZERO preventable maternal and newborn deaths. Key entitlements under SUMAN: free and zero-expense delivery, free caesarean section, free transport, free medicines and diagnostics, zero tolerance for denial of services, respectful maternity care. The vision of zero preventable maternal and newborn deaths aligns with the global Sustainable Development Goal (SDG 3) target of reducing maternal mortality.\"\n},\n{id:89,\nstem:\"Water contamination with high content of which chemical can lead to methaemoglobinaemia?\",\ncorrect:\"Nitrate\",\nopts:[\"Cyanide\",\"Nitrate\",\"Fluoride\",\"Sulphide\"],\nexp:\"Methaemoglobinaemia from contaminated water is classically caused by high NITRATE content. Mechanism: Nitrates (NO3-) in drinking water are reduced to nitrites (NO2-) by gut bacteria (particularly in infants under 6 months who have more alkaline gut pH). Nitrites oxidise the ferrous iron (Fe2+) in haemoglobin to ferric iron (Fe3+), forming methaemoglobin, which cannot carry oxygen. Clinical presentation: cyanosis unresponsive to oxygen, chocolate-brown blood, SaO2 falsely normal on pulse oximetry. This is the Blue Baby Syndrome (infantile methaemoglobinaemia) associated with well water contaminated with nitrates from agricultural fertilisers and sewage. WHO guideline for nitrate in drinking water: 50 mg\/L as NO3. Treatment: methylene blue IV. Nitrate is the correct answer.\"\n},\n{id:90,\nstem:\"With reference to human body's requirement for proteins, they are essential because they are:<br>1. a key supply source for energy.<br>2. required for maintenance of osmotic pressure within the intravascular compartment.<br>3. critical for upkeep of cell mediated immune response.<br>4. vital for the synthesis of certain hormones.<br>Which of the statements given above are correct?\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 3 and 4\",\"1, 2 and 4\",\"2, 3 and 4\",\"1, 2 and 3\"],\nexp:\"Essential functions of dietary proteins: Statement 1 FALSE (partially): Proteins provide energy (4 kcal\/g), but they are NOT a KEY supply source for energy - carbohydrates and fats are the primary energy substrates. Protein is used for energy only when carbohydrate and fat stores are inadequate (starvation\/catabolism). The primary\/essential roles of protein are structural and functional, not energetic. Statement 2 TRUE: Plasma proteins (primarily albumin) are critical for maintaining colloid osmotic (oncotic) pressure within the intravascular compartment, preventing oedema. Statement 3 TRUE: Proteins are essential for cell-mediated immunity (lymphocytes, cytokines, immunoglobulins, complement proteins) - severe protein deficiency causes immune suppression. Statement 4 TRUE: Many hormones are proteins or peptides (insulin, glucagon, growth hormone, thyroid-stimulating hormone, ADH, oxytocin) and require dietary amino acids for synthesis. Statements 2, 3, and 4 are correct.\"\n},\n{id:91,\nstem:\"Which food proteins among the following are considered to be the best and are used in nutritional studies as reference protein?\",\ncorrect:\"Egg proteins\",\nopts:[\"Milk proteins\",\"Egg proteins\",\"Wheat proteins\",\"Legume proteins\"],\nexp:\"Reference protein is a hypothetical ideal protein with a perfect amino acid composition for human needs, used as a standard to evaluate the nutritional quality of other proteins. The egg protein (specifically whole egg protein, particularly egg albumin\/ovalbumin) is internationally accepted as the REFERENCE PROTEIN (biological value = 100, protein digestibility-corrected amino acid score \/ PDCAAS = 1.0) because: (1) It contains all essential amino acids in the optimal proportions for human requirements; (2) It has a biological value (BV) of approximately 100 (the original reference standard); (3) It is highly digestible (digestibility coefficient approximately 98%); (4) It has been used in WHO\/FAO protein quality evaluation studies as the gold standard. Milk protein (casein) is also high quality but egg protein is THE reference protein in nutritional studies.\"\n},\n{id:92,\nstem:\"Consider the following statements with reference to trans fatty acids:<br>1. They are geometrical isomers of cis-unsaturated fatty acids.<br>2. Though atherogenic, being unsaturated they are less so than saturated fatty acids.<br>3. It takes years for trans fatty acids to be flushed from the body.<br>4. They lower both LDL cholesterol and HDL cholesterol in the body.<br>Which of the statements given above are correct?\",\ncorrect:\"1 and 3 only\",\nopts:[\"1 and 2 only\",\"1 and 3 only\",\"1, 2 and 3\",\"2, 3 and 4\"],\nexp:\"Trans fatty acids (TFAs): Statement 1 TRUE: TFAs are geometrical isomers of cis-unsaturated fatty acids; in natural cis configuration, the hydrogen atoms are on the same side of the double bond (bent chain); in trans configuration, they are on opposite sides (straight chain, behaving more like saturated fat). Statement 2 FALSE: TFAs are MORE atherogenic than saturated fatty acids in terms of their net effect on the TC:HDL ratio, because TFAs both RAISE LDL AND LOWER HDL, creating a doubly adverse lipid profile. Saturated fats raise LDL but do not lower HDL to the same extent. TFAs are therefore considered WORSE than saturated fats. Statement 3 TRUE: TFAs are incorporated into cell membranes and adipose tissue and are metabolised very slowly; they may persist in the body for years. Statement 4 FALSE: TFAs RAISE LDL cholesterol AND LOWER HDL cholesterol - this dual effect makes them particularly atherogenic. The statement says they LOWER both - incorrect for LDL. Statements 1 and 3 are correct.\"\n},\n{id:93,\nstem:\"Consider the following disorders:<br>1. Delayed motor milestones<br>2. Extrapyramidal spasticity<br>3. Nyctalopia<br>4. Hearing defects<br>Which of the above disorders occur as part of the spectrum of iodine deficiency disorders?\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 3 and 4\",\"2, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Iodine Deficiency Disorders (IDDs) spectrum - consequences of severe iodine deficiency in pregnancy: Endemic cretinism has two forms: (1) Neurological cretinism: severe intellectual disability, deaf-mutism (hearing defects - statement 4 correct), spastic diplegia (extrapyramidal\/pyramidal spasticity - statement 2 correct), squint; (2) Myxoedematous cretinism: hypothyroidism, growth retardation, delayed motor milestones (statement 1 correct). Nyctalopia (night blindness) is caused by VITAMIN A deficiency, NOT iodine deficiency - statement 3 incorrect. Iodine deficiency affects brain development during fetal life and early infancy, causing neurological damage if deficiency occurs during these critical periods. The spectrum of IDDs includes: goitre, hypothyroidism, cretinism, intellectual disability, delayed milestones, hearing defects, and increased stillbirth\/miscarriage rates. Statements 1, 2, and 4 are correct.\"\n},\n{id:94,\nstem:\"With reference to occupational cancers, consider the following statements:<br>1. Skin cancer is a common occupational hazard in workers employed in nickel and chromium work.<br>2. Cancer bladder is an occupational hazard in workers employed in dye-stuffs and dyeing industry.<br>3. Leukaemia can occur on long exposure to benzol.<br>4. Lung cancer is typically found in workers employed in electric cable industries.<br>Which of the statements given above are correct?\",\ncorrect:\"2 and 3 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"3 and 4 only\",\"1 and 4 only\"],\nexp:\"Occupational cancers: Statement 1 FALSE: Nickel and chromium (hexavalent Cr) exposure primarily causes LUNG cancer and NASAL SINUS cancer, NOT skin cancer as the common occupational hazard. Skin cancer (squamous cell carcinoma, Bowen's disease) is associated with arsenic exposure and UV radiation. Statement 2 TRUE: Bladder cancer (transitional cell carcinoma) is the classic occupational cancer of workers in the dye, rubber, leather, and printing industries; carcinogens include beta-naphthylamine, benzidine, and other aromatic amines. Statement 3 TRUE: Benzene (benzol) is the classic cause of occupational leukaemia (particularly acute myeloid leukaemia \/ aplastic anaemia) in workers exposed to solvents, rubber, shoe manufacturing, and petroleum industries. Statement 4 FALSE: Lung cancer in electric cable industry is not a classic association; asbestosis\/mesothelioma is associated with asbestos (insulation); lung cancer with asbestos, arsenic, chromium, nickel, radon, PAHs. Statements 2 and 3 are correct.\"\n},\n{id:95,\nstem:\"If, on amniocentesis, the alpha fetoprotein is found to be elevated in the amniotic fluid, which defect\/disorder is the foetus likely to harbour?\",\ncorrect:\"Neural tube defects\",\nopts:[\"Cardiac septal defects\",\"Neural tube defects\",\"Duchenne muscular dystrophy\",\"Galactosaemia\"],\nexp:\"Alpha-fetoprotein (AFP) is a fetal glycoprotein produced by the yolk sac and fetal liver. Elevated AFP in amniotic fluid (or maternal serum) is strongly associated with OPEN NEURAL TUBE DEFECTS (NTDs): anencephaly, open spina bifida (myelomeningocele), encephalocele. The mechanism: in open NTDs (where neural tissue is exposed without skin covering), AFP leaks from the fetal circulation into the amniotic fluid, causing markedly elevated AFP levels. AFP is also elevated in abdominal wall defects (gastroschisis, omphalocele) and fetal death. In Down syndrome (trisomy 21), AFP is LOW (combined with low oestriol and elevated hCG in the triple test). Cardiac septal defects, Duchenne muscular dystrophy, and galactosaemia do not cause elevated AFP. Neural tube defects is the correct answer.\"\n},\n{id:96,\nstem:\"Which of the following are domains (or types) of learning?<br>1. Affective learning<br>2. Cognitive learning<br>3. Physiological learning<br>4. Psychomotor learning<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 3 and 4\",\"2, 3 and 4\",\"1, 2 and 3\",\"1, 2 and 4\"],\nexp:\"Bloom's Taxonomy (1956) classifies educational learning objectives into three domains: (1) Cognitive domain (statement 2 correct): intellectual skills, knowledge, comprehension, application, analysis, synthesis, evaluation. (2) Affective domain (statement 1 correct): emotions, attitudes, values, beliefs, motivation - how learners react emotionally and their ability to feel other living things' pain and joy. (3) Psychomotor domain (statement 4 correct): physical skills, coordination, motor skills, manipulation of objects - learning by doing. Physiological learning (statement 3) is NOT one of Bloom's three domains; there is no recognised domain called physiological learning in educational taxonomy. The three domains of Bloom's Taxonomy are Cognitive, Affective, and Psychomotor. Statements 1, 2, and 4 are correct.\"\n},\n{id:97,\nstem:\"Which of the following are beneficiaries of services provided under the Integrated Child Development Scheme (ICDS)?<br>1. Adolescent boys<br>2. Adolescent girls<br>3. Pregnant women<br>4. Children less than 6 years of age<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:\"The Integrated Child Development Scheme (ICDS) is one of the world's largest programmes for early childhood development, launched in India in 1975 under the Ministry of Women and Child Development. Beneficiaries of ICDS services: (1) Children below 6 years of age (0-6 years) - statement 4 correct; they receive supplementary nutrition, immunisation, health check-up, growth monitoring, referral services. (2) Pregnant women - statement 3 correct; they receive supplementary nutrition, health education, antenatal care. (3) Lactating mothers - also beneficiaries (not listed as option). (4) Adolescent girls (11-18 years) - statement 2 is INCORRECT for the ORIGINAL ICDS scope; however, adolescent girls (11-18 years) are now covered under SABLA (Rajiv Gandhi Scheme for Empowerment of Adolescent Girls) which merged with ICDS. (5) Adolescent BOYS - statement 1: adolescent boys are NOT beneficiaries of ICDS. Among the options, 1 (adolescent boys), 3 (pregnant women), and 4 (children under 6) matches - but boys are NOT beneficiaries. The answer is 2, 3 and 4 per standard teaching, but the key gives 1, 3 and 4. Using the exam answer: 1, 3 and 4.\"\n},\n{id:98,\nstem:\"Which of the following correctly represent the three critical determinants of a healthy facility being declared as a First Referral Unit (FRU)?<br>1. Availability of emergency obstetric surgical interventions<br>2. Availability of immunization services<br>3. Blood storage facility<br>4. Newborn care<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 3 and 4\",\"1, 2 and 4\",\"2, 3 and 4\"],\nexp:\"A First Referral Unit (FRU) in India's health system is a Community Health Centre (CHC) or sub-district\/district hospital that has been upgraded to provide emergency obstetric and neonatal care. The THREE CRITICAL determinants for FRU declaration are: (1) Availability of EMERGENCY OBSTETRIC SURGICAL INTERVENTIONS: 24-hour emergency caesarean section, management of obstetric emergencies (PPH, eclampsia, obstructed labour) - statement 1 correct. (2) Blood storage facility (blood bank or blood storage unit): ability to provide blood transfusions for obstetric haemorrhage - statement 3 correct. (3) Newborn care: neonatal resuscitation, newborn stabilisation unit (NBSU) or Special Newborn Care Unit (SNCU) - statement 4 correct. Immunisation services (statement 2) are provided at all levels (subcentre, PHC, CHC) and are NOT a critical determinant specifically for FRU designation. Statements 1, 3, and 4 are the three critical determinants.\"\n},\n{id:99,\nstem:\"What is the correct increasing order of minimum age at which the following vaccines are administered to a child, as part of the National Immunization Schedule (NIS) after birth of child?<br>1. BCG vaccine<br>2. Japanese Encephalitis (JE) vaccine<br>3. Rotavirus vaccine<br>4. Tetanus and adult diphtheria (Td) vaccine<br>Select the correct answer using the code given below.\",\ncorrect:\"1 \u2192 3 \u2192 2 \u2192 4\",\nopts:[\"1 \u2192 2 \u2192 3 \u2192 4\",\"1 \u2192 3 \u2192 2 \u2192 4\",\"2 \u2192 3 \u2192 4 \u2192 1\",\"3 \u2192 1 \u2192 4 \u2192 2\"],\nexp:\"National Immunization Schedule (NIS) - minimum ages for first dose: BCG (1): given at BIRTH (0 days) - earliest vaccine in the schedule. Rotavirus vaccine (3): given at 6 WEEKS (first dose) as part of the pentavalent schedule. Japanese Encephalitis (JE) vaccine (2): given at 9 MONTHS (along with measles-containing vaccine in endemic states). Tetanus and adult diphtheria Td (4): given at 10 YEARS (school entry booster dose) and 16 years. Increasing order of minimum age: BCG (birth) \u2192 Rotavirus (6 weeks) \u2192 JE (9 months) \u2192 Td (10 years) = 1 \u2192 3 \u2192 2 \u2192 4. Option (b) is correct.\"\n},\n{id:100,\nstem:\"Under the National Leprosy Eradication Programme, ASHAs have been entrusted to carry out which of the following activities?<br>1. ASHAs are to search for suspected cases of leprosy in their villages and take them to the PHCs for diagnosis and treatment.<br>2. ASHAs arrange an amount of Rs 5,000 as an incentive to each leprosy affected person in their village for undergoing reconstructive surgery.<br>3. ASHAs ensure that each leprosy affected person in their village receives micro-cellular rubber footwear for protection of insensitive feet.<br>4. ASHAs follow up all confirmed cases of leprosy in their village to ensure their treatment completion.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 4 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 4 only\",\"3 and 4 only\"],\nexp:\"Under the National Leprosy Eradication Programme (NLEP), ASHA roles: Statement 1 TRUE: ASHAs are the first point of contact for suspected leprosy cases; they are trained to identify cardinal signs of leprosy (skin patches, nerve thickening, sensory loss) and refer suspected cases to the PHC\/designated leprosy centre for diagnosis by trained health workers. Statement 2 FALSE: The incentive for reconstructive surgery (RCS) under NLEP is Rs 8,000 (not Rs 5,000), and it is facilitated through the health system, not arranged by the ASHA personally. Statement 3 FALSE: Distribution of micro-cellular rubber (MCR) footwear to prevent plantar ulcers in leprosy patients with insensitive feet is done by health staff at PHC\/district leprosy office level, not specifically by ASHAs. Statement 4 TRUE: ASHAs are specifically entrusted with following up confirmed leprosy cases on MDT (multi-drug therapy) to ensure treatment completion and reduce defaulters. Statements 1 and 4 are correct.\"\n},\n{id:101,\nstem:\"The cost of implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is borne by\",\ncorrect:\"Both Central Government and State Government\",\nopts:[\"Central Government only\",\"State Government only\",\"Both Central Government and State Government\",\"Private institutions only as a part of their Corporate Social Responsibility\"],\nexp:\"Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) - the world's largest government-funded health insurance scheme, launched in September 2018, targeting approximately 50 crore beneficiaries (10 crore poor and vulnerable families). Cost sharing ratio: The premium\/cost of implementation is SHARED between the Central Government and State Government in a ratio of 60:40 (Centre:States) for general category states, 90:10 for North-Eastern states and hilly states (Himachal Pradesh, Uttarakhand, Jammu and Kashmir), and 100:0 (fully centrally funded) for Union Territories without legislature. Both Central and State governments bear the cost of implementation. The scheme provides health coverage of Rs 5 lakh per family per year for secondary and tertiary hospitalization at empanelled hospitals (public and private).\"\n},\n{id:102,\nstem:\"All of the following are dashboard indicators used for monitoring of India Newborn Action Plan (INAP). Which one of them is an impact level indicator?\",\ncorrect:\"Neonatal mortality rate\",\nopts:[\"Caesarean section rate\",\"Neonatal mortality rate\",\"Exclusive breastfeeding rate\",\"Percentage of preterm births\"],\nexp:\"India Newborn Action Plan (INAP) was launched in 2014 to reduce neonatal mortality and stillbirth rates. INAP monitoring dashboard indicators are classified as: IMPACT indicators (measure the ultimate health outcomes - mortality and morbidity): Neonatal mortality rate (NMR), Stillbirth rate - these are the impact level outcomes that INAP aims to reduce. OUTPUT\/COVERAGE indicators (measure service delivery): Caesarean section rate (measure of obstetric intervention), exclusive breastfeeding rate (nutrition outcome), percentage preterm births (risk factor indicator). The neonatal mortality rate is the primary IMPACT LEVEL INDICATOR for INAP - it directly measures whether the programme is achieving its goal of reducing newborn deaths. India's target under INAP: NMR of 16 or less per 1000 live births and stillbirth rate of 10 or less per 1000 total births by 2030.\"\n},\n{id:103,\nstem:\"Which of the following are health education models?<br>1. Medical model<br>2. Motivation model<br>3. Persuasion model<br>4. Social intervention model<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Models of health education (behaviour change communication): The standard classification of health education models includes: (1) Medical model (biomedical model): health is absence of disease; the health educator provides information and the patient complies - statement 1 correct. (2) Behaviour change model (not persuasion model): focuses on changing individual behaviour through various techniques. (3) Educational model: focuses on voluntary behaviour change through knowledge and understanding. (4) Motivation model: addresses underlying motivations, values, and beliefs that drive health behaviours - statement 2 correct. (5) Social intervention model (community\/social change model): addresses socioeconomic determinants of health through policy, community organisation, and advocacy - statement 4 correct. The persuasion model (statement 3) is NOT a standard health education model classification. Statements 1, 2, and 4 are correct health education models.\"\n},\n{id:104,\nstem:\"Who among the following has two general phases - first, simple pneumoconiosis and a second phase characterized by progressive massive fibrosis (PMF)?\",\ncorrect:\"Anthracosis\",\nopts:[\"Anthracosis\",\"Bagassosis\",\"Byssinosis\",\"Siderosis\"],\nexp:\"Progressive Massive Fibrosis (PMF) is the advanced form of coal worker's pneumoconiosis (anthracosis) and silicosis. ANTHRACOSIS (Coal Workers' Pneumoconiosis \/ Black Lung Disease) has two phases: Phase 1 - Simple coal workers' pneumoconiosis (SCWP): exposure to coal dust causes small rounded opacities (1-5 mm) in the upper lobes; minimal symptoms or simple cough; spirometry may be near normal. Phase 2 - Progressive Massive Fibrosis (PMF \/ Complicated CWP): coalescence of nodules forming large masses (greater than 1 cm, PMF defined as opacity greater than 1 cm); causes severe restrictive and obstructive lung disease, cor pulmonale, and disability. Bagassosis (sugarcane dust - hypersensitivity pneumonitis), Byssinosis (cotton dust - occupational asthma), and Siderosis (iron dust - relatively benign) do not characteristically show PMF. Anthracosis is the correct answer.\"\n},\n{id:105,\nstem:\"Consider the following statements about correlation between two variables:<br>1. The correlation is done between an independent variable X and a dependent variable Y.<br>2. The coefficient of correlation can range from -1 to infinity.<br>3. If coefficient of correlation (r) is equal to 1, it indicates there is no association between X and Y.<br>4. Correlation does not necessarily prove causation.<br>Which of the statements given above is\/are correct?\",\ncorrect:\"4 only\",\nopts:[\"1 only\",\"4 only\",\"1, 2 and 3\",\"1 and 4 only\"],\nexp:\"Correlation statistics: Statement 1 FALSE: Correlation does NOT require that one variable be independent and the other dependent; it measures the LINEAR ASSOCIATION between TWO VARIABLES without implying directionality or causation. Regression analysis is used when there is a predictor (independent) and outcome (dependent) variable. Statement 2 FALSE: The Pearson correlation coefficient (r) ranges from -1 to +1 (NOT -1 to infinity). r = +1: perfect positive linear correlation; r = -1: perfect negative linear correlation; r = 0: no linear association. Statement 3 FALSE: r = 1 indicates a PERFECT POSITIVE linear association between X and Y (when X increases, Y increases perfectly proportionally). r = 0 indicates no linear association. Statement 4 TRUE: Correlation measures association\/co-variation, but does NOT establish causation. Confounding, reverse causation, or spurious correlation may explain an observed r. Only statement 4 is correct.\"\n},\n{id:106,\nstem:\"With regard to lead poisoning, consider the following statements:<br>1. Coproporphyrin in urine is a useful screening test.<br>2. Hand washing before eating is an important measure of personal hygiene.<br>3. The use of d-penicillamine has been reported to be effective in management.<br>How many of the statements given above is\/are correct?\",\ncorrect:\"All three\",\nopts:[\"1 only\",\"2 only\",\"All three\",\"None\"],\nexp:\"Lead poisoning (plumbism): Statement 1 TRUE: Urinary coproporphyrin (specifically delta-aminolaevulinic acid \/ ALA and coproporphyrinogen) is a useful SCREENING test for lead poisoning. Lead inhibits several enzymes in the haem synthesis pathway; ALA dehydratase inhibition causes accumulation of delta-ALA; ferrochelatase inhibition causes elevation of free erythrocyte protoporphyrin (FEP) and urinary coproporphyrins. Statement 2 TRUE: Lead absorption in children often occurs through hand-to-mouth activity (ingestion of lead-contaminated soil, paint chips, dust). Hand washing before eating is a simple and effective preventive measure. Statement 3 TRUE: D-penicillamine (oral chelating agent) has been used in the management of lead poisoning, particularly for mild-moderate poisoning or as follow-up after parenteral chelation. Other chelating agents: BAL (dimercaprol) IV for severe poisoning, DMSA (succimer) orally. All three statements are correct.\"\n},\n{id:107,\nstem:\"A water body was inspected to look for the presence of mosquito eggs. It was observed that there were boat-shaped eggs, laid singly, not in clusters. The eggs also had lateral floats. Which one of the following diseases is most likely to be spread by the mosquito whose eggs were found?\",\ncorrect:\"Malaria\",\nopts:[\"Chikungunya fever\",\"Dengue fever\",\"Japanese encephalitis\",\"Malaria\"],\nexp:\"Mosquito egg identification: Anopheles mosquito eggs: BOAT-SHAPED, laid SINGLY (not in clusters\/rafts), with LATERAL FLOATS (air-filled flotation chambers on each side) on the water surface. They are laid singly on water surface. Culex mosquito eggs: cylindrical, laid in RAFTS (clusters of 100-300 eggs stuck together), standing upright. Aedes mosquito eggs: dark, oval, laid singly on damp surfaces above the waterline (not floating). The description - boat-shaped, singly laid, with lateral floats - is pathognomonic of ANOPHELES mosquito eggs. Anopheles mosquitoes are the vectors for MALARIA (Plasmodium species). Chikungunya and Dengue are transmitted by Aedes mosquitoes. Japanese encephalitis is transmitted by Culex mosquitoes. Malaria is the correct answer.\"\n},\n{id:108,\nstem:\"In the National Health Policy 2017, a target of 90:90:90 has been set for HIV\/AIDS. Which among the following are targets for which a 90% level has been set as part of 90:90:90 for HIV\/AIDS?<br>1. Proportion of couples who have safe sex<br>2. Proportion of people living with HIV who know their HIV status<br>3. Proportion of adolescents who have access to contraceptives<br>4. Proportion of people receiving antiretroviral therapy who have viral suppression<br>Select the correct answer using the code given below.\",\ncorrect:\"2 and 4\",\nopts:[\"1 and 4\",\"1 and 3\",\"2 and 3\",\"2 and 4\"],\nexp:\"The UNAIDS 90-90-90 targets (adopted into India's National Health Policy 2017 and linked to SDG 3.3): (1) 90% of all people living with HIV will know their HIV status (diagnosis target) - statement 2 correct. (2) 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy (treatment target). (3) 90% of all people receiving ART will achieve viral suppression (viral load undetectable) (viral suppression target) - statement 4 correct. The 90:90:90 framework specifically addresses: diagnosis, treatment, and viral suppression cascades for people living with HIV. Proportion of couples with safe sex (statement 1) and proportion of adolescents with access to contraceptives (statement 3) are prevention targets, NOT part of the 90:90:90 framework. Statements 2 and 4 are correct.\"\n},\n{id:109,\nstem:\"The Sample Registration System (SRS), an important source of health information consists of continuous enumeration of births and deaths by an enumerator and an independent survey every six months by an investigator-supervisor. Which one of the following terms best describes this system?\",\ncorrect:\"Dual-record system\",\nopts:[\"Dual-record system\",\"Triple-record system\",\"Double blinding\",\"Double data entry\"],\nexp:\"The Sample Registration System (SRS) in India is a large-scale demographic survey for providing reliable estimates of fertility and mortality at the national and state level. The SRS methodology: (1) CONTINUOUS ENUMERATION: a part-time resident enumerator (matched to the local population) continuously records all vital events (births, deaths) in their allocated area. (2) INDEPENDENT RETROSPECTIVE SURVEY: every 6 months, an independent investigator-supervisor visits the same area and independently records all vital events in the survey period. The two records (continuous register + retrospective survey) are then MATCHED and reconciled to identify events recorded in one but not the other, estimating completeness of recording. This matching of two independent records is called a DUAL-RECORD SYSTEM (or capture-recapture methodology). The SRS is the premier demographic data source in India, providing fertility (CBR, TFR) and mortality (CDR, IMR) estimates.\"\n},\n{id:110,\nstem:\"Cross-over type of study designs are those in which each patient serves as his\/her own control. In which of the following conditions is a cross-over study NOT suitable?<br>1. If the drug of interest cures the disease<br>2. If the drug is effective during all stages of the disease<br>3. If the disease changes radically during the period of time required for the study<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3\",\nopts:[\"1 only\",\"2 only\",\"2 and 3\",\"1 and 3\"],\nexp:\"Cross-over study design: patients receive treatment A then cross over to treatment B (with a washout period), serving as their own controls. NOT suitable when: Statement 1 (drug CURES the disease): if the first treatment cures the patient, the patient no longer has the disease during the second period, making comparison invalid. The carry-over effect is permanent. This is a valid contraindication. Statement 2 (drug effective in ALL stages): this would actually make the crossover MORE suitable (the drug works consistently), not less suitable. This is NOT a contraindication. Statement 3 (disease changes radically over the study period): if the disease spontaneously improves, worsens, or changes character significantly during the washout period between treatment phases, the patient is in a different disease state in the second period - making the comparison invalid. This is a valid contraindication. Statements 1 and 3 are conditions where cross-over study is NOT suitable.\"\n},\n{id:111,\nstem:\"In which one of the following diseases are the source of infection and reservoir of infection the same?\",\ncorrect:\"Typhoid\",\nopts:[\"Hookworm infection\",\"Cholera\",\"Tetanus\",\"Typhoid\"],\nexp:\"Source of infection = the person, animal, object, or substance from which the infectious agent passes directly to the host. Reservoir of infection = the natural habitat where the infectious agent lives, multiplies, and reproduces. They are the same (both are HUMANS) in diseases where humans are the only reservoir AND source: Typhoid (Salmonella typhi): humans are the ONLY reservoir AND source; the organism survives only in human intestines (and chronic carriers); there is no animal or environmental reservoir - statement correct. Cholera: humans are the primary host but Vibrio cholerae can survive in aquatic environments (especially estuarine waters, copepods) - the environment is also a reservoir, so source and reservoir are NOT always the same. Hookworm: reservoir includes soil (larvae in soil); source is contaminated soil. Tetanus: Clostridium tetani spores are found in soil (the environmental reservoir); humans are an incidental host, not the reservoir. Typhoid is the correct answer.\"\n},\n{id:112,\nstem:\"Which of the following statements are correct regarding Chikungunya fever?<br>1. It is usually transmitted by Culex mosquito.<br>2. A safe and effective vaccine is available for commercial use.<br>3. Incubation period is 4-7 days.<br>4. One of the prominent symptoms is arthropathy.<br>Select the correct answer using the code given below.\",\ncorrect:\"3 and 4 only\",\nopts:[\"1 and 2 only\",\"1 and 4 only\",\"2 and 3 only\",\"3 and 4 only\"],\nexp:\"Chikungunya fever (caused by Chikungunya virus, alphavirus, family Togaviridae): Statement 1 FALSE: Chikungunya is primarily transmitted by AEDES mosquitoes (Aedes aegypti and Aedes albopictus), NOT Culex mosquitoes. Culex mosquitoes transmit West Nile fever, Japanese encephalitis, and filariasis. Statement 2 FALSE: As of the examination date, no commercially available safe and effective Chikungunya vaccine was approved for widespread commercial use (though clinical trials were underway). This is a classic false statement in this context. Statement 3 TRUE: The incubation period of Chikungunya is 2-12 days, commonly stated as 4-7 days in most textbooks. Statement 4 TRUE: ARTHROPATHY (severe, debilitating polyarthralgia\/polyarthritis) is the HALLMARK symptom of Chikungunya, often persisting for months to years (chronic chikungunya arthropathy). The name Chikungunya means that which bends up in the Makonde language, referring to the stooped posture from joint pain. Statements 3 and 4 are correct.\"\n},\n{id:113,\nstem:\"In which one of the following vector-borne diseases, the transmission chain is Man-Snail-Man?\",\ncorrect:\"Schistosomiasis\",\nopts:[\"Fish tapeworm\",\"Malaria\",\"Onchocerciasis\",\"Schistosomiasis\"],\nexp:\"Transmission chain Man-Snail-Man: SCHISTOSOMIASIS (Bilharzia) - caused by Schistosoma species (S. haematobium, S. mansoni, S. japonicum). The transmission cycle: Human (definitive host) releases eggs in urine\/faeces into water. Miracidia hatch and infect freshwater SNAILS (Bulinus for S. haematobium, Biomphalaria for S. mansoni) - intermediate host. Inside the snail: sporocysts develop and produce cercariae. Cercariae are released into water and actively penetrate human skin. The chain is MAN (eggs in water) \u2192 SNAIL (larval development) \u2192 MAN (cercarial penetration). This is distinctly Man-Snail-Man. Malaria: Man-Mosquito-Man. Fish tapeworm (Diphyllobothrium): Man-Copepod-Fish-Man. Onchocerciasis (River blindness): Man-Blackfly (Simulium)-Man. Schistosomiasis is the correct answer.\"\n},\n{id:114,\nstem:\"Which of the following mosquito-borne diseases are transmitted chiefly by Aedes mosquito?<br>1. Dengue<br>2. West Nile fever<br>3. Yellow fever<br>4. Zika fever<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1 and 3 only\",\"1, 2 and 3\",\"1, 3 and 4\",\"2 and 4 only\"],\nexp:\"Mosquito vectors for important diseases: AEDES mosquito (Aedes aegypti, Aedes albopictus): Dengue (statement 1 correct), Yellow fever (statement 3 correct), Zika (statement 4 correct), Chikungunya. CULEX mosquito: West Nile fever (statement 2 - Culex, NOT Aedes), Japanese encephalitis, Filariasis, St. Louis encephalitis. ANOPHELES mosquito: Malaria. Summary: Dengue, Yellow fever, and Zika are all transmitted by Aedes mosquitoes. West Nile fever is transmitted by Culex mosquitoes (primarily Culex pipiens). Statements 1, 3, and 4 are correct.\"\n},\n{id:115,\nstem:\"Which one among the following is best defined as the interval of time between receipt of infection by a host and maximal infectivity of that host?\",\ncorrect:\"Generation time\",\nopts:[\"Generation time\",\"Latent period\",\"Incubation period\",\"Serial interval\"],\nexp:\"Epidemiological time intervals: Generation time: the interval between receipt of infection by a host (exposure) and MAXIMAL INFECTIVITY (peak transmissibility) of that host. It represents when the infected host is most capable of transmitting the infection to others. This is the definition in the question. Latent period: interval between infection and onset of infectiousness (when the host first becomes capable of transmitting). Incubation period: interval between exposure to an infectious agent and the first appearance of CLINICAL SYMPTOMS. Serial interval (generation interval in practice): average time between the onset of symptoms in the primary case and onset of symptoms in secondary cases. The question specifically describes GENERATION TIME - the interval from infection to maximal infectivity. Generation time is the correct answer.\"\n},\n{id:116,\nstem:\"Consider the following vaccines:<br>1. BCG Vaccine<br>2. Hepatitis B Vaccine<br>3. Inactivated Polio Vaccine (IPV)<br>4. Oral Polio Vaccine (OPV)<br>What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS)?\",\ncorrect:\"4 \u2192 3 \u2192 2 \u2192 1\",\nopts:[\"4 \u2192 3 \u2192 2 \u2192 1\",\"2 \u2192 1 \u2192 3 \u2192 4\",\"2 \u2192 1 \u2192 4 \u2192 3\",\"4 \u2192 3 \u2192 1 \u2192 2\"],\nexp:\"Heat sensitivity of vaccines (most to least sensitive) in India's cold chain: Most heat sensitive (stored at -20 degrees C, most vulnerable to heat): OPV (Oral Polio Vaccine) - live attenuated viral vaccine, extremely heat sensitive; stored in deep freezer; has a cold chain monitor. Next most sensitive (stored at 2-8 degrees C): IPV (Inactivated Polio Vaccine) - more stable than OPV but still requires refrigeration. Hepatitis B vaccine - relatively more stable but requires 2-8 degrees C; can withstand some heat exposure. BCG Vaccine - live attenuated bacterial vaccine, stored at 2-8 degrees C; freeze-dried form is relatively heat stable compared to others. Least heat sensitive: TT, DPT (heat stable vaccines that can withstand some temperature excursions). Order most to least heat sensitive: OPV (4) \u2192 IPV (3) \u2192 Hepatitis B (2) \u2192 BCG (1) = 4 \u2192 3 \u2192 2 \u2192 1. Option (a) is correct.\"\n},\n{id:117,\nstem:\"Exposure to gases is a common hazard in industries. The gases can be classified as simple, asphyxiating and anaesthetic gases. Which among the following are asphyxiating gases?<br>1. Carbon monoxide<br>2. Chloroform<br>3. Cyanide gas<br>4. Hydrogen<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3\",\nopts:[\"1 and 3\",\"1 and 4\",\"2 and 3\",\"2 and 4\"],\nexp:\"Classification of industrial gases: Simple asphyxiants: displace oxygen from the atmosphere without themselves being toxic; e.g., nitrogen, hydrogen (statement 4 is a simple asphyxiant), methane, carbon dioxide, helium. Chemical (toxic) asphyxiants: prevent oxygen utilisation at tissue level despite adequate atmospheric oxygen: Carbon monoxide (CO) - binds haemoglobin with 200x greater affinity than O2, preventing oxygen transport (statement 1 correct as chemical\/toxic asphyxiant). Cyanide (HCN, cyanide gas) - inhibits cytochrome c oxidase (Complex IV), preventing cellular oxygen utilisation (statement 3 correct as chemical\/toxic asphyxiant). Anaesthetic gases: chloroform (statement 2), ether, halothane, nitrous oxide - cause CNS depression and anaesthesia. The question asks specifically for ASPHYXIATING gases. Both CO (chemical asphyxiant) and cyanide (chemical asphyxiant) are asphyxiating. Hydrogen is a simple asphyxiant. Per the examination, statements 1 and 3 (chemical asphyxiants) are the answer.\"\n},\n{id:118,\nstem:\"The Employees State Insurance Act, 1948 of India provides for certain benefits to employees. Which among the following are benefits to insured persons or to other dependents under the Act?<br>1. Disablement benefit<br>2. Funeral expenses<br>3. Maternity benefit<br>4. Travel benefit<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3 only\",\nopts:[\"1 and 3 only\",\"2 and 4 only\",\"1, 2 and 3 only\",\"1, 2, 3 and 4\"],\nexp:\"The Employees State Insurance (ESI) Act, 1948 provides social security to workers in organised sector establishments. Benefits under ESI: (1) Sickness benefit (cash payment during certified sickness). (2) Maternity benefit (statement 3 correct) - for confinement, miscarriage, sickness arising from pregnancy. (3) Disablement benefit (statement 1 correct) - temporary disablement benefit (during incapacity from employment injury) and permanent disablement benefit. (4) Dependants benefit - pension to dependants if insured person dies from employment injury. (5) Funeral expenses (statement 2 correct) - lump sum to meet funeral expenses of the insured person (currently Rs 15,000). (6) Medical benefit - medical care for insured persons and family. Travel benefit (statement 4) is NOT a specified benefit under the ESI Act. There is no travel benefit category in the standard ESI benefit list. Statements 1, 2, and 3 are correct ESI benefits.\"\n},\n{id:119,\nstem:\"Which among the following vaccines best represent interventions that focus on cancer prevention too?<br>1. Hepatitis A vaccine<br>2. Hepatitis B vaccine<br>3. Hemophilus influenzae B vaccine<br>4. Human papilloma virus vaccine<br>Select the correct answer using the code given below.\",\ncorrect:\"2 and 4\",\nopts:[\"1 and 2\",\"2 and 3\",\"2 and 4\",\"1 and 4\"],\nexp:\"Vaccines that prevent cancer: Hepatitis B vaccine (statement 2 correct): HBV causes chronic hepatitis leading to liver cirrhosis and HEPATOCELLULAR CARCINOMA (HCC). The hepatitis B vaccine is the first anti-cancer vaccine; universal HBV vaccination has dramatically reduced HCC rates. Human papilloma virus (HPV) vaccine (statement 4 correct): HPV (types 16 and 18) causes CERVICAL CANCER (and other anogenital cancers, oropharyngeal cancer). HPV vaccines (bivalent, quadrivalent, nonavalent) prevent cervical cancer and other HPV-related cancers. Hepatitis A vaccine (statement 1): HAV causes acute self-limiting hepatitis; it does NOT lead to chronic liver disease or liver cancer. No cancer prevention role. Haemophilus influenzae b (Hib) vaccine (statement 3): prevents bacterial meningitis, pneumonia, and epiglottitis in children; NO cancer prevention role. Statements 2 and 4 are correct.\"\n},\n{id:120,\nstem:\"Consider the following statements: Statement-I: While calculating the number of expected pregnancies per year in an area, a correction factor (usually 10%) is added to the expected number of live births in the year in the area. Statement-II: All the pregnancies in the area may not be registered by the health worker in the area. Which one of the following is correct in respect of the above statements?\",\ncorrect:\"Statement-I and Statement-II are independently correct, and Statement-II is a correct explanation for Statement-I.\",\nopts:[\"Statement-I and Statement-II are independently correct, and Statement-II is a correct explanation for Statement-I.\",\"Statement-I and Statement-II are independently correct, but Statement-II is not a correct explanation for Statement-I.\",\"Statement-I is correct but Statement-II is incorrect.\",\"Statement-I is incorrect but Statement-II is correct.\"],\nexp:\"Statement-I: When estimating the expected number of pregnancies in a population (for planning MCH services, ANC registrations targets, etc.), health planners add a correction factor of approximately 10% to the expected number of live births. This accounts for pregnancies that do not result in live births: stillbirths, miscarriages, abortions, and ectopic pregnancies (approximately 10% of pregnancies). This is a standard maternal health planning formula used in India's MCH programmes. Statement-I is CORRECT. Statement-II: Not all pregnancies may be registered by health workers because of underregistration, home deliveries without antenatal contact, migrant populations, etc. Statement-II is CORRECT. The relationship: Statement-II provides the REASON\/EXPLANATION for why a correction factor is needed in Statement-I - because pregnancies are underregistered and not all pregnancies result in live births, a correction factor is required. Statement-II IS a correct explanation for Statement-I. 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Submitting in 10 Submit Now Combined Medical Services Examination 2023Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part C Preventive & Social Medicine · Epidemiology · Health Programmes · Biostatistics Questions… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36750","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2023 P2 Part-C PSM - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/05\/03\/cms-2023-p2-part-c-psm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2023 P2 Part-C PSM - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2023 | General Medicine & Paediatrics | Paper I | Part A ✓️ 0 ❌ 0 ⏳ 40 left ⏱ 40:00 Net 0 \/ 160 Time's Up! 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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:81,\nstem:\"Which one of the following is defined as the average number of children a woman would have if she were to pass through her reproductive years, bearing children at the same rates as the women now in each age group?\",\ncorrect:\"Total Fertility Rate (TFR)\",\nopts:[\"Age-Specific Fertility Rate (ASFR)\",\"General Fertility Rate (GFR)\",\"Net Reproduction Rate (NRR)\",\"Total Fertility Rate (TFR)\"],\nexp:\"Total Fertility Rate (TFR) is defined as the average number of children a woman would have over her entire reproductive lifetime (ages 15-49) if she experienced the current age-specific fertility rates throughout her reproductive years. It is a synthetic cohort measure (no real cohort is followed). TFR of 2.1 = replacement level fertility. India's TFR was approximately 2.0 (NFHS-5, 2019-21). ASFR is the fertility rate for a specific age group. GFR (General Fertility Rate) is the number of live births per 1000 women of reproductive age (15-49). NRR accounts for female births and mortality; NRR of 1.0 = replacement level. TFR is the correct answer.\"\n},\n{id:82,\nstem:\"Which among the following is correct about yellow fever vaccination requirement for international travellers?<br>1. Term of validity of the certificate is changed from 10 years to the duration of the life of the vaccinated person, some years ago.<br>2. Lifetime validity of the certificate applies automatically to all existing and new certificates.<br>3. Validity of the certificate begins 4 days after vaccination.<br>4. In India, booster dose of yellow fever vaccine is required for those whose certificate is prior to the year 2016.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3\",\nopts:[\"1 and 2\",\"1 and 3\",\"2 and 3\",\"2 and 4\"],\nexp:\"Yellow fever vaccination international certificate: Statement 1 TRUE: WHO amended the International Health Regulations in 2014; the validity of yellow fever vaccination certificates was extended from 10 years to LIFETIME (duration of the life of the vaccinated person), effective from 11 July 2016. A single dose of yellow fever vaccine is now considered to provide lifelong protection. Statement 2 FALSE: Lifetime validity does NOT apply automatically to all EXISTING certificates issued before 11 July 2016. Certificates issued before that date remain valid for 10 years from the date of vaccination (i.e., they expire on their original expiry date), unless reissued. Statement 3 TRUE: The certificate of vaccination becomes valid 10 days after primary vaccination (not 4 days - this statement says 4 days which is INCORRECT, but per the exam answer key, statements 1 and 3 are selected). Statement 4: India does not require a booster for certificates prior to 2016 per current guidelines. Per the UPSC CMS answer key, statements 1 and 3 are correct.\"\n},\n{id:83,\nstem:\"Regarding active immunization against Typhoid fever, consider the following statements:<br>1. The typhoid polysaccharide vaccine is injectable and can be given subcutaneously or intramuscularly.<br>2. The typhoid polysaccharide vaccine is required to be given in two doses and administered on 0 and 7th day.<br>3. The typhoid oral Ty21a vaccine requires to be given in three doses on 0, 3rd and 7th days.<br>4. Protective immunity with typhoid vaccines is achieved immediately after the vaccine is received.<br>Which of the statements given above is\/are correct?\",\ncorrect:\"1 only\",\nopts:[\"1 only\",\"1, 3 and 4\",\"1 and 2 only\",\"2 only\"],\nexp:\"Typhoid vaccines: (1) Vi capsular polysaccharide (ViCPS) vaccine (Typhim Vi, Typherix): Injectable (IM or SC), single dose, provides protection for 2-3 years - statement 1 CORRECT. (2) ViCPS is given as a SINGLE dose (not two doses on days 0 and 7) - statement 2 INCORRECT. Two-dose schedules apply to some other vaccines (e.g., hepatitis A). (3) Ty21a oral typhoid vaccine (Vivotif): given in 3 capsules on alternate days (days 1, 3, 5 - i.e., day 0, day 2, day 4 or similar alternate-day schedule), NOT on days 0, 3, 7. Some regimens state days 0, 2, 4 (3 doses on alternate days) - statement 3 INCORRECT as stated. (4) Protective immunity is NOT achieved immediately; it takes approximately 7-10 days after injectable vaccine and longer after oral - statement 4 INCORRECT. Only statement 1 is correct.\"\n},\n{id:84,\nstem:\"Which of the following statements are correct regarding Mantoux test for tuberculosis?<br>1. It entails injecting 1 TU (Tuberculin Unit) of PPD (Purified Protein Derivative) in 0.1 mL intradermally.<br>2. The injection should be given with the needle bevel facing downward.<br>3. When placed correctly, the injection should produce a pale wheal of the skin, 1-2 mm in diameter.<br>4. The injection should be given with a tuberculin syringe.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 4\",\nopts:[\"1 and 2\",\"1 and 4\",\"2 and 3\",\"2 and 4\"],\nexp:\"Mantoux tuberculin skin test (TST): Statement 1 TRUE: The standard Mantoux test uses 2 TU (Tuberculin Units) of PPD RT-23 in 0.1 mL injected intradermally on the volar surface of the forearm. However, in some countries\/references, 1 TU (Siebert preparation) or 5 TU (US standard) is used. Per Indian guidelines (RNTCP), 1 TU of PPD RT-23 in 0.1 mL is used - statement 1 is considered correct in this context. Statement 2 FALSE: The needle bevel should face UPWARD (not downward) to ensure intradermal injection - a raised wheal forms when the bevel faces up. Statement 3 FALSE: Correct intradermal injection produces a pale wheal (bleb) of 6-10 mm diameter, NOT 1-2 mm (which is too small and suggests subcutaneous injection). Statement 4 TRUE: A 1 mL tuberculin syringe with a short (10 mm) 26-27 gauge needle is used for the Mantoux test to ensure accurate 0.1 mL dosing. Statements 1 and 4 are correct.\"\n},\n{id:85,\nstem:\"Which one among the following types of ventilation, best fits the following description: A system of ventilation in which fresh air is blown into the room by centrifugal fans so as to create a positive pressure, and displace the vitiated air?\",\ncorrect:\"Plenum ventilation\",\nopts:[\"Exhaust ventilation\",\"Balanced ventilation\",\"Natural ventilation\",\"Plenum ventilation\"],\nexp:\"Types of mechanical ventilation: (1) Plenum (Plenum-pressure) ventilation: Fresh air is BLOWN INTO the room by fans, creating POSITIVE PRESSURE inside; the vitiated (stale) air is displaced and exits through outlets\/cracks. This is the description given in the question. Used in operating theatres, clean rooms. (2) Exhaust ventilation: Stale air is EXTRACTED from the room by fans, creating NEGATIVE PRESSURE inside; fresh air enters through inlets. Used in kitchens, laboratories, toilets. (3) Balanced ventilation: Both supply fans (fresh air in) and exhaust fans (stale air out) operate simultaneously, maintaining neutral pressure. (4) Natural ventilation: Driven by wind and thermal buoyancy, no mechanical fans. The description (fresh air blown in by centrifugal fans, positive pressure, displacing vitiated air) exactly matches Plenum ventilation.\"\n},\n{id:86,\nstem:\"The Nalgonda Technique developed by the National Environmental Engineering Research Institute (NEERI) was developed primarily for the removal of which one of the following from water?\",\ncorrect:\"Fluorine\",\nopts:[\"Asbestos\",\"Fluorine\",\"Chlorine\",\"Iron\"],\nexp:\"The Nalgonda Technique was developed by the National Environmental Engineering Research Institute (NEERI), Nagpur, India, specifically for the removal of FLUORIDE (fluorine\/fluoride ions) from drinking water in endemic fluorosis areas. The technique (named after Nalgonda district of Andhra Pradesh where fluorosis was endemic) involves addition of alum (aluminium sulphate) and lime to water, followed by rapid mixing, flocculation, sedimentation, and filtration. The aluminium hydroxide floc adsorbs and co-precipitates fluoride ions, reducing water fluoride levels from above 3-4 mg\/L to below the permissible limit of 1 mg\/L. This is a community-level defluoridation technique suitable for India's rural settings. Fluorine\/fluoride is the correct answer.\"\n},\n{id:87,\nstem:\"Smoking is considered to be a modifiable risk factor for Coronary Heart Disease. Consider the following statements with regard to possible mechanisms on the basis of which it acts as a risk factor:<br>1. Nicotine stimulation of adrenergic drive raises the blood pressure and myocardial oxygen demand.<br>2. It increases carbon monoxide and induces atherogenesis.<br>3. It leads to fall in protective high density lipoproteins.<br>4. It reduces the apolipoprotein-B plasma levels.<br>Which of the statements given above are correct?\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"1 and 3 only\",\"1, 2 and 3\",\"2, 3 and 4\"],\nexp:\"Mechanisms by which smoking causes coronary heart disease: Statement 1 TRUE: Nicotine stimulates catecholamine release (adrenergic activation), causing tachycardia, hypertension, and increased myocardial oxygen demand while simultaneously causing coronary vasoconstriction, creating an oxygen supply-demand mismatch. Statement 2 TRUE: Carbon monoxide (CO) from cigarette smoke binds haemoglobin with 200x greater affinity than oxygen (forming carboxyhaemoglobin), reducing oxygen delivery; CO also directly damages endothelium and induces atherogenesis by promoting lipid deposition. Statement 3 TRUE: Smoking reduces HDL cholesterol (protective lipoprotein), shifting the lipid profile towards a more atherogenic pattern with lower HDL and potentially higher LDL. Statement 4 FALSE: Smoking INCREASES apolipoprotein-B (apo-B) levels (apo-B is the main protein of LDL and VLDL, the atherogenic lipoproteins); it does NOT reduce apo-B. Statements 1, 2, and 3 are correct.\"\n},\n{id:88,\nstem:\"The expected outcome of Government of India's initiative SUMAN is\",\ncorrect:\"Zero preventable maternal and newborn deaths\",\nopts:[\"Zero preventable maternal and newborn deaths\",\"Limit preventable maternal and newborn deaths to between 0.5-1%\",\"Limit preventable maternal and newborn deaths to between 1-2%\",\"Limit preventable maternal and newborn deaths to between 2-5%\"],\nexp:\"SUMAN (Surakshit Matritva Aashwasan) is a Government of India initiative launched in October 2019 under the National Health Mission. SUMAN aims to provide: assured, dignified, respectful, and quality healthcare at no cost, with zero tolerance for denial of services, to every woman and newborn visiting public health facilities. The stated expected outcome of SUMAN is: ZERO preventable maternal and newborn deaths. Key entitlements under SUMAN: free and zero-expense delivery, free caesarean section, free transport, free medicines and diagnostics, zero tolerance for denial of services, respectful maternity care. The vision of zero preventable maternal and newborn deaths aligns with the global Sustainable Development Goal (SDG 3) target of reducing maternal mortality.\"\n},\n{id:89,\nstem:\"Water contamination with high content of which chemical can lead to methaemoglobinaemia?\",\ncorrect:\"Nitrate\",\nopts:[\"Cyanide\",\"Nitrate\",\"Fluoride\",\"Sulphide\"],\nexp:\"Methaemoglobinaemia from contaminated water is classically caused by high NITRATE content. Mechanism: Nitrates (NO3-) in drinking water are reduced to nitrites (NO2-) by gut bacteria (particularly in infants under 6 months who have more alkaline gut pH). Nitrites oxidise the ferrous iron (Fe2+) in haemoglobin to ferric iron (Fe3+), forming methaemoglobin, which cannot carry oxygen. Clinical presentation: cyanosis unresponsive to oxygen, chocolate-brown blood, SaO2 falsely normal on pulse oximetry. This is the Blue Baby Syndrome (infantile methaemoglobinaemia) associated with well water contaminated with nitrates from agricultural fertilisers and sewage. WHO guideline for nitrate in drinking water: 50 mg\/L as NO3. Treatment: methylene blue IV. Nitrate is the correct answer.\"\n},\n{id:90,\nstem:\"With reference to human body's requirement for proteins, they are essential because they are:<br>1. a key supply source for energy.<br>2. required for maintenance of osmotic pressure within the intravascular compartment.<br>3. critical for upkeep of cell mediated immune response.<br>4. vital for the synthesis of certain hormones.<br>Which of the statements given above are correct?\",\ncorrect:\"2, 3 and 4\",\nopts:[\"1, 3 and 4\",\"1, 2 and 4\",\"2, 3 and 4\",\"1, 2 and 3\"],\nexp:\"Essential functions of dietary proteins: Statement 1 FALSE (partially): Proteins provide energy (4 kcal\/g), but they are NOT a KEY supply source for energy - carbohydrates and fats are the primary energy substrates. Protein is used for energy only when carbohydrate and fat stores are inadequate (starvation\/catabolism). The primary\/essential roles of protein are structural and functional, not energetic. Statement 2 TRUE: Plasma proteins (primarily albumin) are critical for maintaining colloid osmotic (oncotic) pressure within the intravascular compartment, preventing oedema. Statement 3 TRUE: Proteins are essential for cell-mediated immunity (lymphocytes, cytokines, immunoglobulins, complement proteins) - severe protein deficiency causes immune suppression. Statement 4 TRUE: Many hormones are proteins or peptides (insulin, glucagon, growth hormone, thyroid-stimulating hormone, ADH, oxytocin) and require dietary amino acids for synthesis. Statements 2, 3, and 4 are correct.\"\n},\n{id:91,\nstem:\"Which food proteins among the following are considered to be the best and are used in nutritional studies as reference protein?\",\ncorrect:\"Egg proteins\",\nopts:[\"Milk proteins\",\"Egg proteins\",\"Wheat proteins\",\"Legume proteins\"],\nexp:\"Reference protein is a hypothetical ideal protein with a perfect amino acid composition for human needs, used as a standard to evaluate the nutritional quality of other proteins. The egg protein (specifically whole egg protein, particularly egg albumin\/ovalbumin) is internationally accepted as the REFERENCE PROTEIN (biological value = 100, protein digestibility-corrected amino acid score \/ PDCAAS = 1.0) because: (1) It contains all essential amino acids in the optimal proportions for human requirements; (2) It has a biological value (BV) of approximately 100 (the original reference standard); (3) It is highly digestible (digestibility coefficient approximately 98%); (4) It has been used in WHO\/FAO protein quality evaluation studies as the gold standard. Milk protein (casein) is also high quality but egg protein is THE reference protein in nutritional studies.\"\n},\n{id:92,\nstem:\"Consider the following statements with reference to trans fatty acids:<br>1. They are geometrical isomers of cis-unsaturated fatty acids.<br>2. Though atherogenic, being unsaturated they are less so than saturated fatty acids.<br>3. It takes years for trans fatty acids to be flushed from the body.<br>4. They lower both LDL cholesterol and HDL cholesterol in the body.<br>Which of the statements given above are correct?\",\ncorrect:\"1 and 3 only\",\nopts:[\"1 and 2 only\",\"1 and 3 only\",\"1, 2 and 3\",\"2, 3 and 4\"],\nexp:\"Trans fatty acids (TFAs): Statement 1 TRUE: TFAs are geometrical isomers of cis-unsaturated fatty acids; in natural cis configuration, the hydrogen atoms are on the same side of the double bond (bent chain); in trans configuration, they are on opposite sides (straight chain, behaving more like saturated fat). Statement 2 FALSE: TFAs are MORE atherogenic than saturated fatty acids in terms of their net effect on the TC:HDL ratio, because TFAs both RAISE LDL AND LOWER HDL, creating a doubly adverse lipid profile. Saturated fats raise LDL but do not lower HDL to the same extent. TFAs are therefore considered WORSE than saturated fats. Statement 3 TRUE: TFAs are incorporated into cell membranes and adipose tissue and are metabolised very slowly; they may persist in the body for years. Statement 4 FALSE: TFAs RAISE LDL cholesterol AND LOWER HDL cholesterol - this dual effect makes them particularly atherogenic. The statement says they LOWER both - incorrect for LDL. Statements 1 and 3 are correct.\"\n},\n{id:93,\nstem:\"Consider the following disorders:<br>1. Delayed motor milestones<br>2. Extrapyramidal spasticity<br>3. Nyctalopia<br>4. Hearing defects<br>Which of the above disorders occur as part of the spectrum of iodine deficiency disorders?\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 3 and 4\",\"2, 3 and 4\",\"1, 2 and 4\"],\nexp:\"Iodine Deficiency Disorders (IDDs) spectrum - consequences of severe iodine deficiency in pregnancy: Endemic cretinism has two forms: (1) Neurological cretinism: severe intellectual disability, deaf-mutism (hearing defects - statement 4 correct), spastic diplegia (extrapyramidal\/pyramidal spasticity - statement 2 correct), squint; (2) Myxoedematous cretinism: hypothyroidism, growth retardation, delayed motor milestones (statement 1 correct). Nyctalopia (night blindness) is caused by VITAMIN A deficiency, NOT iodine deficiency - statement 3 incorrect. Iodine deficiency affects brain development during fetal life and early infancy, causing neurological damage if deficiency occurs during these critical periods. The spectrum of IDDs includes: goitre, hypothyroidism, cretinism, intellectual disability, delayed milestones, hearing defects, and increased stillbirth\/miscarriage rates. Statements 1, 2, and 4 are correct.\"\n},\n{id:94,\nstem:\"With reference to occupational cancers, consider the following statements:<br>1. Skin cancer is a common occupational hazard in workers employed in nickel and chromium work.<br>2. Cancer bladder is an occupational hazard in workers employed in dye-stuffs and dyeing industry.<br>3. Leukaemia can occur on long exposure to benzol.<br>4. Lung cancer is typically found in workers employed in electric cable industries.<br>Which of the statements given above are correct?\",\ncorrect:\"2 and 3 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"3 and 4 only\",\"1 and 4 only\"],\nexp:\"Occupational cancers: Statement 1 FALSE: Nickel and chromium (hexavalent Cr) exposure primarily causes LUNG cancer and NASAL SINUS cancer, NOT skin cancer as the common occupational hazard. Skin cancer (squamous cell carcinoma, Bowen's disease) is associated with arsenic exposure and UV radiation. Statement 2 TRUE: Bladder cancer (transitional cell carcinoma) is the classic occupational cancer of workers in the dye, rubber, leather, and printing industries; carcinogens include beta-naphthylamine, benzidine, and other aromatic amines. Statement 3 TRUE: Benzene (benzol) is the classic cause of occupational leukaemia (particularly acute myeloid leukaemia \/ aplastic anaemia) in workers exposed to solvents, rubber, shoe manufacturing, and petroleum industries. Statement 4 FALSE: Lung cancer in electric cable industry is not a classic association; asbestosis\/mesothelioma is associated with asbestos (insulation); lung cancer with asbestos, arsenic, chromium, nickel, radon, PAHs. Statements 2 and 3 are correct.\"\n},\n{id:95,\nstem:\"If, on amniocentesis, the alpha fetoprotein is found to be elevated in the amniotic fluid, which defect\/disorder is the foetus likely to harbour?\",\ncorrect:\"Neural tube defects\",\nopts:[\"Cardiac septal defects\",\"Neural tube defects\",\"Duchenne muscular dystrophy\",\"Galactosaemia\"],\nexp:\"Alpha-fetoprotein (AFP) is a fetal glycoprotein produced by the yolk sac and fetal liver. Elevated AFP in amniotic fluid (or maternal serum) is strongly associated with OPEN NEURAL TUBE DEFECTS (NTDs): anencephaly, open spina bifida (myelomeningocele), encephalocele. The mechanism: in open NTDs (where neural tissue is exposed without skin covering), AFP leaks from the fetal circulation into the amniotic fluid, causing markedly elevated AFP levels. AFP is also elevated in abdominal wall defects (gastroschisis, omphalocele) and fetal death. In Down syndrome (trisomy 21), AFP is LOW (combined with low oestriol and elevated hCG in the triple test). Cardiac septal defects, Duchenne muscular dystrophy, and galactosaemia do not cause elevated AFP. Neural tube defects is the correct answer.\"\n},\n{id:96,\nstem:\"Which of the following are domains (or types) of learning?<br>1. Affective learning<br>2. Cognitive learning<br>3. Physiological learning<br>4. Psychomotor learning<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 3 and 4\",\"2, 3 and 4\",\"1, 2 and 3\",\"1, 2 and 4\"],\nexp:\"Bloom's Taxonomy (1956) classifies educational learning objectives into three domains: (1) Cognitive domain (statement 2 correct): intellectual skills, knowledge, comprehension, application, analysis, synthesis, evaluation. (2) Affective domain (statement 1 correct): emotions, attitudes, values, beliefs, motivation - how learners react emotionally and their ability to feel other living things' pain and joy. (3) Psychomotor domain (statement 4 correct): physical skills, coordination, motor skills, manipulation of objects - learning by doing. Physiological learning (statement 3) is NOT one of Bloom's three domains; there is no recognised domain called physiological learning in educational taxonomy. The three domains of Bloom's Taxonomy are Cognitive, Affective, and Psychomotor. Statements 1, 2, and 4 are correct.\"\n},\n{id:97,\nstem:\"Which of the following are beneficiaries of services provided under the Integrated Child Development Scheme (ICDS)?<br>1. Adolescent boys<br>2. Adolescent girls<br>3. Pregnant women<br>4. Children less than 6 years of age<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:\"The Integrated Child Development Scheme (ICDS) is one of the world's largest programmes for early childhood development, launched in India in 1975 under the Ministry of Women and Child Development. Beneficiaries of ICDS services: (1) Children below 6 years of age (0-6 years) - statement 4 correct; they receive supplementary nutrition, immunisation, health check-up, growth monitoring, referral services. (2) Pregnant women - statement 3 correct; they receive supplementary nutrition, health education, antenatal care. (3) Lactating mothers - also beneficiaries (not listed as option). (4) Adolescent girls (11-18 years) - statement 2 is INCORRECT for the ORIGINAL ICDS scope; however, adolescent girls (11-18 years) are now covered under SABLA (Rajiv Gandhi Scheme for Empowerment of Adolescent Girls) which merged with ICDS. (5) Adolescent BOYS - statement 1: adolescent boys are NOT beneficiaries of ICDS. Among the options, 1 (adolescent boys), 3 (pregnant women), and 4 (children under 6) matches - but boys are NOT beneficiaries. The answer is 2, 3 and 4 per standard teaching, but the key gives 1, 3 and 4. Using the exam answer: 1, 3 and 4.\"\n},\n{id:98,\nstem:\"Which of the following correctly represent the three critical determinants of a healthy facility being declared as a First Referral Unit (FRU)?<br>1. Availability of emergency obstetric surgical interventions<br>2. Availability of immunization services<br>3. Blood storage facility<br>4. Newborn care<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 3 and 4\",\"1, 2 and 4\",\"2, 3 and 4\"],\nexp:\"A First Referral Unit (FRU) in India's health system is a Community Health Centre (CHC) or sub-district\/district hospital that has been upgraded to provide emergency obstetric and neonatal care. The THREE CRITICAL determinants for FRU declaration are: (1) Availability of EMERGENCY OBSTETRIC SURGICAL INTERVENTIONS: 24-hour emergency caesarean section, management of obstetric emergencies (PPH, eclampsia, obstructed labour) - statement 1 correct. (2) Blood storage facility (blood bank or blood storage unit): ability to provide blood transfusions for obstetric haemorrhage - statement 3 correct. (3) Newborn care: neonatal resuscitation, newborn stabilisation unit (NBSU) or Special Newborn Care Unit (SNCU) - statement 4 correct. Immunisation services (statement 2) are provided at all levels (subcentre, PHC, CHC) and are NOT a critical determinant specifically for FRU designation. Statements 1, 3, and 4 are the three critical determinants.\"\n},\n{id:99,\nstem:\"What is the correct increasing order of minimum age at which the following vaccines are administered to a child, as part of the National Immunization Schedule (NIS) after birth of child?<br>1. BCG vaccine<br>2. Japanese Encephalitis (JE) vaccine<br>3. Rotavirus vaccine<br>4. Tetanus and adult diphtheria (Td) vaccine<br>Select the correct answer using the code given below.\",\ncorrect:\"1 \u2192 3 \u2192 2 \u2192 4\",\nopts:[\"1 \u2192 2 \u2192 3 \u2192 4\",\"1 \u2192 3 \u2192 2 \u2192 4\",\"2 \u2192 3 \u2192 4 \u2192 1\",\"3 \u2192 1 \u2192 4 \u2192 2\"],\nexp:\"National Immunization Schedule (NIS) - minimum ages for first dose: BCG (1): given at BIRTH (0 days) - earliest vaccine in the schedule. Rotavirus vaccine (3): given at 6 WEEKS (first dose) as part of the pentavalent schedule. Japanese Encephalitis (JE) vaccine (2): given at 9 MONTHS (along with measles-containing vaccine in endemic states). Tetanus and adult diphtheria Td (4): given at 10 YEARS (school entry booster dose) and 16 years. Increasing order of minimum age: BCG (birth) \u2192 Rotavirus (6 weeks) \u2192 JE (9 months) \u2192 Td (10 years) = 1 \u2192 3 \u2192 2 \u2192 4. Option (b) is correct.\"\n},\n{id:100,\nstem:\"Under the National Leprosy Eradication Programme, ASHAs have been entrusted to carry out which of the following activities?<br>1. ASHAs are to search for suspected cases of leprosy in their villages and take them to the PHCs for diagnosis and treatment.<br>2. ASHAs arrange an amount of Rs 5,000 as an incentive to each leprosy affected person in their village for undergoing reconstructive surgery.<br>3. ASHAs ensure that each leprosy affected person in their village receives micro-cellular rubber footwear for protection of insensitive feet.<br>4. ASHAs follow up all confirmed cases of leprosy in their village to ensure their treatment completion.<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 4 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 4 only\",\"3 and 4 only\"],\nexp:\"Under the National Leprosy Eradication Programme (NLEP), ASHA roles: Statement 1 TRUE: ASHAs are the first point of contact for suspected leprosy cases; they are trained to identify cardinal signs of leprosy (skin patches, nerve thickening, sensory loss) and refer suspected cases to the PHC\/designated leprosy centre for diagnosis by trained health workers. Statement 2 FALSE: The incentive for reconstructive surgery (RCS) under NLEP is Rs 8,000 (not Rs 5,000), and it is facilitated through the health system, not arranged by the ASHA personally. Statement 3 FALSE: Distribution of micro-cellular rubber (MCR) footwear to prevent plantar ulcers in leprosy patients with insensitive feet is done by health staff at PHC\/district leprosy office level, not specifically by ASHAs. Statement 4 TRUE: ASHAs are specifically entrusted with following up confirmed leprosy cases on MDT (multi-drug therapy) to ensure treatment completion and reduce defaulters. Statements 1 and 4 are correct.\"\n},\n{id:101,\nstem:\"The cost of implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is borne by\",\ncorrect:\"Both Central Government and State Government\",\nopts:[\"Central Government only\",\"State Government only\",\"Both Central Government and State Government\",\"Private institutions only as a part of their Corporate Social Responsibility\"],\nexp:\"Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) - the world's largest government-funded health insurance scheme, launched in September 2018, targeting approximately 50 crore beneficiaries (10 crore poor and vulnerable families). Cost sharing ratio: The premium\/cost of implementation is SHARED between the Central Government and State Government in a ratio of 60:40 (Centre:States) for general category states, 90:10 for North-Eastern states and hilly states (Himachal Pradesh, Uttarakhand, Jammu and Kashmir), and 100:0 (fully centrally funded) for Union Territories without legislature. Both Central and State governments bear the cost of implementation. The scheme provides health coverage of Rs 5 lakh per family per year for secondary and tertiary hospitalization at empanelled hospitals (public and private).\"\n},\n{id:102,\nstem:\"All of the following are dashboard indicators used for monitoring of India Newborn Action Plan (INAP). Which one of them is an impact level indicator?\",\ncorrect:\"Neonatal mortality rate\",\nopts:[\"Caesarean section rate\",\"Neonatal mortality rate\",\"Exclusive breastfeeding rate\",\"Percentage of preterm births\"],\nexp:\"India Newborn Action Plan (INAP) was launched in 2014 to reduce neonatal mortality and stillbirth rates. INAP monitoring dashboard indicators are classified as: IMPACT indicators (measure the ultimate health outcomes - mortality and morbidity): Neonatal mortality rate (NMR), Stillbirth rate - these are the impact level outcomes that INAP aims to reduce. OUTPUT\/COVERAGE indicators (measure service delivery): Caesarean section rate (measure of obstetric intervention), exclusive breastfeeding rate (nutrition outcome), percentage preterm births (risk factor indicator). The neonatal mortality rate is the primary IMPACT LEVEL INDICATOR for INAP - it directly measures whether the programme is achieving its goal of reducing newborn deaths. India's target under INAP: NMR of 16 or less per 1000 live births and stillbirth rate of 10 or less per 1000 total births by 2030.\"\n},\n{id:103,\nstem:\"Which of the following are health education models?<br>1. Medical model<br>2. Motivation model<br>3. Persuasion model<br>4. Social intervention model<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Models of health education (behaviour change communication): The standard classification of health education models includes: (1) Medical model (biomedical model): health is absence of disease; the health educator provides information and the patient complies - statement 1 correct. (2) Behaviour change model (not persuasion model): focuses on changing individual behaviour through various techniques. (3) Educational model: focuses on voluntary behaviour change through knowledge and understanding. (4) Motivation model: addresses underlying motivations, values, and beliefs that drive health behaviours - statement 2 correct. (5) Social intervention model (community\/social change model): addresses socioeconomic determinants of health through policy, community organisation, and advocacy - statement 4 correct. The persuasion model (statement 3) is NOT a standard health education model classification. Statements 1, 2, and 4 are correct health education models.\"\n},\n{id:104,\nstem:\"Who among the following has two general phases - first, simple pneumoconiosis and a second phase characterized by progressive massive fibrosis (PMF)?\",\ncorrect:\"Anthracosis\",\nopts:[\"Anthracosis\",\"Bagassosis\",\"Byssinosis\",\"Siderosis\"],\nexp:\"Progressive Massive Fibrosis (PMF) is the advanced form of coal worker's pneumoconiosis (anthracosis) and silicosis. ANTHRACOSIS (Coal Workers' Pneumoconiosis \/ Black Lung Disease) has two phases: Phase 1 - Simple coal workers' pneumoconiosis (SCWP): exposure to coal dust causes small rounded opacities (1-5 mm) in the upper lobes; minimal symptoms or simple cough; spirometry may be near normal. Phase 2 - Progressive Massive Fibrosis (PMF \/ Complicated CWP): coalescence of nodules forming large masses (greater than 1 cm, PMF defined as opacity greater than 1 cm); causes severe restrictive and obstructive lung disease, cor pulmonale, and disability. Bagassosis (sugarcane dust - hypersensitivity pneumonitis), Byssinosis (cotton dust - occupational asthma), and Siderosis (iron dust - relatively benign) do not characteristically show PMF. Anthracosis is the correct answer.\"\n},\n{id:105,\nstem:\"Consider the following statements about correlation between two variables:<br>1. The correlation is done between an independent variable X and a dependent variable Y.<br>2. The coefficient of correlation can range from -1 to infinity.<br>3. If coefficient of correlation (r) is equal to 1, it indicates there is no association between X and Y.<br>4. Correlation does not necessarily prove causation.<br>Which of the statements given above is\/are correct?\",\ncorrect:\"4 only\",\nopts:[\"1 only\",\"4 only\",\"1, 2 and 3\",\"1 and 4 only\"],\nexp:\"Correlation statistics: Statement 1 FALSE: Correlation does NOT require that one variable be independent and the other dependent; it measures the LINEAR ASSOCIATION between TWO VARIABLES without implying directionality or causation. Regression analysis is used when there is a predictor (independent) and outcome (dependent) variable. Statement 2 FALSE: The Pearson correlation coefficient (r) ranges from -1 to +1 (NOT -1 to infinity). r = +1: perfect positive linear correlation; r = -1: perfect negative linear correlation; r = 0: no linear association. Statement 3 FALSE: r = 1 indicates a PERFECT POSITIVE linear association between X and Y (when X increases, Y increases perfectly proportionally). r = 0 indicates no linear association. Statement 4 TRUE: Correlation measures association\/co-variation, but does NOT establish causation. Confounding, reverse causation, or spurious correlation may explain an observed r. Only statement 4 is correct.\"\n},\n{id:106,\nstem:\"With regard to lead poisoning, consider the following statements:<br>1. Coproporphyrin in urine is a useful screening test.<br>2. Hand washing before eating is an important measure of personal hygiene.<br>3. The use of d-penicillamine has been reported to be effective in management.<br>How many of the statements given above is\/are correct?\",\ncorrect:\"All three\",\nopts:[\"1 only\",\"2 only\",\"All three\",\"None\"],\nexp:\"Lead poisoning (plumbism): Statement 1 TRUE: Urinary coproporphyrin (specifically delta-aminolaevulinic acid \/ ALA and coproporphyrinogen) is a useful SCREENING test for lead poisoning. Lead inhibits several enzymes in the haem synthesis pathway; ALA dehydratase inhibition causes accumulation of delta-ALA; ferrochelatase inhibition causes elevation of free erythrocyte protoporphyrin (FEP) and urinary coproporphyrins. Statement 2 TRUE: Lead absorption in children often occurs through hand-to-mouth activity (ingestion of lead-contaminated soil, paint chips, dust). Hand washing before eating is a simple and effective preventive measure. Statement 3 TRUE: D-penicillamine (oral chelating agent) has been used in the management of lead poisoning, particularly for mild-moderate poisoning or as follow-up after parenteral chelation. Other chelating agents: BAL (dimercaprol) IV for severe poisoning, DMSA (succimer) orally. All three statements are correct.\"\n},\n{id:107,\nstem:\"A water body was inspected to look for the presence of mosquito eggs. It was observed that there were boat-shaped eggs, laid singly, not in clusters. The eggs also had lateral floats. Which one of the following diseases is most likely to be spread by the mosquito whose eggs were found?\",\ncorrect:\"Malaria\",\nopts:[\"Chikungunya fever\",\"Dengue fever\",\"Japanese encephalitis\",\"Malaria\"],\nexp:\"Mosquito egg identification: Anopheles mosquito eggs: BOAT-SHAPED, laid SINGLY (not in clusters\/rafts), with LATERAL FLOATS (air-filled flotation chambers on each side) on the water surface. They are laid singly on water surface. Culex mosquito eggs: cylindrical, laid in RAFTS (clusters of 100-300 eggs stuck together), standing upright. Aedes mosquito eggs: dark, oval, laid singly on damp surfaces above the waterline (not floating). The description - boat-shaped, singly laid, with lateral floats - is pathognomonic of ANOPHELES mosquito eggs. Anopheles mosquitoes are the vectors for MALARIA (Plasmodium species). Chikungunya and Dengue are transmitted by Aedes mosquitoes. Japanese encephalitis is transmitted by Culex mosquitoes. Malaria is the correct answer.\"\n},\n{id:108,\nstem:\"In the National Health Policy 2017, a target of 90:90:90 has been set for HIV\/AIDS. Which among the following are targets for which a 90% level has been set as part of 90:90:90 for HIV\/AIDS?<br>1. Proportion of couples who have safe sex<br>2. Proportion of people living with HIV who know their HIV status<br>3. Proportion of adolescents who have access to contraceptives<br>4. Proportion of people receiving antiretroviral therapy who have viral suppression<br>Select the correct answer using the code given below.\",\ncorrect:\"2 and 4\",\nopts:[\"1 and 4\",\"1 and 3\",\"2 and 3\",\"2 and 4\"],\nexp:\"The UNAIDS 90-90-90 targets (adopted into India's National Health Policy 2017 and linked to SDG 3.3): (1) 90% of all people living with HIV will know their HIV status (diagnosis target) - statement 2 correct. (2) 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy (treatment target). (3) 90% of all people receiving ART will achieve viral suppression (viral load undetectable) (viral suppression target) - statement 4 correct. The 90:90:90 framework specifically addresses: diagnosis, treatment, and viral suppression cascades for people living with HIV. Proportion of couples with safe sex (statement 1) and proportion of adolescents with access to contraceptives (statement 3) are prevention targets, NOT part of the 90:90:90 framework. Statements 2 and 4 are correct.\"\n},\n{id:109,\nstem:\"The Sample Registration System (SRS), an important source of health information consists of continuous enumeration of births and deaths by an enumerator and an independent survey every six months by an investigator-supervisor. Which one of the following terms best describes this system?\",\ncorrect:\"Dual-record system\",\nopts:[\"Dual-record system\",\"Triple-record system\",\"Double blinding\",\"Double data entry\"],\nexp:\"The Sample Registration System (SRS) in India is a large-scale demographic survey for providing reliable estimates of fertility and mortality at the national and state level. The SRS methodology: (1) CONTINUOUS ENUMERATION: a part-time resident enumerator (matched to the local population) continuously records all vital events (births, deaths) in their allocated area. (2) INDEPENDENT RETROSPECTIVE SURVEY: every 6 months, an independent investigator-supervisor visits the same area and independently records all vital events in the survey period. The two records (continuous register + retrospective survey) are then MATCHED and reconciled to identify events recorded in one but not the other, estimating completeness of recording. This matching of two independent records is called a DUAL-RECORD SYSTEM (or capture-recapture methodology). The SRS is the premier demographic data source in India, providing fertility (CBR, TFR) and mortality (CDR, IMR) estimates.\"\n},\n{id:110,\nstem:\"Cross-over type of study designs are those in which each patient serves as his\/her own control. In which of the following conditions is a cross-over study NOT suitable?<br>1. If the drug of interest cures the disease<br>2. If the drug is effective during all stages of the disease<br>3. If the disease changes radically during the period of time required for the study<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3\",\nopts:[\"1 only\",\"2 only\",\"2 and 3\",\"1 and 3\"],\nexp:\"Cross-over study design: patients receive treatment A then cross over to treatment B (with a washout period), serving as their own controls. NOT suitable when: Statement 1 (drug CURES the disease): if the first treatment cures the patient, the patient no longer has the disease during the second period, making comparison invalid. The carry-over effect is permanent. This is a valid contraindication. Statement 2 (drug effective in ALL stages): this would actually make the crossover MORE suitable (the drug works consistently), not less suitable. This is NOT a contraindication. Statement 3 (disease changes radically over the study period): if the disease spontaneously improves, worsens, or changes character significantly during the washout period between treatment phases, the patient is in a different disease state in the second period - making the comparison invalid. This is a valid contraindication. Statements 1 and 3 are conditions where cross-over study is NOT suitable.\"\n},\n{id:111,\nstem:\"In which one of the following diseases are the source of infection and reservoir of infection the same?\",\ncorrect:\"Typhoid\",\nopts:[\"Hookworm infection\",\"Cholera\",\"Tetanus\",\"Typhoid\"],\nexp:\"Source of infection = the person, animal, object, or substance from which the infectious agent passes directly to the host. Reservoir of infection = the natural habitat where the infectious agent lives, multiplies, and reproduces. They are the same (both are HUMANS) in diseases where humans are the only reservoir AND source: Typhoid (Salmonella typhi): humans are the ONLY reservoir AND source; the organism survives only in human intestines (and chronic carriers); there is no animal or environmental reservoir - statement correct. Cholera: humans are the primary host but Vibrio cholerae can survive in aquatic environments (especially estuarine waters, copepods) - the environment is also a reservoir, so source and reservoir are NOT always the same. Hookworm: reservoir includes soil (larvae in soil); source is contaminated soil. Tetanus: Clostridium tetani spores are found in soil (the environmental reservoir); humans are an incidental host, not the reservoir. Typhoid is the correct answer.\"\n},\n{id:112,\nstem:\"Which of the following statements are correct regarding Chikungunya fever?<br>1. It is usually transmitted by Culex mosquito.<br>2. A safe and effective vaccine is available for commercial use.<br>3. Incubation period is 4-7 days.<br>4. One of the prominent symptoms is arthropathy.<br>Select the correct answer using the code given below.\",\ncorrect:\"3 and 4 only\",\nopts:[\"1 and 2 only\",\"1 and 4 only\",\"2 and 3 only\",\"3 and 4 only\"],\nexp:\"Chikungunya fever (caused by Chikungunya virus, alphavirus, family Togaviridae): Statement 1 FALSE: Chikungunya is primarily transmitted by AEDES mosquitoes (Aedes aegypti and Aedes albopictus), NOT Culex mosquitoes. Culex mosquitoes transmit West Nile fever, Japanese encephalitis, and filariasis. Statement 2 FALSE: As of the examination date, no commercially available safe and effective Chikungunya vaccine was approved for widespread commercial use (though clinical trials were underway). This is a classic false statement in this context. Statement 3 TRUE: The incubation period of Chikungunya is 2-12 days, commonly stated as 4-7 days in most textbooks. Statement 4 TRUE: ARTHROPATHY (severe, debilitating polyarthralgia\/polyarthritis) is the HALLMARK symptom of Chikungunya, often persisting for months to years (chronic chikungunya arthropathy). The name Chikungunya means that which bends up in the Makonde language, referring to the stooped posture from joint pain. Statements 3 and 4 are correct.\"\n},\n{id:113,\nstem:\"In which one of the following vector-borne diseases, the transmission chain is Man-Snail-Man?\",\ncorrect:\"Schistosomiasis\",\nopts:[\"Fish tapeworm\",\"Malaria\",\"Onchocerciasis\",\"Schistosomiasis\"],\nexp:\"Transmission chain Man-Snail-Man: SCHISTOSOMIASIS (Bilharzia) - caused by Schistosoma species (S. haematobium, S. mansoni, S. japonicum). The transmission cycle: Human (definitive host) releases eggs in urine\/faeces into water. Miracidia hatch and infect freshwater SNAILS (Bulinus for S. haematobium, Biomphalaria for S. mansoni) - intermediate host. Inside the snail: sporocysts develop and produce cercariae. Cercariae are released into water and actively penetrate human skin. The chain is MAN (eggs in water) \u2192 SNAIL (larval development) \u2192 MAN (cercarial penetration). This is distinctly Man-Snail-Man. Malaria: Man-Mosquito-Man. Fish tapeworm (Diphyllobothrium): Man-Copepod-Fish-Man. Onchocerciasis (River blindness): Man-Blackfly (Simulium)-Man. Schistosomiasis is the correct answer.\"\n},\n{id:114,\nstem:\"Which of the following mosquito-borne diseases are transmitted chiefly by Aedes mosquito?<br>1. Dengue<br>2. West Nile fever<br>3. Yellow fever<br>4. Zika fever<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1 and 3 only\",\"1, 2 and 3\",\"1, 3 and 4\",\"2 and 4 only\"],\nexp:\"Mosquito vectors for important diseases: AEDES mosquito (Aedes aegypti, Aedes albopictus): Dengue (statement 1 correct), Yellow fever (statement 3 correct), Zika (statement 4 correct), Chikungunya. CULEX mosquito: West Nile fever (statement 2 - Culex, NOT Aedes), Japanese encephalitis, Filariasis, St. Louis encephalitis. ANOPHELES mosquito: Malaria. Summary: Dengue, Yellow fever, and Zika are all transmitted by Aedes mosquitoes. West Nile fever is transmitted by Culex mosquitoes (primarily Culex pipiens). Statements 1, 3, and 4 are correct.\"\n},\n{id:115,\nstem:\"Which one among the following is best defined as the interval of time between receipt of infection by a host and maximal infectivity of that host?\",\ncorrect:\"Generation time\",\nopts:[\"Generation time\",\"Latent period\",\"Incubation period\",\"Serial interval\"],\nexp:\"Epidemiological time intervals: Generation time: the interval between receipt of infection by a host (exposure) and MAXIMAL INFECTIVITY (peak transmissibility) of that host. It represents when the infected host is most capable of transmitting the infection to others. This is the definition in the question. Latent period: interval between infection and onset of infectiousness (when the host first becomes capable of transmitting). Incubation period: interval between exposure to an infectious agent and the first appearance of CLINICAL SYMPTOMS. Serial interval (generation interval in practice): average time between the onset of symptoms in the primary case and onset of symptoms in secondary cases. The question specifically describes GENERATION TIME - the interval from infection to maximal infectivity. Generation time is the correct answer.\"\n},\n{id:116,\nstem:\"Consider the following vaccines:<br>1. BCG Vaccine<br>2. Hepatitis B Vaccine<br>3. Inactivated Polio Vaccine (IPV)<br>4. Oral Polio Vaccine (OPV)<br>What is the correct order of the above vaccines as per their sensitivity to heat (most sensitive to least sensitive) given in the National Immunization Schedule (NIS)?\",\ncorrect:\"4 \u2192 3 \u2192 2 \u2192 1\",\nopts:[\"4 \u2192 3 \u2192 2 \u2192 1\",\"2 \u2192 1 \u2192 3 \u2192 4\",\"2 \u2192 1 \u2192 4 \u2192 3\",\"4 \u2192 3 \u2192 1 \u2192 2\"],\nexp:\"Heat sensitivity of vaccines (most to least sensitive) in India's cold chain: Most heat sensitive (stored at -20 degrees C, most vulnerable to heat): OPV (Oral Polio Vaccine) - live attenuated viral vaccine, extremely heat sensitive; stored in deep freezer; has a cold chain monitor. Next most sensitive (stored at 2-8 degrees C): IPV (Inactivated Polio Vaccine) - more stable than OPV but still requires refrigeration. Hepatitis B vaccine - relatively more stable but requires 2-8 degrees C; can withstand some heat exposure. BCG Vaccine - live attenuated bacterial vaccine, stored at 2-8 degrees C; freeze-dried form is relatively heat stable compared to others. Least heat sensitive: TT, DPT (heat stable vaccines that can withstand some temperature excursions). Order most to least heat sensitive: OPV (4) \u2192 IPV (3) \u2192 Hepatitis B (2) \u2192 BCG (1) = 4 \u2192 3 \u2192 2 \u2192 1. Option (a) is correct.\"\n},\n{id:117,\nstem:\"Exposure to gases is a common hazard in industries. The gases can be classified as simple, asphyxiating and anaesthetic gases. Which among the following are asphyxiating gases?<br>1. Carbon monoxide<br>2. Chloroform<br>3. Cyanide gas<br>4. Hydrogen<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 3\",\nopts:[\"1 and 3\",\"1 and 4\",\"2 and 3\",\"2 and 4\"],\nexp:\"Classification of industrial gases: Simple asphyxiants: displace oxygen from the atmosphere without themselves being toxic; e.g., nitrogen, hydrogen (statement 4 is a simple asphyxiant), methane, carbon dioxide, helium. Chemical (toxic) asphyxiants: prevent oxygen utilisation at tissue level despite adequate atmospheric oxygen: Carbon monoxide (CO) - binds haemoglobin with 200x greater affinity than O2, preventing oxygen transport (statement 1 correct as chemical\/toxic asphyxiant). Cyanide (HCN, cyanide gas) - inhibits cytochrome c oxidase (Complex IV), preventing cellular oxygen utilisation (statement 3 correct as chemical\/toxic asphyxiant). Anaesthetic gases: chloroform (statement 2), ether, halothane, nitrous oxide - cause CNS depression and anaesthesia. The question asks specifically for ASPHYXIATING gases. Both CO (chemical asphyxiant) and cyanide (chemical asphyxiant) are asphyxiating. Hydrogen is a simple asphyxiant. Per the examination, statements 1 and 3 (chemical asphyxiants) are the answer.\"\n},\n{id:118,\nstem:\"The Employees State Insurance Act, 1948 of India provides for certain benefits to employees. Which among the following are benefits to insured persons or to other dependents under the Act?<br>1. Disablement benefit<br>2. Funeral expenses<br>3. Maternity benefit<br>4. Travel benefit<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3 only\",\nopts:[\"1 and 3 only\",\"2 and 4 only\",\"1, 2 and 3 only\",\"1, 2, 3 and 4\"],\nexp:\"The Employees State Insurance (ESI) Act, 1948 provides social security to workers in organised sector establishments. Benefits under ESI: (1) Sickness benefit (cash payment during certified sickness). (2) Maternity benefit (statement 3 correct) - for confinement, miscarriage, sickness arising from pregnancy. (3) Disablement benefit (statement 1 correct) - temporary disablement benefit (during incapacity from employment injury) and permanent disablement benefit. (4) Dependants benefit - pension to dependants if insured person dies from employment injury. (5) Funeral expenses (statement 2 correct) - lump sum to meet funeral expenses of the insured person (currently Rs 15,000). (6) Medical benefit - medical care for insured persons and family. Travel benefit (statement 4) is NOT a specified benefit under the ESI Act. There is no travel benefit category in the standard ESI benefit list. Statements 1, 2, and 3 are correct ESI benefits.\"\n},\n{id:119,\nstem:\"Which among the following vaccines best represent interventions that focus on cancer prevention too?<br>1. Hepatitis A vaccine<br>2. Hepatitis B vaccine<br>3. Hemophilus influenzae B vaccine<br>4. Human papilloma virus vaccine<br>Select the correct answer using the code given below.\",\ncorrect:\"2 and 4\",\nopts:[\"1 and 2\",\"2 and 3\",\"2 and 4\",\"1 and 4\"],\nexp:\"Vaccines that prevent cancer: Hepatitis B vaccine (statement 2 correct): HBV causes chronic hepatitis leading to liver cirrhosis and HEPATOCELLULAR CARCINOMA (HCC). The hepatitis B vaccine is the first anti-cancer vaccine; universal HBV vaccination has dramatically reduced HCC rates. Human papilloma virus (HPV) vaccine (statement 4 correct): HPV (types 16 and 18) causes CERVICAL CANCER (and other anogenital cancers, oropharyngeal cancer). HPV vaccines (bivalent, quadrivalent, nonavalent) prevent cervical cancer and other HPV-related cancers. Hepatitis A vaccine (statement 1): HAV causes acute self-limiting hepatitis; it does NOT lead to chronic liver disease or liver cancer. No cancer prevention role. Haemophilus influenzae b (Hib) vaccine (statement 3): prevents bacterial meningitis, pneumonia, and epiglottitis in children; NO cancer prevention role. Statements 2 and 4 are correct.\"\n},\n{id:120,\nstem:\"Consider the following statements: Statement-I: While calculating the number of expected pregnancies per year in an area, a correction factor (usually 10%) is added to the expected number of live births in the year in the area. Statement-II: All the pregnancies in the area may not be registered by the health worker in the area. Which one of the following is correct in respect of the above statements?\",\ncorrect:\"Statement-I and Statement-II are independently correct, and Statement-II is a correct explanation for Statement-I.\",\nopts:[\"Statement-I and Statement-II are independently correct, and Statement-II is a correct explanation for Statement-I.\",\"Statement-I and Statement-II are independently correct, but Statement-II is not a correct explanation for Statement-I.\",\"Statement-I is correct but Statement-II is incorrect.\",\"Statement-I is incorrect but Statement-II is correct.\"],\nexp:\"Statement-I: When estimating the expected number of pregnancies in a population (for planning MCH services, ANC registrations targets, etc.), health planners add a correction factor of approximately 10% to the expected number of live births. This accounts for pregnancies that do not result in live births: stillbirths, miscarriages, abortions, and ectopic pregnancies (approximately 10% of pregnancies). This is a standard maternal health planning formula used in India's MCH programmes. Statement-I is CORRECT. Statement-II: Not all pregnancies may be registered by health workers because of underregistration, home deliveries without antenatal contact, migrant populations, etc. Statement-II is CORRECT. The relationship: Statement-II provides the REASON\/EXPLANATION for why a correction factor is needed in Statement-I - because pregnancies are underregistered and not all pregnancies result in live births, a correction factor is required. Statement-II IS a correct explanation for Statement-I. 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Submitting in 10 Submit Now Combined Medical Services Examination 2023Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part C Preventive & Social Medicine · Epidemiology · Health Programmes · Biostatistics Questions… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36750","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2023 P2 Part-C PSM - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/05\/03\/cms-2023-p2-part-c-psm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2023 P2 Part-C PSM - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2023 | General Medicine & Paediatrics | Paper I | Part A ✓️ 0 ❌ 0 ⏳ 40 left ⏱ 40:00 Net 0 \/ 160 Time's Up! 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