CMS 2016 Paper II \u2013 Part B (Q41\u2013Q80)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms16p2b \u2500\u2500 *\/\n#cms16p2b *,#cms16p2b *::before,#cms16p2b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms16p2b{\n --ter:#C0603A;--ter-light:#e8825f;--ter-pale:#fdf1ec;\n --teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#e0d8d4;--bg:#fdfaf8;--white:#ffffff;\n --correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;\n --wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--bg);\n line-height:1.7;padding:0 0 48px;\n}\n#cms16p2b .cq-sentinel{height:1px}\n#cms16p2b .cq-statusbar{\n 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.cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms16p2b\">\n <div class=\"cq-sentinel\" id=\"cms16p2b-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms16p2b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms16p2b-timer-item\">\u23f1 <strong id=\"cms16p2b-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms16p2b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms16p2b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms16p2b-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms16p2b-sn\">0<\/strong> \/ <strong id=\"cms16p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms16p2b-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms16p2b-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms16p2b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms16p2b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2016<br>Paper II \u00b7 Part B<\/h1>\n <p>Preventive & Social Medicine \u00b7 Biostatistics \u00b7 Community Health<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 41 \u2013 80<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms16p2b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms16p2b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms16p2b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms16p2b-score\">\n <div class=\"cq-score-ring\" id=\"cms16p2b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms16p2b-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms16p2b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms16p2b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms16p2b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms16p2b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms16p2b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms16p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms16p2b', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60, GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:41,\n stem:'The two important values necessary for describing the variation in a series of observations are:',\n correct:'Mean and standard deviation',\n options:['Mean and standard deviation','Mean and range','Median and range','Median and standard deviation'],\n exp:'To fully describe a dataset you need a measure of central tendency AND a measure of dispersion. Mean (arithmetic average) describes the centre; Standard Deviation (SD) describes the spread around the mean in normally distributed data. Together they completely characterise a normal distribution (the basis of most parametric statistics). Range (max\u2212min) is a crude measure of spread influenced by outliers. Median + range is used for skewed data, but the classical pair for interval data with normal distribution is mean + SD.'\n },\n {\n id:42,\n stem:'The time period between the entry of an infective agent in a host and the maximal infectivity of that host is:',\n correct:'Generation time',\n options:['Incubation period','Serial interval','Generation time','Period of communicability'],\n exp:'Generation time is the interval from the entry of the infectious agent into a host to the time of maximal infectivity (peak transmissibility) of that host \u2014 i.e., the time to produce the maximum number of infective organisms. Incubation period = entry to first symptoms. Serial interval = time between onset of symptoms in successive cases in a chain. Period of communicability = the entire duration during which the host can transmit infection. Generation time is distinct and specific to the question asked.'\n },\n {\n id:43,\n stem:'Symposium is a method of health education characterised by:\\n1. A series of speeches on a selected topic\\n2. Presentation of different aspects of a topic by 3 or 4 experts\\n3. A discussion among the symposium members\\n4. The chairperson making a comprehensive summary at the end\\n\\nWhich of these statements are correct?',\n correct:'1, 2 and 4',\n options:['2 and 3 only','1, 3 and 4','1, 2 and 4','1, 2 and 3'],\n exp:'A symposium is a formal health education method in which: (1) A series of speeches\/presentations are made on a selected topic \u2014 correct. (2) Three to four experts each present a different aspect of the topic \u2014 correct. (3) There is NO formal discussion among symposium members (that is a panel discussion); the audience may ask questions but members do not debate \u2014 statement 3 is WRONG. (4) The chairperson summarises at the end \u2014 correct. A symposium is one-way communication from experts to audience, unlike a seminar or panel discussion.'\n },\n {\n id:44,\n stem:'Match List I (Major Group of Insecticides) with List II (Name of Insecticide):\\nA. Stomach poison\\nB. Organo-chlorine compound\\nC. Organo-phosphorous compound\\nD. Carbamates\\n\\n1. Temephos\\n2. Propoxur\\n3. Sodium fluoride\\n4. Dieldrin',\n correct:'A-3, B-4, C-1, D-2',\n options:['A-4, B-3, C-1, D-2','A-4, B-3, C-2, D-1','A-3, B-4, C-1, D-2','A-3, B-4, C-2, D-1'],\n exp:'Stomach poison = Sodium fluoride (3) \u2014 ingested by insects during feeding, inhibits metabolic enzymes. Organo-chlorine compound = Dieldrin (4) \u2014 cyclopentadiene organochlorine; others: DDT, BHC, aldrin. Organo-phosphorous compound = Temephos (Abate, 1) \u2014 larvicide used in water bodies for mosquito control; others: malathion, parathion. Carbamate = Propoxur (Baygon, 2) \u2014 inhibits acetylcholinesterase reversibly; others: carbaryl, bendiocarb. All four match correctly: A-3, B-4, C-1, D-2.'\n },\n {\n id:45,\n stem:'Consider the following diseases:\\n1. Rift Valley fever\\n2. Yellow Fever\\n3. Chikungunya fever\\n4. West Nile fever\\n\\nWhich of the above diseases are transmitted by Aedes mosquito?',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],\n exp:'Aedes mosquito-transmitted diseases: Rift Valley fever (Aedes and other mosquitoes, 1), Yellow fever (Aedes aegypti, 2), Chikungunya (Aedes aegypti and Aedes albopictus, 3), Dengue (Aedes aegypti), Zika (Aedes). West Nile fever (4) is primarily transmitted by CULEX mosquitoes (Culex pipiens, Culex quinquefasciatus), not Aedes. Therefore 1, 2 and 3 are Aedes-transmitted, while West Nile fever is Culex-transmitted.'\n },\n {\n id:46,\n stem:'Prophylactic disinfection includes:\\n1. Disinfection of urine specimen of a patient with enteric fever\\n2. Pasteurisation of milk\\n3. Disinfection of contaminated linen\\n4. Disinfection of water by chlorine\\n\\nWhich of these statements are correct?',\n correct:'2 and 4 only',\n options:['1, 2, 3 and 4','2 and 4 only','1, 2 and 4 only','1 and 3 only'],\n exp:'Prophylactic (preventive) disinfection is applied BEFORE infection occurs, to prevent contamination of people\/environment. Examples: pasteurisation of milk (2) \u2014 prevents infection in healthy consumers; chlorination of water (4) \u2014 prevents waterborne disease in the community. Concurrent disinfection (done during the period of communicability) includes disinfection of a patient\\'s excretions like urine in enteric fever (1) and contaminated linen (3) \u2014 these are done WHILE disease is present, not prophylactically. Only 2 and 4 are prophylactic.'\n },\n {\n id:47,\n stem:'Consider the following statements:\\n1. Registration of birth, even if the child is born in a hospital, is essentially the responsibility of parents only.\\n2. At present, the registration of birth has to be done not more than 15 days after the birth.\\n\\nWhich of these statements is\/are correct?',\n correct:'Neither 1 nor 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Under the Registration of Births and Deaths Act, 1969 (India): Statement 1 is WRONG \u2014 for births in hospitals\/health institutions, the medical officer in charge (not the parents) is responsible for registration. Statement 2 is WRONG \u2014 the registration must be done within 21 days (not 15 days) of the birth. Late registration (after 21 days but within 30 days) requires no fine; beyond 30 days requires magistrate permission. Both statements contain incorrect figures\/facts. Answer: neither 1 nor 2 is correct.'\n },\n {\n id:48,\n stem:'Sullivan Index is a measure of which of the following?',\n correct:'Quality of life',\n options:['Disability rate','Pregnancy rate','Literacy rate','Quality of life'],\n exp:'The Sullivan Index (Disability-Free Life Expectancy, DFLE), developed by Daniel Sullivan in 1971, measures the number of years a person can expect to live free of disability \u2014 combining mortality data with morbidity\/disability data into a single composite measure. It is therefore a measure of the QUALITY of life (healthy life expectancy), not merely the quantity (crude life expectancy). It is one of the key health status indicators recommended by WHO and is used in international health comparisons.'\n },\n {\n id:49,\n stem:'The strategy to eradicate poliomyelitis in India comprised of:\\n1. Conducting national immunisation days\\n2. Mopping-up rounds with OPV\\n3. Acute flaccid paralysis surveillance\\n4. Public awareness through multimedia\\n\\nWhich of these statements are correct?',\n correct:'1, 2, 3 and 4',\n options:['1 and 3 only','2 and 4 only','1, 2 and 3 only','1, 2, 3 and 4'],\n exp:'India\\'s Pulse Polio Programme (1995\u20132014, certified polio-free 2014) used a comprehensive four-pronged strategy: (1) National Immunisation Days (NIDs) \u2014 pulse immunisation of all children <5 with OPV simultaneously. (2) Mopping-up rounds \u2014 house-to-house vaccination in high-risk areas after NIDs. (3) AFP (acute flaccid paralysis) surveillance \u2014 identifying suspected polio cases for investigation. (4) Social mobilisation and public awareness through multimedia \u2014 critical to achieve >95% coverage. All four were essential pillars of the eradication strategy.'\n },\n {\n id:50,\n stem:'In the estimation of statistical probability, Z score is applicable to:',\n correct:'Normal distribution',\n options:['Normal distribution','Skewed distribution','Binomial distribution','Poisson distribution'],\n exp:'The Z score (standard normal deviate) is calculated as Z = (X \u2212 \u03bc)\/\u03c3, converting any normally distributed variable into the standard normal distribution (mean=0, SD=1). It is applicable specifically to NORMAL (Gaussian) distribution. Probability estimates using Z scores are based on the area under the normal curve. Skewed distributions require non-parametric methods. Binomial distribution uses its own probability function. Poisson distribution has its own distribution tables. Z scores are only valid when data is normally distributed.'\n },\n {\n id:51,\n stem:'Transovarian transmission is demonstrated in:\\n1. Aedes mosquito\\n2. Flea\\n3. Ticks\\n4. Itch mite\\n\\nSelect the correct answer:',\n correct:'1 and 3',\n options:['1 and 2','2 and 4','1 and 3','3 and 4'],\n exp:'Transovarian (vertical) transmission = pathogen passes from adult female vector to offspring through the eggs. Demonstrated in: Ticks (3) \u2014 most important vectors for transovarian transmission; Rickettsia, Borrelia, tick-borne encephalitis, Crimean-Congo haemorrhagic fever viruses pass transovarially. Aedes mosquito (1) \u2014 dengue and Zika viruses show transovarian transmission in Aedes. Fleas transmit Yersinia pestis and murine typhus but NOT transovarially. Itch mite (Sarcoptes) transmits scabies by direct contact, no transovarian transmission.'\n },\n {\n id:52,\n stem:'The most sensitive indicator of the health status of a community is the:',\n correct:'Infant mortality rate',\n options:['Crude death rate','Maternal mortality rate','Infant mortality rate','Child mortality rate'],\n exp:'Infant Mortality Rate (IMR = deaths under 1 year per 1000 live births) is universally accepted as the SINGLE MOST SENSITIVE indicator of community health status. It reflects: maternal health, antenatal care quality, nutrition, sanitation, access to healthcare, socioeconomic conditions, and immunisation coverage \u2014 all in one number. It is sensitive to changes in living conditions and health services. Maternal mortality rate reflects maternal care specifically. Crude death rate is influenced by age structure. IMR is the gold standard community health indicator.'\n },\n {\n id:53,\n stem:'Chemoprophylaxis is an example of:',\n correct:'Specific protection',\n options:['Specific protection','Health promotion','Early detection','Rehabilitation'],\n exp:'Leavell and Clark\\'s levels of prevention: Primary prevention (before disease) = health promotion + specific protection. Chemoprophylaxis (e.g., antimalarial drugs, isoniazid for TB contacts, rifampicin for meningococcal contacts) is a specific protective measure against a specific pathogen \u2014 it falls under SPECIFIC PROTECTION (primary prevention). Health promotion is non-specific (nutrition, sanitation, education). Early detection = secondary prevention. Rehabilitation = tertiary prevention. Chemoprophylaxis = specific protection.'\n },\n {\n id:54,\n stem:'A rapid mass screening method that can be employed by a paramedical worker for detecting malnutrition in pre-school (age 1 to 5 years) children is:',\n correct:'Mid-arm circumference',\n options:['Weight for age','Height for age','Mid-arm circumference','Body Mass Index'],\n exp:'Mid-upper arm circumference (MUAC) is the ideal screening tool for malnutrition in pre-school children by paramedical workers because: it requires only a simple tape measure (no scale needed), is quick and easy to perform, correlates well with nutritional status, and the \"traffic light\" colour-coded MUAC tape (red <11.5 cm = SAM, yellow 11.5\u201312.5 cm = MAM, green >12.5 cm = normal) needs no calculation. Weight-for-age requires accurate weighing. Height-for-age requires a stadiometer and calculation. BMI is impractical in field settings for children.'\n },\n {\n id:55,\n stem:'The most important single determinant of infant mortality is:',\n correct:'Birth weight',\n options:['Birth weight','Age of the mother','Order of birth','Interval between births'],\n exp:'Birth weight is the single most important determinant of infant survival and mortality. Low birth weight (<2500 g) is associated with substantially higher risks of neonatal death, infections, hypothermia, hypoglycaemia, and long-term developmental problems. The WHO estimates that LBW babies are 20\u00d7 more likely to die than normal-weight babies. Birth weight integrates the effects of gestational age, maternal nutrition, placental function, and intrauterine environment. All other listed factors (maternal age, birth order, inter-birth interval) are secondary determinants.'\n },\n {\n id:56,\n stem:'The immunoglobulins that can be transported across the placenta include:',\n correct:'IgG only',\n options:['IgG only','IgA only','Both IgG and IgA','Neither IgG nor IgA'],\n exp:'IgG is the ONLY immunoglobulin class that crosses the placenta, transported by the neonatal Fc receptor (FcRn) via active transcytosis. This provides the neonate with passive humoral immunity for the first 3\u20136 months of life. IgA does NOT cross the placenta; it is provided to the neonate via breast milk (especially colostrum). IgM, IgE, and IgD do not cross the placenta. Therefore, only IgG is transported transplacentally \u2014 maternal IgG antibodies against measles, rubella, tetanus etc. protect the newborn.'\n },\n {\n id:57,\n stem:'Consider the following statements:\\n1. The duration of immunity is longer when a live vaccine is administered compared to a killed vaccine.\\n2. In the case of killed vaccine, a single dose is sufficient, whereas multiple doses are always required for live vaccines.\\n\\nWhich of these statements is\/are correct?',\n correct:'1 only',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Statement 1 is CORRECT: Live attenuated vaccines (measles, BCG, yellow fever, OPV) stimulate all arms of immunity (cellular, humoral, mucosal) and produce a response mimicking natural infection \u2014 typically producing lifelong immunity after one or two doses. Killed\/inactivated vaccines generally produce shorter-duration immunity requiring boosters. Statement 2 is WRONG: It is the KILLED vaccines that typically require multiple doses (e.g., IPV \u00d7 3, DPT \u00d7 3) not live vaccines. Most live vaccines require only 1\u20132 doses. Statement 2 has the relationship reversed.'\n },\n {\n id:58,\n stem:'Match List I (Disease) with List II (Incubation Period):\\nA. Measles\\nB. Diphtheria\\nC. Hepatitis A\\nD. Hepatitis B\\n\\n1. 6 weeks to 6 months\\n2. 15 to 50 days\\n3. 10 to 14 days\\n4. 2 to 6 days',\n correct:'A-3, B-4, C-2, D-1',\n options:['A-3, B-4, C-1, D-2','A-4, B-3, C-2, D-1','A-4, B-3, C-1, D-2','A-3, B-4, C-2, D-1'],\n exp:'Measles = 10\u201314 days (A=3). Diphtheria = 2\u20136 days (B=4). Hepatitis A = 15\u201350 days (average 28\u201330 days) (C=2). Hepatitis B = 6 weeks to 6 months (average 60\u201390 days) (D=1). These are standard incubation period ranges from Park\\'s Textbook of Preventive and Social Medicine. Hepatitis B has the longest incubation period among common vaccine-preventable diseases due to the slow replication cycle of HBV and the long time required for hepatocyte injury to become symptomatic.'\n },\n {\n id:59,\n stem:'Throat swab positive and Schick test negative indicate that the person is:',\n correct:'Immune to diphtheria',\n options:['Suffering from diphtheria','Susceptible to diphtheria','Hypersensitive to diphtheria','Immune to diphtheria'],\n exp:'Schick test interpretation: Schick test POSITIVE = susceptible (no antitoxin), Schick test NEGATIVE = immune (has protective antitoxin \u22650.03 IU\/mL). Throat swab POSITIVE = Corynebacterium diphtheriae is present (colonised\/carrier). Combining both: throat swab positive (carrier of C. diphtheriae) + Schick test negative (immune, has antitoxin) = CARRIER STATE \u2014 the person is IMMUNE to diphtheria clinically but carries and can transmit the organism. For examination purposes, this combination indicates IMMUNITY to clinical diphtheria despite carriage.'\n },\n {\n id:60,\n stem:'The following are manifestations of psychosis EXCEPT:',\n correct:'Psychoneurosis',\n options:['Psychoneurosis','Schizophrenia','Manic depressive psychosis','Paranoia'],\n exp:'Psychosis = loss of contact with reality, featuring hallucinations, delusions, and disorganised thought. Manifestations: schizophrenia, manic-depressive psychosis (bipolar disorder with psychotic features), and paranoia (delusional disorder). Psychoneurosis (neurosis) is distinctly DIFFERENT \u2014 it involves anxiety, phobias, obsessions, and conversion disorders WITHOUT loss of reality testing. The patient is aware their thoughts\/behaviours are abnormal. Neuroses do not involve psychotic features. Psychoneurosis is therefore NOT a manifestation of psychosis.'\n },\n {\n id:61,\n stem:'Effectiveness measures the extent to which predetermined objectives are achieved. Efficiency measures how well resources are utilised.\\n\\nWhich of the following assertions are true?\\n1. Percentage of bed occupancy measures effectiveness\\n2. Immunisation coverage rate measures efficiency\\n3. Cost per patient treated measures efficiency\\n4. Reduction in mortality measures effectiveness\\n\\nSelect the correct answer:',\n correct:'3 and 4 only',\n options:['1 and 2','2 and 3 only','3 and 4 only','2, 3 and 4'],\n exp:'Effectiveness = achieving objectives (outcome measures). Efficiency = output per unit input (resource utilisation). (1) Bed occupancy = how well a resource (beds) is being used = EFFICIENCY, not effectiveness. (2) Immunisation coverage rate = the proportion of the target population immunised = EFFECTIVENESS (objective: cover all children). (3) Cost per patient treated = resource input per unit output = EFFICIENCY \u2014 correct. (4) Reduction in mortality = achieving the health objective = EFFECTIVENESS \u2014 correct. So 3 (efficiency) and 4 (effectiveness) are both correctly assigned. Only option (c) is internally consistent.'\n },\n {\n id:62,\n stem:'With reference to the Revised National Tuberculosis Control Programme, consider the following statements:\\n1. Active case finding is pursued under this Programme.\\n2. Microscopy centres are established for every one lakh population and in hilly\/tribal areas for every 50,000 population.\\n\\nWhich of these statements is\/are correct?',\n correct:'2 only',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Statement 1 is FALSE: RNTCP (now NTEP) follows PASSIVE case finding \u2014 patients who self-report with symptoms to health facilities are diagnosed. Active case finding (screening asymptomatic populations) is NOT the standard RNTCP strategy, though targeted active case finding in high-risk groups has been introduced under NTEP. Statement 2 is CORRECT: RNTCP established Designated Microscopy Centres (DMC) at the rate of 1 per 1,00,000 population in plains, and 1 per 50,000 in hilly, tribal, and difficult terrains to ensure access to sputum microscopy. Only statement 2 is correct.'\n },\n {\n id:63,\n stem:'Which one of the following correctly describes \\'Neonatal Tetanus Elimination\\' status?',\n correct:'Incidence rate less than 0.1\/1000 births, two doses of TT vaccine coverage more than 90%, attended deliveries more than 75%',\n options:[\n 'Incidence rate more than 2\/1000 births, TT vaccine coverage less than 70%, attended deliveries 60\u201370%',\n 'Incidence rate 1\u20132\/1000 births, three doses TT coverage 70%, attended deliveries more than 75%',\n 'Incidence rate 0.5\u20131\/1000 births, three doses TT coverage 70\u201380%, attended deliveries 65\u201370%',\n 'Incidence rate less than 0.1\/1000 births, two doses of TT vaccine coverage more than 90%, attended deliveries more than 75%'\n ],\n exp:'WHO defines Neonatal Tetanus Elimination (NTE) as reducing NNT to <1 case per 1,000 live births in every district. The district is classified as having achieved NTE when: NNT incidence <0.1\/1000 live births (some sources say <1\/1000 at district level), TT2+ coverage \u226590% in pregnant women, and \u226570\u201375% of deliveries attended by skilled birth attendants. Option (d) with NNT <0.1\/1000, TT coverage >90%, and attended deliveries >75% best describes the elimination criteria.'\n },\n {\n id:64,\n stem:'Influenza vaccine is recommended for:\\n1. Elderly\\n2. Persons with underlying chronic diseases\\n3. HIV infected\\n4. General population\\n\\nSelect the correct answer:',\n correct:'1, 2 and 3',\n options:['1 and 2 only','4','2 and 3 only','1, 2 and 3'],\n exp:'Annual influenza vaccination is recommended for high-risk groups: (1) Elderly (\u226565 years) \u2014 impaired immune response and higher complication risk. (2) Persons with chronic diseases \u2014 diabetes, chronic cardiac\/pulmonary\/renal disease, immunosuppression. (3) HIV-infected persons \u2014 immune compromise increases severity risk. Also: healthcare workers, pregnant women, and residents of long-term care facilities. Routine annual vaccination of the GENERAL POPULATION (4) as a universal strategy is recommended in some high-income countries but is NOT the standard recommendation in the Indian\/UPSC CMS context. Options 1, 2, and 3 are correct.'\n },\n {\n id:65,\n stem:'With reference to mumps, consider the following statements:\\n1. The average age of incidence of mumps is higher than that of measles and chicken pox.\\n2. The mumps disease tends to be more severe in adults than in children.\\n\\nWhich of the statements given above is\/are correct?',\n correct:'Both 1 and 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Both statements are correct. (1) Mumps typically affects older children (5\u201314 years) and young adults, while measles and chickenpox commonly affect younger children (2\u20135 years). The higher maternal antibody waning and different contact patterns explain this. (2) Mumps in adults is significantly more severe \u2014 orchitis (20\u201330% of post-pubertal males), oophoritis, pancreatitis, aseptic meningitis, encephalitis, and nerve deafness are more common in adults. Children usually have mild parotitis with full recovery. Both statements are therefore correct.'\n },\n {\n id:66,\n stem:'Consider the following statements about content\/yield of 100 g of some foodstuffs:\\n1. Fat content of Bengal gram is less than that of maize\\n2. Protein content of maize is more than that of rice\\n3. Calorie yield of fish and egg is the same\\n\\nWhich of the statements given above is\/are correct?',\n correct:'2 only',\n options:['1 only','2 only','1 and 2','2 and 3'],\n exp:'Using Nutritive Value of Indian Foods (ICMR\/NIN): Bengal gram (chana) contains ~5.6 g fat\/100 g; maize contains ~3.6 g fat\/100 g \u2014 Bengal gram has MORE fat than maize, so statement 1 is WRONG. Protein: maize ~8.8 g\/100 g; rice ~6.8 g\/100 g \u2014 maize has MORE protein than rice, so statement 2 is CORRECT. Calories: fish ~100\u2013105 kcal\/100 g; egg ~173 kcal\/100 g \u2014 NOT the same, so statement 3 is WRONG. Only statement 2 is correct.'\n },\n {\n id:67,\n stem:'Consider the following statements:\\n1. Protein content of soyabean is more than that of meat (per 100 g)\\n2. Fat content of fish is more than that of soyabean (per 100 g)\\n3. Calorie yield for each 100 g of fish is almost the same as for 100 g of banana\\n4. Fat content of soyabean is more than that of eggs (per 100 g)\\n\\nWhich of the above statements are correct?',\n correct:'1 and 4 only',\n options:['1 and 2','1 and 4 only','2 and 3','1, 3 and 4'],\n exp:'Using ICMR nutritive values: Soyabean protein ~43 g\/100 g vs meat ~22 g\/100 g \u2192 soyabean has MORE protein than meat (1 = CORRECT). Fat: fish ~2.5\u20135 g\/100 g vs soyabean ~19.5 g\/100 g \u2192 fish has LESS fat than soyabean (2 = WRONG). Calories: fish ~100 kcal\/100 g vs banana ~116 kcal\/100 g \u2192 similar but not \"almost same\" in most tables (3 = borderline, generally considered wrong). Soyabean fat ~19.5 g\/100 g vs eggs ~13.3 g\/100 g \u2192 soyabean has MORE fat than eggs (4 = CORRECT). Statements 1 and 4 are correct.'\n },\n {\n id:68,\n stem:'Features of food poisoning: incubation period less than 24 hours, source of infection is milk products, symptoms include diarrhoea and vomiting.\\n\\nTo which of the following does the above description apply?\\n1. Staphylococcal food poisoning\\n2. Salmonella food poisoning\\n3. Botulism\\n\\nSelect the correct answer:',\n correct:'1 only',\n options:['1 only','1 and 2','1 and 3','2 only'],\n exp:'Staphylococcal food poisoning (1) fits exactly: incubation 1\u20136 hours (well under 24 hours, shortest of all food poisonings), source includes cream-filled pastries, custards, and dairy\/milk products contaminated by food handlers, symptoms are predominantly vomiting then diarrhoea (enterotoxin-mediated). Salmonella (2) has incubation 12\u201336 hours (>24 h) and source is eggs, poultry, meat \u2014 not specifically milk products. Botulism (3) has incubation 12\u201336 hours and causes neurological symptoms (descending paralysis), not primarily diarrhoea\/vomiting. Only (1) matches all three criteria.'\n },\n {\n id:69,\n stem:'For adolescents, what is the weekly iron and folic acid supplementation dose?',\n correct:'Weekly: 60 mg elemental iron and 400 \u00b5g folic acid',\n options:['Weekly: 60 mg elemental iron and 400 \u00b5g folic acid','Weekly: 100 mg elemental iron and 500 \u00b5g folic acid','Weekly: 120 mg elemental iron and 400 \u00b5g folic acid','Weekly: 150 mg elemental iron and 500 \u00b5g folic acid'],\n exp:'Under India\\'s Weekly Iron and Folic Acid Supplementation (WIFS) programme for adolescents (10\u201319 years), the dose is: 60 mg elemental iron + 400 \u00b5g (0.4 mg) folic acid, given once weekly throughout the year. For pregnant women, the daily dose is 100 mg iron + 500 \u00b5g folic acid. The WIFS programme targets anaemia prevention in adolescent girls and boys through schools and Anganwadis. The 60 mg weekly dose is the WHO-recommended adolescent supplementation schedule.'\n },\n {\n id:70,\n stem:'Which of the following statements is\/are true about the proportional case rate of malaria?\\n1. This indicator is used since morbidity rate is difficult to determine\\n2. This is defined as the number of cases of malaria for every 100 patients seen in hospital OPDs\\n3. It is a crude index since cases are not related to their time and space distribution\\n\\nSelect the correct answer:',\n correct:'1, 2 and 3',\n options:['2 only','2 and 3 only','3 only','1, 2 and 3'],\n exp:'All three statements about the Proportional Case Rate (PCR) of malaria are correct: (1) True morbidity rates require population denominators which are difficult to obtain in malaria-endemic areas; PCR uses health facility data as a proxy. (2) PCR = (Number of malaria cases \/ Total OPD patients) \u00d7 100 \u2014 this is the standard definition. (3) PCR is a crude index because it does not account for seasonal variation (time), geographic clustering (space), or healthcare-seeking behaviour differences. All three statements accurately describe the nature and limitations of PCR.'\n },\n {\n id:71,\n stem:'Consider the following statements:\\n1. Type 2 poliovirus was eliminated in India in 2005.\\n2. Main cause of vaccine-derived polioviruses (VDPV) is the Type 2 component of OPV.\\n\\nWhich of the statements given above is\/are correct?',\n correct:'Both 1 and 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Both statements are correct. (1) Wild poliovirus Type 2 was globally eradicated in 1999 and India certified Type 2 eliminated by 2005 (no wild Type 2 circulation). (2) The Type 2 component of trivalent OPV (tOPV) has the highest rate of reversion to virulence and is responsible for the majority of circulating vaccine-derived poliovirus (cVDPV) outbreaks worldwide. This was the rationale for the global switch from tOPV to bivalent OPV (bOPV, types 1+3) and introduction of at least one IPV dose \u2014 the \"switch\" completed globally in 2016. Both statements are correct.'\n },\n {\n id:72,\n stem:'Which of the following statements is true about hydatid disease?',\n correct:'It is a zoonosis',\n options:['It is a zoonosis','It is rare in sheep-rearing countries','It is a protozoal disease','Man is the definitive host'],\n exp:'Hydatid disease (cystic echinococcosis) is caused by the larval stage of Echinococcus granulosus, a cestode (tapeworm). (1) It is a ZOONOSIS \u2014 transmitted between animals (dogs as definitive host, sheep\/cattle as intermediate hosts) and humans (accidental intermediate host). (2) It is COMMON in sheep-rearing countries (Australia, New Zealand, Mediterranean, Middle East, India) \u2014 not rare. (3) It is a HELMINTHIC (cestode) disease, not protozoal. (4) The DEFINITIVE host is the dog (adult tapeworm in intestine); man is the INTERMEDIATE (accidental) host. Only statement (a) is correct.'\n },\n {\n id:73,\n stem:'Which of the following statements is true about direct age standardisation?',\n correct:'A standard population is used',\n options:['Standardised mortality ratio is used','A standard population is used','Age-specific death rates are not known','Number of people in each age group is not known'],\n exp:'In direct age standardisation, a STANDARD (reference) population is used \u2014 the age-specific death rates of the study population are applied to the standard population\\'s age distribution to calculate an \"expected\" death count, yielding the standardised rate. This allows valid comparison between populations with different age structures. Indirect standardisation (used when age-specific rates are unknown) uses the Standardised Mortality Ratio (SMR). Direct standardisation requires known age-specific death rates. Indirect requires only total observed deaths and the age structure of the study population.'\n },\n {\n id:74,\n stem:'Match List I (Disease type) with List II (Example):\\nA. Nosocomial\\nB. Opportunistic\\nC. Iatrogenic\\nD. Epornithic\\n\\n1. Cytomegaloviral infection\\n2. Hepatitis B viral infection\\n3. Aplastic anaemia\\n4. Influenza',\n correct:'A-2, B-1, C-3, D-4',\n options:['A-2, B-1, C-3, D-4','A-2, B-1, C-4, D-3','A-1, B-2, C-4, D-3','A-1, B-2, C-3, D-4'],\n exp:'Nosocomial (hospital-acquired) = Hepatitis B (2) \u2014 acquired through contaminated blood\/needles in healthcare settings. Opportunistic = CMV infection (1) \u2014 occurs in immunocompromised hosts (AIDS, transplant) where CMV exploits the immune deficiency. Iatrogenic (caused by medical treatment) = Aplastic anaemia (3) \u2014 can result from chloramphenicol, chemotherapy, or radiation therapy. Epornithic (epidemic among birds) = Influenza (4) \u2014 avian influenza outbreaks are classic epornithics (epizootic in birds).'\n },\n {\n id:75,\n stem:'With reference to the International Certificate of Vaccination for Yellow Fever, the validity of the certificate begins how many days after the vaccination?',\n correct:'10 days',\n options:['5 days','10 days','14 days','20 days'],\n exp:'The International Certificate of Vaccination or Prophylaxis (ICVP) for Yellow Fever becomes valid 10 days after primary vaccination (to allow time for full immunity to develop). Once valid, it is now considered to provide LIFELONG protection (WHO revised this in 2014, removing the previous 10-year re-vaccination requirement). The certificate is required for travellers entering countries in the yellow fever zone (sub-Saharan Africa, tropical South America) or coming from endemic areas. The 10-day gap is the internationally agreed standard.'\n },\n {\n id:76,\n stem:'With reference to dengue virus, consider the following statements:\\n1. In India, all four serotypes are found.\\n2. The reservoir of infection is both man and mosquito.\\n3. Adults usually have a milder disease than children.\\n4. Dengue haemorrhagic fever is caused by infection with more than one dengue virus.\\n\\nWhich of the statements given above is\/are correct?',\n correct:'1, 2 and 4',\n options:['1 and 2 only','1, 2 and 4','4 only','2, 3 and 4'],\n exp:'(1) All four dengue serotypes (DENV-1, 2, 3, 4) circulate in India \u2014 CORRECT. (2) Man is the amplifying host and Aedes mosquito is both the vector and a reservoir (via transovarian transmission) \u2014 CORRECT. (3) WRONG \u2014 DHF\/DSS is actually more common and severe in CHILDREN; adults tend to have classical dengue fever. (4) DHF (dengue haemorrhagic fever) is caused by secondary infection with a DIFFERENT serotype \u2014 antibody-dependent enhancement leads to increased viral replication and immune activation \u2014 CORRECT. Statements 1, 2, and 4 are correct.'\n },\n {\n id:77,\n stem:'What is the window period for HIV infection?',\n correct:'6 \u2013 24 weeks',\n options:['3 \u2013 15 days','6 \u2013 24 weeks','6 \u2013 8 months','None of these'],\n exp:'The HIV window period is the time from infection to when the test becomes reliably positive. For standard antibody tests (ELISA\/Western blot), the window period is approximately 3 weeks to 3 months (most commonly cited as 6\u201312 weeks). With 4th-generation combination Ag\/Ab tests, the window is shorter (~18 days to 6 weeks). The traditional teaching answer for the HIV window period in Indian exam context is 6 weeks to 6 months, with the commonly tested answer being 6\u201324 weeks (approximately 1.5\u20136 months). This corresponds to option (b).'\n },\n {\n id:78,\n stem:'Among the following foodstuffs, which one has the highest protein content per 100 g?',\n correct:'Black gram',\n options:['Black gram','Egg','Ragi','Wheat'],\n exp:'Protein content per 100 g (ICMR\/NIN values): Black gram (urad dal) \u2248 24 g, Egg \u2248 13 g, Ragi (finger millet) \u2248 7.3 g, Wheat \u2248 11 g. Black gram (Vigna mungo) is a protein-rich pulse with ~24 g protein per 100 g \u2014 the highest among these options. Pulses\/legumes are generally excellent plant protein sources in the Indian diet. Eggs have high biological value protein (~13 g\/100 g) but lower quantity than black gram. Cereals like wheat and ragi are relatively low in protein.'\n },\n {\n id:79,\n stem:'Smoking is associated with all the following diseases EXCEPT:',\n correct:'Sarcoidosis',\n options:['Emphysema','Cardiovascular disease','Sarcoidosis','Lung cancer'],\n exp:'Smoking is causally linked to: emphysema\/COPD (direct toxic effect on alveoli and airways), cardiovascular disease (atherosclerosis, MI, stroke \u2014 major risk factor), lung cancer (squamous cell and small cell especially), plus bladder cancer, oesophageal cancer, oral cancer, peripheral vascular disease, and peptic ulcer. Sarcoidosis is a granulomatous disease of UNKNOWN aetiology \u2014 interestingly, it is actually LESS common in smokers (inverse association). Smoking is NOT a risk factor for sarcoidosis and the two are not associated. Sarcoidosis is the exception.'\n },\n {\n id:80,\n stem:'Bleaching powder can be used for disinfection of which of the following?\\n1. Skin\\n2. Water\\n3. Faeces\\n4. Urine',\n correct:'2, 3 and 4',\n options:['1 and 2 only','1, 2 and 3','2 and 3 only','2, 3 and 4'],\n exp:'Bleaching powder (calcium hypochlorite, Ca(OCl)\u2082) is used for: Water disinfection (2) \u2014 standard method for well\/water supply disinfection. Faeces disinfection (3) \u2014 covering night soil\/stools in cholera, typhoid (terminal disinfection). Urine disinfection (4) \u2014 disinfecting excreta of patients with enteric fever, cholera. Bleaching powder is NOT used on SKIN (1) \u2014 it is highly irritant, caustic, and damaging to skin and mucous membranes. Skin disinfection uses antiseptics (chlorhexidine, povidone-iodine, alcohol). Answers 2, 3, and 4 are correct.'\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[a[i],a[j]]=[a[j],a[i]];}\n return a;\n }\n const LETTERS=['A','B','C','D'];\n let userAnswers={},answered=0,shuffledOpts={};\n let timerRunning=false,timerRemaining=TIMER_SECS,timerInterval=null,graceInterval=null;\n let quizSubmitted=false;\n\n function fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return String(m).padStart(2,'0')+':'+String(sec).padStart(2,'0');}\n\n function startTimer(){\n if(timerRunning||quizSubmitted)return;\n timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 '+fmtTime(timerRemaining);btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n timerRemaining--;\n const disp=fmtTime(timerRemaining);\n document.getElementById(NS+'-timer-display').textContent=disp;\n btn.textContent='\u23f1 '+disp;\n if(timerRemaining<=300) document.getElementById(NS+'-timer-item').classList.add('warning');\n if(timerRemaining<=0){clearInterval(timerInterval);timerInterval=null;triggerGrace();}\n },1000);\n }\n function stopTimer(){if(timerInterval){clearInterval(timerInterval);timerInterval=null;}timerRunning=false;}\n function triggerGrace(){\n if(quizSubmitted)return;\n let g=GRACE_SECS;\n document.getElementById(NS+'-grace-count').textContent=g;\n document.getElementById(NS+'-grace').classList.add('show');\n graceInterval=setInterval(function(){g--;document.getElementById(NS+'-grace-count').textContent=g;if(g<=0){clearInterval(graceInterval);dismissGrace();showScore();}},1000);\n }\n function dismissGrace(){document.getElementById(NS+'-grace').classList.remove('show');if(graceInterval){clearInterval(graceInterval);graceInterval=null;}}\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n 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id=\"'+NS+'-opts'+q.id+'\">'+\n opts.map(function(o,i){return '<div class=\"cq-opt\" id=\"'+NS+'-o'+q.id+'-'+i+'\" role=\"button\" tabindex=\"0\"><span class=\"cq-opt-letter\">'+LETTERS[i]+'<\/span><span class=\"cq-opt-text\">'+o+'<\/span><\/div>';}).join('')+\n '<\/div><div class=\"cq-explanation\" id=\"'+NS+'-exp'+q.id+'\"><div class=\"cq-exp-label\">Explanation<\/div>'+q.exp+'<\/div>';\n container.appendChild(card);\n opts.forEach(function(_,i){document.getElementById(NS+'-o'+q.id+'-'+i).addEventListener('click',function(){pick(q.id,i);});});\n });\n }\n\n function pick(qid,oi){\n if(userAnswers[qid]!==undefined||quizSubmitted)return;\n const q=QUESTIONS.find(function(x){return x.id===qid;});\n const opts=shuffledOpts[qid];\n const correct=opts[oi]===q.correct;\n userAnswers[qid]=correct?'correct':'wrong';answered++;\n opts.forEach(function(o,i){\n const el=document.getElementById(NS+'-o'+qid+'-'+i);\n if(o===q.correct) el.classList.add('cq-correct','cq-locked');\n else if(i===oi) 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Submitted';\n document.getElementById(NS+'-timer-btn').classList.remove('running');\n const c=Object.values(userAnswers).filter(function(v){return v==='correct';}).length;\n const w=Object.values(userAnswers).filter(function(v){return v==='wrong';}).length;\n const s=TOTAL-answered,net=(c*4)-w;\n const pct=Math.max(0,Math.round((net\/MAX)*100));\n const disp=Math.min(100,Math.max(0,pct));\n document.getElementById(NS+'-ring').style.background='conic-gradient(var(--teal) '+disp+'%,var(--line) 0%)';\n document.getElementById(NS+'-ring-pct').textContent=pct+'%';\n document.getElementById(NS+'-net-line').textContent='Net Score: '+net+' \/ '+MAX;\n const v=pct>=80?'Excellent \u2014 well above the qualifying threshold.':pct>=60?'Good attempt \u2014 consolidate the weaker areas.':pct>=40?'Fair \u2014 systematic revision of these topics is recommended.':'Needs significant revision across these topics.';\n document.getElementById(NS+'-verdict').textContent=v;\n 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Submitting in 10 Submit Now Combined Medical Services Examination 2016Paper II \u00b7 Part B Preventive & Social Medicine \u00b7 Biostatistics \u00b7 Community Health Questions 41 \u2013 80 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba… <\/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-36760","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2016 P2 Part-B - 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\/06\/cms-2016-p2-part-b\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2016 P2 Part-B - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2016 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! 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0.2s;display:flex;align-items:center;gap:6px;}\n#cms16p2b .cq-timer-btn:hover{background:rgba(255,255,255,0.15)}\n#cms16p2b .cq-timer-btn.running{background:rgba(255,255,255,0.2);border-color:var(--white);}\n#cms16p2b .cq-body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms16p2b .cq-card{background:var(--white);border:1px solid var(--line);border-radius:var(--radius);margin:24px 0;overflow:hidden;transition:box-shadow 0.2s;}\n#cms16p2b .cq-card:hover{box-shadow:0 2px 12px rgba(192,96,58,0.1)}\n#cms16p2b .cq-qhead{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start;}\n#cms16p2b .cq-qnum{flex-shrink:0;width:26px;height:26px;border-radius:50%;background:var(--ter);color:#fff;font-size:0.72rem;font-weight:700;display:flex;align-items:center;justify-content:center;margin-top:2px;transition:background 0.2s;}\n#cms16p2b .cq-qnum.ans-c{background:var(--correct-border)}\n#cms16p2b 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.cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white);}\n#cms16p2b .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms16p2b .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms16p2b .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms16p2b .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms16p2b .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms16p2b .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms16p2b .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms16p2b .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms16p2b .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms16p2b .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms16p2b .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms16p2b .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s,color 0.2s;}\n#cms16p2b .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){\n #cms16p2b .cq-header h1{font-size:1.15rem}\n #cms16p2b .cq-qtext{font-size:0.88rem}\n #cms16p2b .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms16p2b\">\n <div class=\"cq-sentinel\" id=\"cms16p2b-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms16p2b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms16p2b-timer-item\">\u23f1 <strong id=\"cms16p2b-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms16p2b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms16p2b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms16p2b-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms16p2b-sn\">0<\/strong> \/ <strong id=\"cms16p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms16p2b-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms16p2b-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms16p2b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms16p2b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2016<br>Paper II \u00b7 Part B<\/h1>\n <p>Preventive & Social Medicine \u00b7 Biostatistics \u00b7 Community Health<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 41 \u2013 80<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms16p2b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms16p2b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms16p2b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms16p2b-score\">\n <div class=\"cq-score-ring\" id=\"cms16p2b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms16p2b-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms16p2b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms16p2b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms16p2b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms16p2b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms16p2b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms16p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms16p2b', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60, GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:41,\n stem:'The two important values necessary for describing the variation in a series of observations are:',\n correct:'Mean and standard deviation',\n options:['Mean and standard deviation','Mean and range','Median and range','Median and standard deviation'],\n exp:'To fully describe a dataset you need a measure of central tendency AND a measure of dispersion. Mean (arithmetic average) describes the centre; Standard Deviation (SD) describes the spread around the mean in normally distributed data. Together they completely characterise a normal distribution (the basis of most parametric statistics). Range (max\u2212min) is a crude measure of spread influenced by outliers. Median + range is used for skewed data, but the classical pair for interval data with normal distribution is mean + SD.'\n },\n {\n id:42,\n stem:'The time period between the entry of an infective agent in a host and the maximal infectivity of that host is:',\n correct:'Generation time',\n options:['Incubation period','Serial interval','Generation time','Period of communicability'],\n exp:'Generation time is the interval from the entry of the infectious agent into a host to the time of maximal infectivity (peak transmissibility) of that host \u2014 i.e., the time to produce the maximum number of infective organisms. Incubation period = entry to first symptoms. Serial interval = time between onset of symptoms in successive cases in a chain. Period of communicability = the entire duration during which the host can transmit infection. Generation time is distinct and specific to the question asked.'\n },\n {\n id:43,\n stem:'Symposium is a method of health education characterised by:\\n1. A series of speeches on a selected topic\\n2. Presentation of different aspects of a topic by 3 or 4 experts\\n3. A discussion among the symposium members\\n4. The chairperson making a comprehensive summary at the end\\n\\nWhich of these statements are correct?',\n correct:'1, 2 and 4',\n options:['2 and 3 only','1, 3 and 4','1, 2 and 4','1, 2 and 3'],\n exp:'A symposium is a formal health education method in which: (1) A series of speeches\/presentations are made on a selected topic \u2014 correct. (2) Three to four experts each present a different aspect of the topic \u2014 correct. (3) There is NO formal discussion among symposium members (that is a panel discussion); the audience may ask questions but members do not debate \u2014 statement 3 is WRONG. (4) The chairperson summarises at the end \u2014 correct. A symposium is one-way communication from experts to audience, unlike a seminar or panel discussion.'\n },\n {\n id:44,\n stem:'Match List I (Major Group of Insecticides) with List II (Name of Insecticide):\\nA. Stomach poison\\nB. Organo-chlorine compound\\nC. Organo-phosphorous compound\\nD. Carbamates\\n\\n1. Temephos\\n2. Propoxur\\n3. Sodium fluoride\\n4. Dieldrin',\n correct:'A-3, B-4, C-1, D-2',\n options:['A-4, B-3, C-1, D-2','A-4, B-3, C-2, D-1','A-3, B-4, C-1, D-2','A-3, B-4, C-2, D-1'],\n exp:'Stomach poison = Sodium fluoride (3) \u2014 ingested by insects during feeding, inhibits metabolic enzymes. Organo-chlorine compound = Dieldrin (4) \u2014 cyclopentadiene organochlorine; others: DDT, BHC, aldrin. Organo-phosphorous compound = Temephos (Abate, 1) \u2014 larvicide used in water bodies for mosquito control; others: malathion, parathion. Carbamate = Propoxur (Baygon, 2) \u2014 inhibits acetylcholinesterase reversibly; others: carbaryl, bendiocarb. All four match correctly: A-3, B-4, C-1, D-2.'\n },\n {\n id:45,\n stem:'Consider the following diseases:\\n1. Rift Valley fever\\n2. Yellow Fever\\n3. Chikungunya fever\\n4. West Nile fever\\n\\nWhich of the above diseases are transmitted by Aedes mosquito?',\n correct:'1, 2 and 3',\n options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],\n exp:'Aedes mosquito-transmitted diseases: Rift Valley fever (Aedes and other mosquitoes, 1), Yellow fever (Aedes aegypti, 2), Chikungunya (Aedes aegypti and Aedes albopictus, 3), Dengue (Aedes aegypti), Zika (Aedes). West Nile fever (4) is primarily transmitted by CULEX mosquitoes (Culex pipiens, Culex quinquefasciatus), not Aedes. Therefore 1, 2 and 3 are Aedes-transmitted, while West Nile fever is Culex-transmitted.'\n },\n {\n id:46,\n stem:'Prophylactic disinfection includes:\\n1. Disinfection of urine specimen of a patient with enteric fever\\n2. Pasteurisation of milk\\n3. Disinfection of contaminated linen\\n4. Disinfection of water by chlorine\\n\\nWhich of these statements are correct?',\n correct:'2 and 4 only',\n options:['1, 2, 3 and 4','2 and 4 only','1, 2 and 4 only','1 and 3 only'],\n exp:'Prophylactic (preventive) disinfection is applied BEFORE infection occurs, to prevent contamination of people\/environment. Examples: pasteurisation of milk (2) \u2014 prevents infection in healthy consumers; chlorination of water (4) \u2014 prevents waterborne disease in the community. Concurrent disinfection (done during the period of communicability) includes disinfection of a patient\\'s excretions like urine in enteric fever (1) and contaminated linen (3) \u2014 these are done WHILE disease is present, not prophylactically. Only 2 and 4 are prophylactic.'\n },\n {\n id:47,\n stem:'Consider the following statements:\\n1. Registration of birth, even if the child is born in a hospital, is essentially the responsibility of parents only.\\n2. At present, the registration of birth has to be done not more than 15 days after the birth.\\n\\nWhich of these statements is\/are correct?',\n correct:'Neither 1 nor 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Under the Registration of Births and Deaths Act, 1969 (India): Statement 1 is WRONG \u2014 for births in hospitals\/health institutions, the medical officer in charge (not the parents) is responsible for registration. Statement 2 is WRONG \u2014 the registration must be done within 21 days (not 15 days) of the birth. Late registration (after 21 days but within 30 days) requires no fine; beyond 30 days requires magistrate permission. Both statements contain incorrect figures\/facts. Answer: neither 1 nor 2 is correct.'\n },\n {\n id:48,\n stem:'Sullivan Index is a measure of which of the following?',\n correct:'Quality of life',\n options:['Disability rate','Pregnancy rate','Literacy rate','Quality of life'],\n exp:'The Sullivan Index (Disability-Free Life Expectancy, DFLE), developed by Daniel Sullivan in 1971, measures the number of years a person can expect to live free of disability \u2014 combining mortality data with morbidity\/disability data into a single composite measure. It is therefore a measure of the QUALITY of life (healthy life expectancy), not merely the quantity (crude life expectancy). It is one of the key health status indicators recommended by WHO and is used in international health comparisons.'\n },\n {\n id:49,\n stem:'The strategy to eradicate poliomyelitis in India comprised of:\\n1. Conducting national immunisation days\\n2. Mopping-up rounds with OPV\\n3. Acute flaccid paralysis surveillance\\n4. Public awareness through multimedia\\n\\nWhich of these statements are correct?',\n correct:'1, 2, 3 and 4',\n options:['1 and 3 only','2 and 4 only','1, 2 and 3 only','1, 2, 3 and 4'],\n exp:'India\\'s Pulse Polio Programme (1995\u20132014, certified polio-free 2014) used a comprehensive four-pronged strategy: (1) National Immunisation Days (NIDs) \u2014 pulse immunisation of all children <5 with OPV simultaneously. (2) Mopping-up rounds \u2014 house-to-house vaccination in high-risk areas after NIDs. (3) AFP (acute flaccid paralysis) surveillance \u2014 identifying suspected polio cases for investigation. (4) Social mobilisation and public awareness through multimedia \u2014 critical to achieve >95% coverage. All four were essential pillars of the eradication strategy.'\n },\n {\n id:50,\n stem:'In the estimation of statistical probability, Z score is applicable to:',\n correct:'Normal distribution',\n options:['Normal distribution','Skewed distribution','Binomial distribution','Poisson distribution'],\n exp:'The Z score (standard normal deviate) is calculated as Z = (X \u2212 \u03bc)\/\u03c3, converting any normally distributed variable into the standard normal distribution (mean=0, SD=1). It is applicable specifically to NORMAL (Gaussian) distribution. Probability estimates using Z scores are based on the area under the normal curve. Skewed distributions require non-parametric methods. Binomial distribution uses its own probability function. Poisson distribution has its own distribution tables. Z scores are only valid when data is normally distributed.'\n },\n {\n id:51,\n stem:'Transovarian transmission is demonstrated in:\\n1. Aedes mosquito\\n2. Flea\\n3. Ticks\\n4. Itch mite\\n\\nSelect the correct answer:',\n correct:'1 and 3',\n options:['1 and 2','2 and 4','1 and 3','3 and 4'],\n exp:'Transovarian (vertical) transmission = pathogen passes from adult female vector to offspring through the eggs. Demonstrated in: Ticks (3) \u2014 most important vectors for transovarian transmission; Rickettsia, Borrelia, tick-borne encephalitis, Crimean-Congo haemorrhagic fever viruses pass transovarially. Aedes mosquito (1) \u2014 dengue and Zika viruses show transovarian transmission in Aedes. Fleas transmit Yersinia pestis and murine typhus but NOT transovarially. Itch mite (Sarcoptes) transmits scabies by direct contact, no transovarian transmission.'\n },\n {\n id:52,\n stem:'The most sensitive indicator of the health status of a community is the:',\n correct:'Infant mortality rate',\n options:['Crude death rate','Maternal mortality rate','Infant mortality rate','Child mortality rate'],\n exp:'Infant Mortality Rate (IMR = deaths under 1 year per 1000 live births) is universally accepted as the SINGLE MOST SENSITIVE indicator of community health status. It reflects: maternal health, antenatal care quality, nutrition, sanitation, access to healthcare, socioeconomic conditions, and immunisation coverage \u2014 all in one number. It is sensitive to changes in living conditions and health services. Maternal mortality rate reflects maternal care specifically. Crude death rate is influenced by age structure. IMR is the gold standard community health indicator.'\n },\n {\n id:53,\n stem:'Chemoprophylaxis is an example of:',\n correct:'Specific protection',\n options:['Specific protection','Health promotion','Early detection','Rehabilitation'],\n exp:'Leavell and Clark\\'s levels of prevention: Primary prevention (before disease) = health promotion + specific protection. Chemoprophylaxis (e.g., antimalarial drugs, isoniazid for TB contacts, rifampicin for meningococcal contacts) is a specific protective measure against a specific pathogen \u2014 it falls under SPECIFIC PROTECTION (primary prevention). Health promotion is non-specific (nutrition, sanitation, education). Early detection = secondary prevention. Rehabilitation = tertiary prevention. Chemoprophylaxis = specific protection.'\n },\n {\n id:54,\n stem:'A rapid mass screening method that can be employed by a paramedical worker for detecting malnutrition in pre-school (age 1 to 5 years) children is:',\n correct:'Mid-arm circumference',\n options:['Weight for age','Height for age','Mid-arm circumference','Body Mass Index'],\n exp:'Mid-upper arm circumference (MUAC) is the ideal screening tool for malnutrition in pre-school children by paramedical workers because: it requires only a simple tape measure (no scale needed), is quick and easy to perform, correlates well with nutritional status, and the \"traffic light\" colour-coded MUAC tape (red <11.5 cm = SAM, yellow 11.5\u201312.5 cm = MAM, green >12.5 cm = normal) needs no calculation. Weight-for-age requires accurate weighing. Height-for-age requires a stadiometer and calculation. BMI is impractical in field settings for children.'\n },\n {\n id:55,\n stem:'The most important single determinant of infant mortality is:',\n correct:'Birth weight',\n options:['Birth weight','Age of the mother','Order of birth','Interval between births'],\n exp:'Birth weight is the single most important determinant of infant survival and mortality. Low birth weight (<2500 g) is associated with substantially higher risks of neonatal death, infections, hypothermia, hypoglycaemia, and long-term developmental problems. The WHO estimates that LBW babies are 20\u00d7 more likely to die than normal-weight babies. Birth weight integrates the effects of gestational age, maternal nutrition, placental function, and intrauterine environment. All other listed factors (maternal age, birth order, inter-birth interval) are secondary determinants.'\n },\n {\n id:56,\n stem:'The immunoglobulins that can be transported across the placenta include:',\n correct:'IgG only',\n options:['IgG only','IgA only','Both IgG and IgA','Neither IgG nor IgA'],\n exp:'IgG is the ONLY immunoglobulin class that crosses the placenta, transported by the neonatal Fc receptor (FcRn) via active transcytosis. This provides the neonate with passive humoral immunity for the first 3\u20136 months of life. IgA does NOT cross the placenta; it is provided to the neonate via breast milk (especially colostrum). IgM, IgE, and IgD do not cross the placenta. Therefore, only IgG is transported transplacentally \u2014 maternal IgG antibodies against measles, rubella, tetanus etc. protect the newborn.'\n },\n {\n id:57,\n stem:'Consider the following statements:\\n1. The duration of immunity is longer when a live vaccine is administered compared to a killed vaccine.\\n2. In the case of killed vaccine, a single dose is sufficient, whereas multiple doses are always required for live vaccines.\\n\\nWhich of these statements is\/are correct?',\n correct:'1 only',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Statement 1 is CORRECT: Live attenuated vaccines (measles, BCG, yellow fever, OPV) stimulate all arms of immunity (cellular, humoral, mucosal) and produce a response mimicking natural infection \u2014 typically producing lifelong immunity after one or two doses. Killed\/inactivated vaccines generally produce shorter-duration immunity requiring boosters. Statement 2 is WRONG: It is the KILLED vaccines that typically require multiple doses (e.g., IPV \u00d7 3, DPT \u00d7 3) not live vaccines. Most live vaccines require only 1\u20132 doses. Statement 2 has the relationship reversed.'\n },\n {\n id:58,\n stem:'Match List I (Disease) with List II (Incubation Period):\\nA. Measles\\nB. Diphtheria\\nC. Hepatitis A\\nD. Hepatitis B\\n\\n1. 6 weeks to 6 months\\n2. 15 to 50 days\\n3. 10 to 14 days\\n4. 2 to 6 days',\n correct:'A-3, B-4, C-2, D-1',\n options:['A-3, B-4, C-1, D-2','A-4, B-3, C-2, D-1','A-4, B-3, C-1, D-2','A-3, B-4, C-2, D-1'],\n exp:'Measles = 10\u201314 days (A=3). Diphtheria = 2\u20136 days (B=4). Hepatitis A = 15\u201350 days (average 28\u201330 days) (C=2). Hepatitis B = 6 weeks to 6 months (average 60\u201390 days) (D=1). These are standard incubation period ranges from Park\\'s Textbook of Preventive and Social Medicine. Hepatitis B has the longest incubation period among common vaccine-preventable diseases due to the slow replication cycle of HBV and the long time required for hepatocyte injury to become symptomatic.'\n },\n {\n id:59,\n stem:'Throat swab positive and Schick test negative indicate that the person is:',\n correct:'Immune to diphtheria',\n options:['Suffering from diphtheria','Susceptible to diphtheria','Hypersensitive to diphtheria','Immune to diphtheria'],\n exp:'Schick test interpretation: Schick test POSITIVE = susceptible (no antitoxin), Schick test NEGATIVE = immune (has protective antitoxin \u22650.03 IU\/mL). Throat swab POSITIVE = Corynebacterium diphtheriae is present (colonised\/carrier). Combining both: throat swab positive (carrier of C. diphtheriae) + Schick test negative (immune, has antitoxin) = CARRIER STATE \u2014 the person is IMMUNE to diphtheria clinically but carries and can transmit the organism. For examination purposes, this combination indicates IMMUNITY to clinical diphtheria despite carriage.'\n },\n {\n id:60,\n stem:'The following are manifestations of psychosis EXCEPT:',\n correct:'Psychoneurosis',\n options:['Psychoneurosis','Schizophrenia','Manic depressive psychosis','Paranoia'],\n exp:'Psychosis = loss of contact with reality, featuring hallucinations, delusions, and disorganised thought. Manifestations: schizophrenia, manic-depressive psychosis (bipolar disorder with psychotic features), and paranoia (delusional disorder). Psychoneurosis (neurosis) is distinctly DIFFERENT \u2014 it involves anxiety, phobias, obsessions, and conversion disorders WITHOUT loss of reality testing. The patient is aware their thoughts\/behaviours are abnormal. Neuroses do not involve psychotic features. Psychoneurosis is therefore NOT a manifestation of psychosis.'\n },\n {\n id:61,\n stem:'Effectiveness measures the extent to which predetermined objectives are achieved. Efficiency measures how well resources are utilised.\\n\\nWhich of the following assertions are true?\\n1. Percentage of bed occupancy measures effectiveness\\n2. Immunisation coverage rate measures efficiency\\n3. Cost per patient treated measures efficiency\\n4. Reduction in mortality measures effectiveness\\n\\nSelect the correct answer:',\n correct:'3 and 4 only',\n options:['1 and 2','2 and 3 only','3 and 4 only','2, 3 and 4'],\n exp:'Effectiveness = achieving objectives (outcome measures). Efficiency = output per unit input (resource utilisation). (1) Bed occupancy = how well a resource (beds) is being used = EFFICIENCY, not effectiveness. (2) Immunisation coverage rate = the proportion of the target population immunised = EFFECTIVENESS (objective: cover all children). (3) Cost per patient treated = resource input per unit output = EFFICIENCY \u2014 correct. (4) Reduction in mortality = achieving the health objective = EFFECTIVENESS \u2014 correct. So 3 (efficiency) and 4 (effectiveness) are both correctly assigned. Only option (c) is internally consistent.'\n },\n {\n id:62,\n stem:'With reference to the Revised National Tuberculosis Control Programme, consider the following statements:\\n1. Active case finding is pursued under this Programme.\\n2. Microscopy centres are established for every one lakh population and in hilly\/tribal areas for every 50,000 population.\\n\\nWhich of these statements is\/are correct?',\n correct:'2 only',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Statement 1 is FALSE: RNTCP (now NTEP) follows PASSIVE case finding \u2014 patients who self-report with symptoms to health facilities are diagnosed. Active case finding (screening asymptomatic populations) is NOT the standard RNTCP strategy, though targeted active case finding in high-risk groups has been introduced under NTEP. Statement 2 is CORRECT: RNTCP established Designated Microscopy Centres (DMC) at the rate of 1 per 1,00,000 population in plains, and 1 per 50,000 in hilly, tribal, and difficult terrains to ensure access to sputum microscopy. Only statement 2 is correct.'\n },\n {\n id:63,\n stem:'Which one of the following correctly describes \\'Neonatal Tetanus Elimination\\' status?',\n correct:'Incidence rate less than 0.1\/1000 births, two doses of TT vaccine coverage more than 90%, attended deliveries more than 75%',\n options:[\n 'Incidence rate more than 2\/1000 births, TT vaccine coverage less than 70%, attended deliveries 60\u201370%',\n 'Incidence rate 1\u20132\/1000 births, three doses TT coverage 70%, attended deliveries more than 75%',\n 'Incidence rate 0.5\u20131\/1000 births, three doses TT coverage 70\u201380%, attended deliveries 65\u201370%',\n 'Incidence rate less than 0.1\/1000 births, two doses of TT vaccine coverage more than 90%, attended deliveries more than 75%'\n ],\n exp:'WHO defines Neonatal Tetanus Elimination (NTE) as reducing NNT to <1 case per 1,000 live births in every district. The district is classified as having achieved NTE when: NNT incidence <0.1\/1000 live births (some sources say <1\/1000 at district level), TT2+ coverage \u226590% in pregnant women, and \u226570\u201375% of deliveries attended by skilled birth attendants. Option (d) with NNT <0.1\/1000, TT coverage >90%, and attended deliveries >75% best describes the elimination criteria.'\n },\n {\n id:64,\n stem:'Influenza vaccine is recommended for:\\n1. Elderly\\n2. Persons with underlying chronic diseases\\n3. HIV infected\\n4. General population\\n\\nSelect the correct answer:',\n correct:'1, 2 and 3',\n options:['1 and 2 only','4','2 and 3 only','1, 2 and 3'],\n exp:'Annual influenza vaccination is recommended for high-risk groups: (1) Elderly (\u226565 years) \u2014 impaired immune response and higher complication risk. (2) Persons with chronic diseases \u2014 diabetes, chronic cardiac\/pulmonary\/renal disease, immunosuppression. (3) HIV-infected persons \u2014 immune compromise increases severity risk. Also: healthcare workers, pregnant women, and residents of long-term care facilities. Routine annual vaccination of the GENERAL POPULATION (4) as a universal strategy is recommended in some high-income countries but is NOT the standard recommendation in the Indian\/UPSC CMS context. Options 1, 2, and 3 are correct.'\n },\n {\n id:65,\n stem:'With reference to mumps, consider the following statements:\\n1. The average age of incidence of mumps is higher than that of measles and chicken pox.\\n2. The mumps disease tends to be more severe in adults than in children.\\n\\nWhich of the statements given above is\/are correct?',\n correct:'Both 1 and 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Both statements are correct. (1) Mumps typically affects older children (5\u201314 years) and young adults, while measles and chickenpox commonly affect younger children (2\u20135 years). The higher maternal antibody waning and different contact patterns explain this. (2) Mumps in adults is significantly more severe \u2014 orchitis (20\u201330% of post-pubertal males), oophoritis, pancreatitis, aseptic meningitis, encephalitis, and nerve deafness are more common in adults. Children usually have mild parotitis with full recovery. Both statements are therefore correct.'\n },\n {\n id:66,\n stem:'Consider the following statements about content\/yield of 100 g of some foodstuffs:\\n1. Fat content of Bengal gram is less than that of maize\\n2. Protein content of maize is more than that of rice\\n3. Calorie yield of fish and egg is the same\\n\\nWhich of the statements given above is\/are correct?',\n correct:'2 only',\n options:['1 only','2 only','1 and 2','2 and 3'],\n exp:'Using Nutritive Value of Indian Foods (ICMR\/NIN): Bengal gram (chana) contains ~5.6 g fat\/100 g; maize contains ~3.6 g fat\/100 g \u2014 Bengal gram has MORE fat than maize, so statement 1 is WRONG. Protein: maize ~8.8 g\/100 g; rice ~6.8 g\/100 g \u2014 maize has MORE protein than rice, so statement 2 is CORRECT. Calories: fish ~100\u2013105 kcal\/100 g; egg ~173 kcal\/100 g \u2014 NOT the same, so statement 3 is WRONG. Only statement 2 is correct.'\n },\n {\n id:67,\n stem:'Consider the following statements:\\n1. Protein content of soyabean is more than that of meat (per 100 g)\\n2. Fat content of fish is more than that of soyabean (per 100 g)\\n3. Calorie yield for each 100 g of fish is almost the same as for 100 g of banana\\n4. Fat content of soyabean is more than that of eggs (per 100 g)\\n\\nWhich of the above statements are correct?',\n correct:'1 and 4 only',\n options:['1 and 2','1 and 4 only','2 and 3','1, 3 and 4'],\n exp:'Using ICMR nutritive values: Soyabean protein ~43 g\/100 g vs meat ~22 g\/100 g \u2192 soyabean has MORE protein than meat (1 = CORRECT). Fat: fish ~2.5\u20135 g\/100 g vs soyabean ~19.5 g\/100 g \u2192 fish has LESS fat than soyabean (2 = WRONG). Calories: fish ~100 kcal\/100 g vs banana ~116 kcal\/100 g \u2192 similar but not \"almost same\" in most tables (3 = borderline, generally considered wrong). Soyabean fat ~19.5 g\/100 g vs eggs ~13.3 g\/100 g \u2192 soyabean has MORE fat than eggs (4 = CORRECT). Statements 1 and 4 are correct.'\n },\n {\n id:68,\n stem:'Features of food poisoning: incubation period less than 24 hours, source of infection is milk products, symptoms include diarrhoea and vomiting.\\n\\nTo which of the following does the above description apply?\\n1. Staphylococcal food poisoning\\n2. Salmonella food poisoning\\n3. Botulism\\n\\nSelect the correct answer:',\n correct:'1 only',\n options:['1 only','1 and 2','1 and 3','2 only'],\n exp:'Staphylococcal food poisoning (1) fits exactly: incubation 1\u20136 hours (well under 24 hours, shortest of all food poisonings), source includes cream-filled pastries, custards, and dairy\/milk products contaminated by food handlers, symptoms are predominantly vomiting then diarrhoea (enterotoxin-mediated). Salmonella (2) has incubation 12\u201336 hours (>24 h) and source is eggs, poultry, meat \u2014 not specifically milk products. Botulism (3) has incubation 12\u201336 hours and causes neurological symptoms (descending paralysis), not primarily diarrhoea\/vomiting. Only (1) matches all three criteria.'\n },\n {\n id:69,\n stem:'For adolescents, what is the weekly iron and folic acid supplementation dose?',\n correct:'Weekly: 60 mg elemental iron and 400 \u00b5g folic acid',\n options:['Weekly: 60 mg elemental iron and 400 \u00b5g folic acid','Weekly: 100 mg elemental iron and 500 \u00b5g folic acid','Weekly: 120 mg elemental iron and 400 \u00b5g folic acid','Weekly: 150 mg elemental iron and 500 \u00b5g folic acid'],\n exp:'Under India\\'s Weekly Iron and Folic Acid Supplementation (WIFS) programme for adolescents (10\u201319 years), the dose is: 60 mg elemental iron + 400 \u00b5g (0.4 mg) folic acid, given once weekly throughout the year. For pregnant women, the daily dose is 100 mg iron + 500 \u00b5g folic acid. The WIFS programme targets anaemia prevention in adolescent girls and boys through schools and Anganwadis. The 60 mg weekly dose is the WHO-recommended adolescent supplementation schedule.'\n },\n {\n id:70,\n stem:'Which of the following statements is\/are true about the proportional case rate of malaria?\\n1. This indicator is used since morbidity rate is difficult to determine\\n2. This is defined as the number of cases of malaria for every 100 patients seen in hospital OPDs\\n3. It is a crude index since cases are not related to their time and space distribution\\n\\nSelect the correct answer:',\n correct:'1, 2 and 3',\n options:['2 only','2 and 3 only','3 only','1, 2 and 3'],\n exp:'All three statements about the Proportional Case Rate (PCR) of malaria are correct: (1) True morbidity rates require population denominators which are difficult to obtain in malaria-endemic areas; PCR uses health facility data as a proxy. (2) PCR = (Number of malaria cases \/ Total OPD patients) \u00d7 100 \u2014 this is the standard definition. (3) PCR is a crude index because it does not account for seasonal variation (time), geographic clustering (space), or healthcare-seeking behaviour differences. All three statements accurately describe the nature and limitations of PCR.'\n },\n {\n id:71,\n stem:'Consider the following statements:\\n1. Type 2 poliovirus was eliminated in India in 2005.\\n2. Main cause of vaccine-derived polioviruses (VDPV) is the Type 2 component of OPV.\\n\\nWhich of the statements given above is\/are correct?',\n correct:'Both 1 and 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Both statements are correct. (1) Wild poliovirus Type 2 was globally eradicated in 1999 and India certified Type 2 eliminated by 2005 (no wild Type 2 circulation). (2) The Type 2 component of trivalent OPV (tOPV) has the highest rate of reversion to virulence and is responsible for the majority of circulating vaccine-derived poliovirus (cVDPV) outbreaks worldwide. This was the rationale for the global switch from tOPV to bivalent OPV (bOPV, types 1+3) and introduction of at least one IPV dose \u2014 the \"switch\" completed globally in 2016. Both statements are correct.'\n },\n {\n id:72,\n stem:'Which of the following statements is true about hydatid disease?',\n correct:'It is a zoonosis',\n options:['It is a zoonosis','It is rare in sheep-rearing countries','It is a protozoal disease','Man is the definitive host'],\n exp:'Hydatid disease (cystic echinococcosis) is caused by the larval stage of Echinococcus granulosus, a cestode (tapeworm). (1) It is a ZOONOSIS \u2014 transmitted between animals (dogs as definitive host, sheep\/cattle as intermediate hosts) and humans (accidental intermediate host). (2) It is COMMON in sheep-rearing countries (Australia, New Zealand, Mediterranean, Middle East, India) \u2014 not rare. (3) It is a HELMINTHIC (cestode) disease, not protozoal. (4) The DEFINITIVE host is the dog (adult tapeworm in intestine); man is the INTERMEDIATE (accidental) host. Only statement (a) is correct.'\n },\n {\n id:73,\n stem:'Which of the following statements is true about direct age standardisation?',\n correct:'A standard population is used',\n options:['Standardised mortality ratio is used','A standard population is used','Age-specific death rates are not known','Number of people in each age group is not known'],\n exp:'In direct age standardisation, a STANDARD (reference) population is used \u2014 the age-specific death rates of the study population are applied to the standard population\\'s age distribution to calculate an \"expected\" death count, yielding the standardised rate. This allows valid comparison between populations with different age structures. Indirect standardisation (used when age-specific rates are unknown) uses the Standardised Mortality Ratio (SMR). Direct standardisation requires known age-specific death rates. Indirect requires only total observed deaths and the age structure of the study population.'\n },\n {\n id:74,\n stem:'Match List I (Disease type) with List II (Example):\\nA. Nosocomial\\nB. Opportunistic\\nC. Iatrogenic\\nD. Epornithic\\n\\n1. Cytomegaloviral infection\\n2. Hepatitis B viral infection\\n3. Aplastic anaemia\\n4. Influenza',\n correct:'A-2, B-1, C-3, D-4',\n options:['A-2, B-1, C-3, D-4','A-2, B-1, C-4, D-3','A-1, B-2, C-4, D-3','A-1, B-2, C-3, D-4'],\n exp:'Nosocomial (hospital-acquired) = Hepatitis B (2) \u2014 acquired through contaminated blood\/needles in healthcare settings. Opportunistic = CMV infection (1) \u2014 occurs in immunocompromised hosts (AIDS, transplant) where CMV exploits the immune deficiency. Iatrogenic (caused by medical treatment) = Aplastic anaemia (3) \u2014 can result from chloramphenicol, chemotherapy, or radiation therapy. Epornithic (epidemic among birds) = Influenza (4) \u2014 avian influenza outbreaks are classic epornithics (epizootic in birds).'\n },\n {\n id:75,\n stem:'With reference to the International Certificate of Vaccination for Yellow Fever, the validity of the certificate begins how many days after the vaccination?',\n correct:'10 days',\n options:['5 days','10 days','14 days','20 days'],\n exp:'The International Certificate of Vaccination or Prophylaxis (ICVP) for Yellow Fever becomes valid 10 days after primary vaccination (to allow time for full immunity to develop). Once valid, it is now considered to provide LIFELONG protection (WHO revised this in 2014, removing the previous 10-year re-vaccination requirement). The certificate is required for travellers entering countries in the yellow fever zone (sub-Saharan Africa, tropical South America) or coming from endemic areas. The 10-day gap is the internationally agreed standard.'\n },\n {\n id:76,\n stem:'With reference to dengue virus, consider the following statements:\\n1. In India, all four serotypes are found.\\n2. The reservoir of infection is both man and mosquito.\\n3. Adults usually have a milder disease than children.\\n4. Dengue haemorrhagic fever is caused by infection with more than one dengue virus.\\n\\nWhich of the statements given above is\/are correct?',\n correct:'1, 2 and 4',\n options:['1 and 2 only','1, 2 and 4','4 only','2, 3 and 4'],\n exp:'(1) All four dengue serotypes (DENV-1, 2, 3, 4) circulate in India \u2014 CORRECT. (2) Man is the amplifying host and Aedes mosquito is both the vector and a reservoir (via transovarian transmission) \u2014 CORRECT. (3) WRONG \u2014 DHF\/DSS is actually more common and severe in CHILDREN; adults tend to have classical dengue fever. (4) DHF (dengue haemorrhagic fever) is caused by secondary infection with a DIFFERENT serotype \u2014 antibody-dependent enhancement leads to increased viral replication and immune activation \u2014 CORRECT. Statements 1, 2, and 4 are correct.'\n },\n {\n id:77,\n stem:'What is the window period for HIV infection?',\n correct:'6 \u2013 24 weeks',\n options:['3 \u2013 15 days','6 \u2013 24 weeks','6 \u2013 8 months','None of these'],\n exp:'The HIV window period is the time from infection to when the test becomes reliably positive. For standard antibody tests (ELISA\/Western blot), the window period is approximately 3 weeks to 3 months (most commonly cited as 6\u201312 weeks). With 4th-generation combination Ag\/Ab tests, the window is shorter (~18 days to 6 weeks). The traditional teaching answer for the HIV window period in Indian exam context is 6 weeks to 6 months, with the commonly tested answer being 6\u201324 weeks (approximately 1.5\u20136 months). This corresponds to option (b).'\n },\n {\n id:78,\n stem:'Among the following foodstuffs, which one has the highest protein content per 100 g?',\n correct:'Black gram',\n options:['Black gram','Egg','Ragi','Wheat'],\n exp:'Protein content per 100 g (ICMR\/NIN values): Black gram (urad dal) \u2248 24 g, Egg \u2248 13 g, Ragi (finger millet) \u2248 7.3 g, Wheat \u2248 11 g. Black gram (Vigna mungo) is a protein-rich pulse with ~24 g protein per 100 g \u2014 the highest among these options. Pulses\/legumes are generally excellent plant protein sources in the Indian diet. Eggs have high biological value protein (~13 g\/100 g) but lower quantity than black gram. Cereals like wheat and ragi are relatively low in protein.'\n },\n {\n id:79,\n stem:'Smoking is associated with all the following diseases EXCEPT:',\n correct:'Sarcoidosis',\n options:['Emphysema','Cardiovascular disease','Sarcoidosis','Lung cancer'],\n exp:'Smoking is causally linked to: emphysema\/COPD (direct toxic effect on alveoli and airways), cardiovascular disease (atherosclerosis, MI, stroke \u2014 major risk factor), lung cancer (squamous cell and small cell especially), plus bladder cancer, oesophageal cancer, oral cancer, peripheral vascular disease, and peptic ulcer. Sarcoidosis is a granulomatous disease of UNKNOWN aetiology \u2014 interestingly, it is actually LESS common in smokers (inverse association). Smoking is NOT a risk factor for sarcoidosis and the two are not associated. Sarcoidosis is the exception.'\n },\n {\n id:80,\n stem:'Bleaching powder can be used for disinfection of which of the following?\\n1. Skin\\n2. Water\\n3. Faeces\\n4. Urine',\n correct:'2, 3 and 4',\n options:['1 and 2 only','1, 2 and 3','2 and 3 only','2, 3 and 4'],\n exp:'Bleaching powder (calcium hypochlorite, Ca(OCl)\u2082) is used for: Water disinfection (2) \u2014 standard method for well\/water supply disinfection. Faeces disinfection (3) \u2014 covering night soil\/stools in cholera, typhoid (terminal disinfection). Urine disinfection (4) \u2014 disinfecting excreta of patients with enteric fever, cholera. Bleaching powder is NOT used on SKIN (1) \u2014 it is highly irritant, caustic, and damaging to skin and mucous membranes. Skin disinfection uses antiseptics (chlorhexidine, povidone-iodine, alcohol). Answers 2, 3, and 4 are correct.'\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[a[i],a[j]]=[a[j],a[i]];}\n return a;\n }\n const LETTERS=['A','B','C','D'];\n let userAnswers={},answered=0,shuffledOpts={};\n let timerRunning=false,timerRemaining=TIMER_SECS,timerInterval=null,graceInterval=null;\n let quizSubmitted=false;\n\n function fmtTime(s){const m=Math.floor(s\/60),sec=s%60;return String(m).padStart(2,'0')+':'+String(sec).padStart(2,'0');}\n\n function startTimer(){\n if(timerRunning||quizSubmitted)return;\n timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 '+fmtTime(timerRemaining);btn.classList.add('running');\n document.getElementById(NS+'-timer-item').classList.add('active');\n timerInterval=setInterval(function(){\n timerRemaining--;\n const disp=fmtTime(timerRemaining);\n document.getElementById(NS+'-timer-display').textContent=disp;\n btn.textContent='\u23f1 '+disp;\n if(timerRemaining<=300) document.getElementById(NS+'-timer-item').classList.add('warning');\n if(timerRemaining<=0){clearInterval(timerInterval);timerInterval=null;triggerGrace();}\n },1000);\n }\n function stopTimer(){if(timerInterval){clearInterval(timerInterval);timerInterval=null;}timerRunning=false;}\n function triggerGrace(){\n if(quizSubmitted)return;\n let g=GRACE_SECS;\n document.getElementById(NS+'-grace-count').textContent=g;\n document.getElementById(NS+'-grace').classList.add('show');\n graceInterval=setInterval(function(){g--;document.getElementById(NS+'-grace-count').textContent=g;if(g<=0){clearInterval(graceInterval);dismissGrace();showScore();}},1000);\n }\n function dismissGrace(){document.getElementById(NS+'-grace').classList.remove('show');if(graceInterval){clearInterval(graceInterval);graceInterval=null;}}\n\n function build(){\n const container=document.getElementById(NS+'-questions');\n container.innerHTML='';userAnswers={};answered=0;shuffledOpts={};\n quizSubmitted=false;timerRunning=false;timerRemaining=TIMER_SECS;\n stopTimer();if(graceInterval){clearInterval(graceInterval);graceInterval=null;}dismissGrace();\n document.getElementById(NS+'-score').style.display='none';\n document.getElementById(NS+'-timer-item').classList.remove('active','warning');\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 Start Timed Mode';btn.classList.remove('running');\n document.getElementById(NS+'-timer-display').textContent=fmtTime(TIMER_SECS);\n updateStats();\n QUESTIONS.forEach(function(q){\n const opts=shuffle(q.options);shuffledOpts[q.id]=opts;\n const card=document.createElement('div');card.className='cq-card';\n card.innerHTML=\n '<div class=\"cq-qhead\"><div class=\"cq-qnum\" id=\"'+NS+'-n'+q.id+'\">'+q.id+'<\/div>'+\n '<div class=\"cq-qtext\">'+q.stem.replace(\/\\n\/g,'<br>')+'<\/div><\/div>'+\n '<div class=\"cq-options\" id=\"'+NS+'-opts'+q.id+'\">'+\n opts.map(function(o,i){return '<div class=\"cq-opt\" id=\"'+NS+'-o'+q.id+'-'+i+'\" role=\"button\" tabindex=\"0\"><span class=\"cq-opt-letter\">'+LETTERS[i]+'<\/span><span class=\"cq-opt-text\">'+o+'<\/span><\/div>';}).join('')+\n '<\/div><div class=\"cq-explanation\" id=\"'+NS+'-exp'+q.id+'\"><div class=\"cq-exp-label\">Explanation<\/div>'+q.exp+'<\/div>';\n container.appendChild(card);\n opts.forEach(function(_,i){document.getElementById(NS+'-o'+q.id+'-'+i).addEventListener('click',function(){pick(q.id,i);});});\n });\n }\n\n function pick(qid,oi){\n if(userAnswers[qid]!==undefined||quizSubmitted)return;\n const q=QUESTIONS.find(function(x){return x.id===qid;});\n const opts=shuffledOpts[qid];\n const correct=opts[oi]===q.correct;\n userAnswers[qid]=correct?'correct':'wrong';answered++;\n opts.forEach(function(o,i){\n const el=document.getElementById(NS+'-o'+qid+'-'+i);\n if(o===q.correct) el.classList.add('cq-correct','cq-locked');\n else if(i===oi) 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