CMS 2017 Paper II \u2013 Part C (Q81\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#cms17p2c *,#cms17p2c *::before,#cms17p2c *::after{box-sizing:border-box;margin:0;padding:0}\n#cms17p2c{--ter:#C0603A;--ter-pale:#fdf1ec;--teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;--ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;--line:#e0d8d4;--bg:#fdfaf8;--white:#ffffff;--correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;--wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;--radius:10px;font-family:'Source Serif 4',Georgia,serif;font-size:16px;color:var(--ink);background:var(--bg);line-height:1.7;padding:0 0 48px}\n#cms17p2c .cq-sentinel{height:1px}\n#cms17p2c .cq-statusbar{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px solid 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.cq-qtext{font-size:.88rem}#cms17p2c .cq-opt-text{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms17p2c\">\n<div class=\"cq-sentinel\" id=\"cms17p2c-sentinel\"><\/div>\n<div class=\"cq-statusbar\" id=\"cms17p2c-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms17p2c-timer-item\">⏳ <strong id=\"cms17p2c-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">✅ <strong id=\"cms17p2c-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">❌ <strong id=\"cms17p2c-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">⏳ <strong id=\"cms17p2c-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms17p2c-sn\">0<\/strong> \/ <strong id=\"cms17p2c-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms17p2c-fill\"><\/div><\/div>\n<\/div>\n<div class=\"cq-grace\" id=\"cms17p2c-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms17p2c-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms17p2c-grace-now\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2017<br>Paper II · Part C<\/h1>\n <p>Preventive & Social Medicine · Biostatistics · Epidemiology · Immunisation<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 81 – 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms17p2c-timer-btn\">⏳ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"cq-body\">\n <div id=\"cms17p2c-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms17p2c-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms17p2c-score\">\n <div class=\"cq-score-ring\" id=\"cms17p2c-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms17p2c-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=\"cms17p2c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms17p2c-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms17p2c-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms17p2c-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms17p2c-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms17p2c-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms17p2c',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\nvar Q=[\n{id:81,s:'Which is\/are the measure(s) of dispersion?\\n1. Mode\\n2. Median\\n3. Standard Deviation',a:'3 only',o:['1 and 2 only','3 only','2 and 3 only','1, 2 and 3'],e:'Mode and Median are measures of CENTRAL TENDENCY. Standard Deviation (SD) is a measure of DISPERSION \u2014 it describes spread around the mean. Range, IQR, variance, and SD are all measures of dispersion. Only statement 3 is correct.'},\n{id:82,s:'Which among the following is\/are examples of primordial prevention?\\n1. Adopting healthy lifestyles from childhood\\n2. Immunisation of infants\\n3. Screening of cervical cancer',a:'1 only',o:['1 only','1 and 2 only','1 and 3 only','1, 2 and 3'],e:'Primordial prevention prevents emergence of risk factors before they develop. Adopting healthy lifestyles from childhood (1) = correct. Immunisation (2) = specific protection = primary prevention. Cancer screening (3) = early diagnosis = secondary prevention. Only statement 1 qualifies as primordial prevention.'},\n{id:83,s:'The appropriate statistical test to find out obesity as a significant risk factor for breast cancer is:',a:'Chi-square test',o:[\"Student's paired t-test\",\"Student's unpaired t-test\",'Chi-square test',\"Wilcoxon's signed rank test\"],e:'Obesity (yes\/no) and breast cancer (present\/absent) are both CATEGORICAL variables. The CHI-SQUARE TEST is used to test association between two categorical variables \u2014 the standard test for 2x2 contingency tables in case-control and cross-sectional studies.'},\n{id:84,s:'In a case-control study, confounding factors can be minimised by the following EXCEPT:',a:'Increasing sample size for cases and controls',o:['Matching of variables such as age and sex','Randomisation during selection','Stratification during analysis','Increasing sample size for cases and controls'],e:'Methods to control confounding: matching, randomisation, stratified analysis (Mantel-Haenszel), multivariate regression. INCREASING SAMPLE SIZE increases statistical power but does NOT reduce confounding \u2014 a larger biased study is still biased. Sample size is not a method of confounding control.'},\n{id:85,s:'Which one of the following is FALSE regarding confounding factor in epidemiological studies?',a:'Distributed equally between study and control groups',o:['Associated both with exposure and disease','Distributed equally between study and control groups','Independent risk factor for disease in question','Source of bias in interpretation'],e:'A confounder must be associated with both exposure and disease, be an independent risk factor, and be unequally distributed between groups (creating the confounding). \"Distributed equally\" is FALSE \u2014 if equal distribution existed, there would be no confounding. Equal distribution is the desired outcome AFTER controlling for confounding.'},\n{id:86,s:'Denominator in calculation of case fatality rate is:',a:'Total number of cases due to the disease concerned',o:['Total number of deaths due to all causes','Total number of hospital admissions','Total number of cases due to the disease concerned','Total number of deaths due to the disease concerned'],e:'Case Fatality Rate = (Deaths from specific disease \/ Total CASES of that disease) x 100. The denominator is total number of CASES \u2014 patients diagnosed with the disease. CFR measures killing power\/severity of a disease.'},\n{id:87,s:'A well of contaminated water resulting in an epidemic of acute watery diarrhoea is a typical example for:',a:'Common source, continuous exposure epidemic',o:['Common source, single exposure epidemic','Common source, continuous exposure epidemic','Slow epidemic','Propagated epidemic'],e:'A contaminated well provides continuous ongoing exposure \u2014 COMMON SOURCE, CONTINUOUS EXPOSURE epidemic. The epidemic curve shows a prolonged plateau. Point source = single exposure event. Propagated = person-to-person spread. The well is used continuously = continuous common source.'},\n{id:88,s:'An important measure of communicability of a disease is:',a:'Secondary attack rate',o:['Incidence rate','Case fatality rate','Prevalence rate','Secondary attack rate'],e:'Secondary Attack Rate (SAR) = new cases among contacts \/ total susceptible contacts x 100. SAR directly quantifies how readily disease spreads from an index case \u2014 the primary measure of COMMUNICABILITY. CFR measures lethality. Incidence measures new cases in general population. SAR = communicability.'},\n{id:89,s:'Which of the following statements is NOT correct regarding case fatality rate?',a:'Very useful indicator for both acute and chronic diseases',o:['Very useful indicator for both acute and chronic diseases','One of the measures related to virulence','It is the ratio of deaths to cases expressed as percentage','Variation can occur for the same disease because of changes in the agent factors'],e:'CFR is most useful for ACUTE infectious diseases where the time relationship between diagnosis and death is clear. For CHRONIC diseases, CFR is less meaningful because prolonged timeframes and competing causes complicate attribution. \"Very useful for both acute AND chronic diseases\" is FALSE.'},\n{id:90,s:\"Farmer's lung is caused by the inhalation of:\",a:'Grain dust with actinomycetes',o:['Grain dust with actinomycetes','Sugarcane dust','Silica dust','Cotton fibre dust'],e:\"Farmer's lung = hypersensitivity pneumonitis from inhalation of thermophilic ACTINOMYCETES (Saccharopolyspora rectivirgula) in mouldy hay\/grain. Bagassosis = sugarcane dust. Silicosis = silica. Byssinosis = cotton fibre. Grain dust + actinomycetes = Farmer's lung.\"},\n{id:91,s:'Suraksha Clinics are conducted under the aegis of which National Health Programme?',a:'National AIDS Control Programme',o:['Revised National Tuberculosis Control Programme','Iodine Deficiency Disorders Programme','National AIDS Control Programme','Reproductive and Child Health Programme'],e:'Suraksha Clinics are STI\/RTI clinics established under the NATIONAL AIDS CONTROL PROGRAMME (NACP). They provide free confidential diagnosis and treatment of STIs\/RTIs, as treating STIs reduces HIV transmission risk.'},\n{id:92,s:'Mean + 2 SD contains:',a:'95.4% values',o:['68.3% values','91.2% values','95.4% values','99.7% values'],e:'Normal distribution empirical rule: Mean +\/- 1 SD = 68.3%. Mean +\/- 2 SD = 95.4%. Mean +\/- 3 SD = 99.7%. Mean +\/- 1.96 SD = 95.0% (used for confidence intervals). Mean +\/- 2 SD = 95.4%.'},\n{id:93,s:'Infant Mortality Rate is expressed per:',a:'1000 live births',o:['1000 pregnancies','1000 live births','1000 under-five children','100,000 live births'],e:'IMR = (Deaths under 1 year \/ Total live births) x 1000. Denominator is LIVE BIRTHS. Pregnancies would include stillbirths. 100,000 is used for Maternal Mortality Rate. IMR is the most sensitive single indicator of community health status.'},\n{id:94,s:'Which of the following tests is NOT used for checking quality of pasteurisation of milk?',a:'Orthotolidine test',o:['Phosphatase test','Standard plate count','Coliform count','Orthotolidine test'],e:'Tests for milk pasteurisation: Phosphatase test (ALP destroyed by pasteurisation \u2014 gold standard), Standard Plate Count, Coliform count. Orthotolidine test detects RESIDUAL CHLORINE in WATER disinfection \u2014 it is NOT used for milk quality testing.'},\n{id:95,s:'Which of the following are components of the epidemiological triad?',a:'Agent, host and environmental factors',o:['Sensitivity, specificity and predictive value','Time, place and person distribution','Agent, host and environmental factors','Prevalence, incidence and attack rate'],e:'The epidemiological triad = AGENT (cause) + HOST (susceptible person) + ENVIRONMENT (milieu enabling transmission). Disease occurs when the triad balance is disrupted. Time-place-person = descriptive epidemiology. Sensitivity\/specificity = screening test properties.'},\n{id:96,s:'By applying the principles of ergonomics which of the following can be improved?\\n1. Designing of equipment and tools\\n2. Human efficiency\\n3. Layout of place of work\\n4. Reduction in industrial accidents',a:'1, 2, 3 and 4',o:['1, 2 and 3 only','1, 2, 3 and 4','2, 3 and 4 only','1, 3 and 4 only'],e:'Ergonomics designs work systems to fit human capabilities. All four are improved: equipment design (1), human efficiency (2), workplace layout (3), and reduced accidents (4). All four are valid and well-established ergonomics outcomes.'},\n{id:97,s:'The risk of disease is measured by:',a:'Incidence rate',o:['Prevalence rate','Incidence rate','Attrition rate','Fatality rate'],e:'INCIDENCE RATE = new cases \/ population at risk = the probability (RISK) of developing disease. It is the key measure used in cohort studies. Prevalence = existing cases = disease burden. CFR = probability of dying given disease. Attrition = dropout rate. Incidence = risk.'},\n{id:98,s:'Tetanus spores can only be killed by:',a:'Gamma irradiation',o:['Large doses of penicillin','Anti-tetanus serum','Tetanus toxoid','Gamma irradiation'],e:'C. tetani spores resist boiling and most disinfectants. Only AUTOCLAVING (121 degrees C) or GAMMA IRRADIATION destroy spores. Penicillin kills vegetative bacteria but NOT spores. Antitoxin neutralises toxin but not spores. Toxoid confers immunity. Among the options, gamma irradiation is the only sporicidal agent.'},\n{id:99,s:'Which is\/are the correct statements regarding cut-off points for diagnosis of anaemia?\\n1. Haemoglobin for adult males is 13 g\/dL\\n2. Haemoglobin for adult non-pregnant females is 12 g\/dL\\n3. Haemoglobin for adult pregnant females is 11 g\/dL\\n4. Haemoglobin for children 6 months to 6 years of age is 11 g\/dL',a:'1, 2, 3 and 4',o:['1 only','1, 2, 3 and 4','2 and 4 only','1 and 3 only'],e:'WHO haemoglobin cut-offs: Adult males below 13 g\/dL (1 correct). Non-pregnant adult females below 12 g\/dL (2 correct). Pregnant females below 11 g\/dL (3 correct). Children 6 months to 5 years below 11 g\/dL (4 correct). All four statements are correct WHO\/ICMR values.'},\n{id:100,s:'Health functionary at PHC level is:',a:'Health Assistant (Female)',o:['ASHA','Anganwadi Worker','Health Assistant (Female)','Health Worker (Female)'],e:'ASHA and AWW operate at village level. Health Worker Female (ANM) works at sub-centre. HEALTH ASSISTANT FEMALE (Lady Health Visitor\/LHV) is the PHC-level functionary who supervises ANMs and manages MCH services. Health Assistant (Female) = LHV = PHC level.'},\n{id:101,s:'Due to a measles outbreak, a medical officer immunised a child aged 7 months with measles vaccine. When should the next measles vaccine be administered?',a:'When the child completes nine months of age',o:['Not required','After four weeks','When the child completes nine months of age','When the child completes fifteen months of age'],e:'A measles vaccine given before 9 months is a ZERO DOSE \u2014 maternal antibodies may interfere. The child must still receive the scheduled first dose at 9 months. The 7-month emergency dose does NOT replace the standard schedule. Next dose: at 9 months of age.'},\n{id:102,s:'Which of the following is\/are the methods of assessment of nutritional status?\\n1. Clinical examination\\n2. Anthropometry\\n3. Biochemical evaluation\\n4. Orthotolidine test',a:'1, 2 and 3 only',o:['1 only','1 and 3 only','1, 2 and 3 only','1, 2, 3 and 4'],e:'Nutritional assessment (ABCDE): Anthropometry (2), Biochemical tests (3), Clinical examination (1), Dietary surveys, Ecological data. Orthotolidine test (4) detects RESIDUAL CHLORINE in water \u2014 it is NOT a nutritional assessment method. Only 1, 2, and 3 are methods of nutritional assessment.'},\n{id:103,s:'Retrospective cohort studies have the following features EXCEPT:',a:'Generally more expensive than prospective studies',o:['Outcomes have occurred before the start of the study','Generally more expensive than prospective studies','Results are obtained more quickly','Investigator goes back in time to select study groups'],e:'Retrospective cohort features: outcomes already occurred (a-true), results obtained quickly (c-true), investigator goes back in time using historical records (d-true). Retrospective cohort studies are generally LESS expensive than prospective studies because they use existing data without years of follow-up costs. Statement (b) is FALSE.'},\n{id:104,s:'What is the correct sequence of the following levels of prevention?\\n1. Specific protection\\n2. Early diagnosis and prompt treatment\\n3. Disability limitation and rehabilitation\\n4. Health promotion',a:'4, 1, 2, 3',o:['1, 2, 3, 4','4, 1, 2, 3','2, 3, 4, 1','3, 4, 1, 2'],e:'Leavell and Clark levels of prevention: PRIMARY = (4) Health Promotion then (1) Specific Protection. SECONDARY = (2) Early Diagnosis and Prompt Treatment. TERTIARY = (3) Disability Limitation and Rehabilitation. Correct chronological sequence: 4, 1, 2, 3.'},\n{id:105,s:'Which of the following items are among the uses of epidemiology?',a:'All of these',o:['To study historically the rise and fall of diseases','To arrive at community diagnosis','To identify syndromes','All of these'],e:'Uses of epidemiology (MacMahon and Pugh) include: historical trends (rise\/fall of diseases), community diagnosis (health status of populations), identifying syndromes (AIDS was first identified epidemiologically), evaluating interventions, identifying risk factors, and guiding health policy. All three options are recognised uses.'},\n{id:106,s:'Consider the following statements regarding folic acid:\\n1. It is needed for normal development of blood cells in the marrow\\n2. It has a role in synthesis of nucleic acids\\n3. It is resistant to boiling',a:'1 and 2',o:['1 only','1 and 2','1 and 3','2 and 3'],e:'Folic acid: (1) Essential for haematopoiesis \u2014 deficiency causes megaloblastic anaemia (correct). (2) Cofactor for purine and thymidylate synthesis (DNA\/RNA) (correct). (3) Folic acid is HEAT-LABILE \u2014 destroyed by boiling. Extensive cooking destroys 50-90% of dietary folate. Statement 3 is FALSE. Statements 1 and 2 are correct.'},\n{id:107,s:'The MCH indicator that gives a good indicator of the extent of pregnancy wastage as well as the quantity and quality of health care available to the mother and newborn is:',a:'Perinatal Mortality Rate',o:['Maternal Mortality Rate','Still Birth Rate','Infant Mortality Rate','Perinatal Mortality Rate'],e:'Perinatal Mortality Rate (PMR) = (Late foetal deaths + Early neonatal deaths 0-7 days) \/ (Live births + Late foetal deaths) x 1000. PMR captures BOTH pregnancy wastage (stillbirths) AND neonatal deaths \u2014 a comprehensive indicator of obstetric and neonatal care quality. PMR is the best combined indicator.'},\n{id:108,s:'To control Mansonioides mosquitoes, the most effective method is:',a:'Removal of water plants',o:['Oiling of water','Larvicidal insecticides','Avoidance of water collections','Removal of water plants'],e:'Mansonia larvae and pupae ATTACH to roots of aquatic plants (Pistia, Salvinia) to obtain oxygen \u2014 bypassing the water surface. Oiling is therefore INEFFECTIVE. The most effective control is REMOVAL OF AQUATIC PLANTS \u2014 without host plants, larvae cannot attach and suffocate. This is the unique feature of Mansonia control.'},\n{id:109,s:'What is the fertility indicator that gives the approximate magnitude of completed family size?',a:'Total Fertility Rate',o:['General Fertility Rate','Age Specific Fertility Rate','Total Fertility Rate','Gross Reproduction Rate'],e:'TOTAL FERTILITY RATE (TFR) = average number of children a woman would have if she lived through all reproductive years (15-49) at current age-specific fertility rates. TFR represents COMPLETED FAMILY SIZE. Replacement level TFR = 2.1. TFR is the most used summary fertility indicator.'},\n{id:110,s:'For a child aged four years, an Anganwadi Worker detects that the weight is lower than expected. What should the AWW do FIRST?',a:'Give nutritional counselling to the mother',o:['Refer the child to the nearby Health Centre','Refer the child to a nearby nutritional rehabilitation centre','Give nutritional counselling to the mother','Start fortnightly deworming'],e:'When AWW detects lower-than-expected weight (moderate malnutrition), the FIRST ACTION is NUTRITIONAL COUNSELLING TO THE MOTHER about proper feeding practices. Referral to Health Centre or NRC is for SAM with complications. Deworming is periodic. Counselling first = empowerment at community level.'},\n{id:111,s:'Which of the following anthropometrical measurements is\/are carried out to assess the growth of children under five years of age?\\n1. Weight measurement\\n2. Height measurement\\n3. Mid upper arm circumference',a:'1, 2 and 3',o:['1 only','1 and 2 only','2 and 3 only','1, 2 and 3'],e:'Anthropometric measurements for under-5 growth: Weight for weight-for-age and weight-for-height indices (1), Height\/length for height-for-age\/stunting (2), MUAC for rapid SAM screening with colour-coded tape (3). All three are used in ICDS, IMNCI, and WHO growth monitoring. All three are correct.'},\n{id:112,s:'Which of the following is included in detecting a child with severe acute malnutrition?\\n1. Weight-for-age Z-score less than minus 3 SD\\n2. Bilateral pitting oedema\\n3. Weight-for-height Z-score less than minus 3 SD\\n4. Mid upper arm circumference of less than 12 cm',a:'2 and 3 only',o:['1 and 3 only','2 and 3 only','3 and 4 only','1, 2, 3 and 4'],e:'WHO SAM criteria: Weight-for-HEIGHT (WHZ) less than minus 3 SD (3 = correct) and Bilateral pitting oedema (2 = correct). Weight-for-AGE (WAZ) reflects chronic undernutrition, NOT SAM. MUAC less than 11.5 cm (not 12 cm) is the current WHO cut-off. Statements 2 and 3 correctly identify SAM by current WHO standards.'},\n{id:113,s:'Which of the following statements is\/are correct regarding Essential Obstetric Care under RMNCH+A?\\n1. Early registration of pregnancy\\n2. Provision of first referral units\\n3. Provision of safe delivery practices\\n4. Provision of at least four postnatal checkups',a:'1 and 3 only',o:['1 and 2 only','1 and 3 only','2 and 3 only','1, 2, 3 and 4'],e:'Essential Obstetric Care components: Early ANC registration (1 = correct), safe delivery practices with skilled birth attendance (3 = correct). First Referral Units (FRUs) are infrastructure for Emergency Obstetric Care, not specifically listed as EOC components. Four postnatal checkups is not a standard EOC specification. Statements 1 and 3 best represent EOC.'},\n{id:114,s:'A pregnant woman received two doses of TT vaccine four years ago. Which step should the medical officer take regarding TT vaccine?',a:'Only one dose of Tetanus Toxoid vaccine is required',o:['Tetanus Immunoglobulin in the third trimester','Two doses of TT with four-week interval','Only one dose of Tetanus Toxoid vaccine is required','No Tetanus Toxoid vaccine is required'],e:'If a woman received 2 TT doses more than 3 years ago (here 4 years), ONE BOOSTER dose is required. Complete re-immunisation (2 doses) is only for never-vaccinated or unknown status. No vaccine is incorrect (4-year gap exceeds protection window). TIG is not indicated. One booster dose is the correct answer.'},\n{id:115,s:'With reference to quarantine measures, which of the following statements is\/are correct?\\n1. Quarantine measures are at times also applied to aircraft, trains, or containers\\n2. The duration of quarantine period is equivalent to the minimum incubation period',a:'1 only',o:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],e:'(1) IHR 2005 allows quarantine of conveyances (aircraft, ships, trains), baggage, cargo, and containers \u2014 CORRECT. (2) Quarantine duration equals the MAXIMUM incubation period (not minimum) \u2014 to ensure all potentially exposed persons are past the maximum time they could develop symptoms. Statement 2 is FALSE. Only statement 1 is correct.'},\n{id:116,s:'Which is the first step in carrying out an Adverse Event Following Immunisation (AEFI)?',a:'Confirm information in report',o:['Formulate a working hypothesis','Observe the immunisation service in action','Confirm information in report','Collect data about the suspected vaccine'],e:'AEFI investigation steps: (1) CONFIRM the information in the report \u2014 verify the event occurred, obtain case details, confirm diagnosis. (2) Collect data about vaccine. (3) Observe immunisation service. (4) Formulate working hypothesis. Confirming the reported event is the FIRST step \u2014 without confirmation, subsequent steps are meaningless.'},\n{id:117,s:'At the end of an immunisation session, a reconstituted BCG vial has two doses left. What should be done?',a:'Discard the vial in a red coloured bin',o:['Reuse the remaining two doses during the next immunisation session','Discard the vial in a black coloured bin','Discard the vial in a red coloured bin','Take decision depending upon the VVM status'],e:'BCG is a live vaccine \u2014 once reconstituted, it MUST be used within 4 hours and any remaining vaccine DISCARDED at session end (cannot be saved). Dispose as per BMW rules: RED BIN for contaminated\/potentially infectious biological waste containing live organisms. VVM status is irrelevant \u2014 reconstituted BCG must be discarded regardless.'},\n{id:118,s:'With reference to Vaccine Vial Monitors (VVM), which of the following statements is\/are correct?\\n1. It gives information about heat exposure over a period of time\\n2. It directly indicates vaccine potency',a:'1 only',o:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],e:'VVM is a heat-sensitive label attached to vaccine vials. It records CUMULATIVE HEAT EXPOSURE over time \u2014 a square inside a circle changes colour as heat accumulates (statement 1 = CORRECT). VVM does NOT directly indicate vaccine potency \u2014 it provides a PROXY indicator of likely potency based on heat exposure history, but cannot directly test vaccine potency. Statement 2 is FALSE. Only statement 1 is correct.'},\n{id:119,s:'Why is matching done in a case-control study?\\n1. To remove the effect of known confounders\\n2. To remove the effect of unknown confounders\\n3. To eliminate selection bias\\n4. To eliminate interviewer\\'s bias',a:'1 only',o:['1 only','2 and 3','1, 3 and 4','4 only'],e:'Matching in case-control studies is done specifically to REMOVE THE EFFECT OF KNOWN CONFOUNDERS (statement 1 = correct) by selecting controls who are similar to cases on matched variables (age, sex). Matching does NOT control unknown confounders (2 = wrong). Matching reduces selection bias partially but is not primarily for eliminating it (3 = wrong). Matching does not address interviewer bias (4 = wrong). Only statement 1 correctly states the purpose of matching.'},\n{id:120,s:'Which of the following vaccines has NOT been introduced in the Universal Immunisation Programme in India?',a:'Cervical cancer vaccine',o:['Pentavalent vaccine','MMR vaccine','Injectable polio vaccine','Cervical cancer vaccine'],e:'UIP vaccines: OPV, BCG, DPT, Hepatitis B, Hib (combined as Pentavalent), IPV (introduced 2015), Measles\/MR (now MR vaccine), MMR (introduced 2017 in some states), PCV (pneumococcal), Rotavirus vaccine. Cervical cancer vaccine (HPV vaccine) has NOT been introduced in India\\'s Universal Immunisation Programme \u2014 it remains in pilot\/demonstration phase and is not part of the national UIP schedule as of the exam year. 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id=\"cms17p2c-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">✅ <strong id=\"cms17p2c-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">❌ <strong id=\"cms17p2c-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">⏳ <strong id=\"cms17p2c-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms17p2c-sn\">0<\/strong> \/ <strong id=\"cms17p2c-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms17p2c-fill\"><\/div><\/div>\n<\/div>\n<div class=\"cq-grace\" id=\"cms17p2c-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms17p2c-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms17p2c-grace-now\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2017<br>Paper II · Part C<\/h1>\n <p>Preventive & Social Medicine · Biostatistics · Epidemiology · Immunisation<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 81 – 120<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms17p2c-timer-btn\">⏳ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"cq-body\">\n <div id=\"cms17p2c-questions\"><\/div>\n <div class=\"cq-submit-wrap\"><button class=\"cq-btn\" id=\"cms17p2c-submit\">Submit Answers<\/button><\/div>\n <div class=\"cq-score\" id=\"cms17p2c-score\">\n <div class=\"cq-score-ring\" id=\"cms17p2c-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms17p2c-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=\"cms17p2c-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms17p2c-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms17p2c-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms17p2c-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms17p2c-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms17p2c-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms17p2c',TOTAL=40,MAX=160,TIMER_SECS=2400,GRACE_SECS=10;\nvar Q=[\n{id:81,s:'Which is\/are the measure(s) of dispersion?\\n1. Mode\\n2. Median\\n3. Standard Deviation',a:'3 only',o:['1 and 2 only','3 only','2 and 3 only','1, 2 and 3'],e:'Mode and Median are measures of CENTRAL TENDENCY. Standard Deviation (SD) is a measure of DISPERSION \u2014 it describes spread around the mean. Range, IQR, variance, and SD are all measures of dispersion. Only statement 3 is correct.'},\n{id:82,s:'Which among the following is\/are examples of primordial prevention?\\n1. Adopting healthy lifestyles from childhood\\n2. Immunisation of infants\\n3. Screening of cervical cancer',a:'1 only',o:['1 only','1 and 2 only','1 and 3 only','1, 2 and 3'],e:'Primordial prevention prevents emergence of risk factors before they develop. Adopting healthy lifestyles from childhood (1) = correct. Immunisation (2) = specific protection = primary prevention. Cancer screening (3) = early diagnosis = secondary prevention. Only statement 1 qualifies as primordial prevention.'},\n{id:83,s:'The appropriate statistical test to find out obesity as a significant risk factor for breast cancer is:',a:'Chi-square test',o:[\"Student's paired t-test\",\"Student's unpaired t-test\",'Chi-square test',\"Wilcoxon's signed rank test\"],e:'Obesity (yes\/no) and breast cancer (present\/absent) are both CATEGORICAL variables. The CHI-SQUARE TEST is used to test association between two categorical variables \u2014 the standard test for 2x2 contingency tables in case-control and cross-sectional studies.'},\n{id:84,s:'In a case-control study, confounding factors can be minimised by the following EXCEPT:',a:'Increasing sample size for cases and controls',o:['Matching of variables such as age and sex','Randomisation during selection','Stratification during analysis','Increasing sample size for cases and controls'],e:'Methods to control confounding: matching, randomisation, stratified analysis (Mantel-Haenszel), multivariate regression. INCREASING SAMPLE SIZE increases statistical power but does NOT reduce confounding \u2014 a larger biased study is still biased. Sample size is not a method of confounding control.'},\n{id:85,s:'Which one of the following is FALSE regarding confounding factor in epidemiological studies?',a:'Distributed equally between study and control groups',o:['Associated both with exposure and disease','Distributed equally between study and control groups','Independent risk factor for disease in question','Source of bias in interpretation'],e:'A confounder must be associated with both exposure and disease, be an independent risk factor, and be unequally distributed between groups (creating the confounding). \"Distributed equally\" is FALSE \u2014 if equal distribution existed, there would be no confounding. Equal distribution is the desired outcome AFTER controlling for confounding.'},\n{id:86,s:'Denominator in calculation of case fatality rate is:',a:'Total number of cases due to the disease concerned',o:['Total number of deaths due to all causes','Total number of hospital admissions','Total number of cases due to the disease concerned','Total number of deaths due to the disease concerned'],e:'Case Fatality Rate = (Deaths from specific disease \/ Total CASES of that disease) x 100. The denominator is total number of CASES \u2014 patients diagnosed with the disease. CFR measures killing power\/severity of a disease.'},\n{id:87,s:'A well of contaminated water resulting in an epidemic of acute watery diarrhoea is a typical example for:',a:'Common source, continuous exposure epidemic',o:['Common source, single exposure epidemic','Common source, continuous exposure epidemic','Slow epidemic','Propagated epidemic'],e:'A contaminated well provides continuous ongoing exposure \u2014 COMMON SOURCE, CONTINUOUS EXPOSURE epidemic. The epidemic curve shows a prolonged plateau. Point source = single exposure event. Propagated = person-to-person spread. The well is used continuously = continuous common source.'},\n{id:88,s:'An important measure of communicability of a disease is:',a:'Secondary attack rate',o:['Incidence rate','Case fatality rate','Prevalence rate','Secondary attack rate'],e:'Secondary Attack Rate (SAR) = new cases among contacts \/ total susceptible contacts x 100. SAR directly quantifies how readily disease spreads from an index case \u2014 the primary measure of COMMUNICABILITY. CFR measures lethality. Incidence measures new cases in general population. SAR = communicability.'},\n{id:89,s:'Which of the following statements is NOT correct regarding case fatality rate?',a:'Very useful indicator for both acute and chronic diseases',o:['Very useful indicator for both acute and chronic diseases','One of the measures related to virulence','It is the ratio of deaths to cases expressed as percentage','Variation can occur for the same disease because of changes in the agent factors'],e:'CFR is most useful for ACUTE infectious diseases where the time relationship between diagnosis and death is clear. For CHRONIC diseases, CFR is less meaningful because prolonged timeframes and competing causes complicate attribution. \"Very useful for both acute AND chronic diseases\" is FALSE.'},\n{id:90,s:\"Farmer's lung is caused by the inhalation of:\",a:'Grain dust with actinomycetes',o:['Grain dust with actinomycetes','Sugarcane dust','Silica dust','Cotton fibre dust'],e:\"Farmer's lung = hypersensitivity pneumonitis from inhalation of thermophilic ACTINOMYCETES (Saccharopolyspora rectivirgula) in mouldy hay\/grain. Bagassosis = sugarcane dust. Silicosis = silica. Byssinosis = cotton fibre. Grain dust + actinomycetes = Farmer's lung.\"},\n{id:91,s:'Suraksha Clinics are conducted under the aegis of which National Health Programme?',a:'National AIDS Control Programme',o:['Revised National Tuberculosis Control Programme','Iodine Deficiency Disorders Programme','National AIDS Control Programme','Reproductive and Child Health Programme'],e:'Suraksha Clinics are STI\/RTI clinics established under the NATIONAL AIDS CONTROL PROGRAMME (NACP). They provide free confidential diagnosis and treatment of STIs\/RTIs, as treating STIs reduces HIV transmission risk.'},\n{id:92,s:'Mean + 2 SD contains:',a:'95.4% values',o:['68.3% values','91.2% values','95.4% values','99.7% values'],e:'Normal distribution empirical rule: Mean +\/- 1 SD = 68.3%. Mean +\/- 2 SD = 95.4%. Mean +\/- 3 SD = 99.7%. Mean +\/- 1.96 SD = 95.0% (used for confidence intervals). Mean +\/- 2 SD = 95.4%.'},\n{id:93,s:'Infant Mortality Rate is expressed per:',a:'1000 live births',o:['1000 pregnancies','1000 live births','1000 under-five children','100,000 live births'],e:'IMR = (Deaths under 1 year \/ Total live births) x 1000. Denominator is LIVE BIRTHS. Pregnancies would include stillbirths. 100,000 is used for Maternal Mortality Rate. IMR is the most sensitive single indicator of community health status.'},\n{id:94,s:'Which of the following tests is NOT used for checking quality of pasteurisation of milk?',a:'Orthotolidine test',o:['Phosphatase test','Standard plate count','Coliform count','Orthotolidine test'],e:'Tests for milk pasteurisation: Phosphatase test (ALP destroyed by pasteurisation \u2014 gold standard), Standard Plate Count, Coliform count. Orthotolidine test detects RESIDUAL CHLORINE in WATER disinfection \u2014 it is NOT used for milk quality testing.'},\n{id:95,s:'Which of the following are components of the epidemiological triad?',a:'Agent, host and environmental factors',o:['Sensitivity, specificity and predictive value','Time, place and person distribution','Agent, host and environmental factors','Prevalence, incidence and attack rate'],e:'The epidemiological triad = AGENT (cause) + HOST (susceptible person) + ENVIRONMENT (milieu enabling transmission). Disease occurs when the triad balance is disrupted. Time-place-person = descriptive epidemiology. Sensitivity\/specificity = screening test properties.'},\n{id:96,s:'By applying the principles of ergonomics which of the following can be improved?\\n1. Designing of equipment and tools\\n2. Human efficiency\\n3. Layout of place of work\\n4. Reduction in industrial accidents',a:'1, 2, 3 and 4',o:['1, 2 and 3 only','1, 2, 3 and 4','2, 3 and 4 only','1, 3 and 4 only'],e:'Ergonomics designs work systems to fit human capabilities. All four are improved: equipment design (1), human efficiency (2), workplace layout (3), and reduced accidents (4). All four are valid and well-established ergonomics outcomes.'},\n{id:97,s:'The risk of disease is measured by:',a:'Incidence rate',o:['Prevalence rate','Incidence rate','Attrition rate','Fatality rate'],e:'INCIDENCE RATE = new cases \/ population at risk = the probability (RISK) of developing disease. It is the key measure used in cohort studies. Prevalence = existing cases = disease burden. CFR = probability of dying given disease. Attrition = dropout rate. Incidence = risk.'},\n{id:98,s:'Tetanus spores can only be killed by:',a:'Gamma irradiation',o:['Large doses of penicillin','Anti-tetanus serum','Tetanus toxoid','Gamma irradiation'],e:'C. tetani spores resist boiling and most disinfectants. Only AUTOCLAVING (121 degrees C) or GAMMA IRRADIATION destroy spores. Penicillin kills vegetative bacteria but NOT spores. Antitoxin neutralises toxin but not spores. Toxoid confers immunity. Among the options, gamma irradiation is the only sporicidal agent.'},\n{id:99,s:'Which is\/are the correct statements regarding cut-off points for diagnosis of anaemia?\\n1. Haemoglobin for adult males is 13 g\/dL\\n2. Haemoglobin for adult non-pregnant females is 12 g\/dL\\n3. Haemoglobin for adult pregnant females is 11 g\/dL\\n4. Haemoglobin for children 6 months to 6 years of age is 11 g\/dL',a:'1, 2, 3 and 4',o:['1 only','1, 2, 3 and 4','2 and 4 only','1 and 3 only'],e:'WHO haemoglobin cut-offs: Adult males below 13 g\/dL (1 correct). Non-pregnant adult females below 12 g\/dL (2 correct). Pregnant females below 11 g\/dL (3 correct). Children 6 months to 5 years below 11 g\/dL (4 correct). All four statements are correct WHO\/ICMR values.'},\n{id:100,s:'Health functionary at PHC level is:',a:'Health Assistant (Female)',o:['ASHA','Anganwadi Worker','Health Assistant (Female)','Health Worker (Female)'],e:'ASHA and AWW operate at village level. Health Worker Female (ANM) works at sub-centre. HEALTH ASSISTANT FEMALE (Lady Health Visitor\/LHV) is the PHC-level functionary who supervises ANMs and manages MCH services. Health Assistant (Female) = LHV = PHC level.'},\n{id:101,s:'Due to a measles outbreak, a medical officer immunised a child aged 7 months with measles vaccine. When should the next measles vaccine be administered?',a:'When the child completes nine months of age',o:['Not required','After four weeks','When the child completes nine months of age','When the child completes fifteen months of age'],e:'A measles vaccine given before 9 months is a ZERO DOSE \u2014 maternal antibodies may interfere. The child must still receive the scheduled first dose at 9 months. The 7-month emergency dose does NOT replace the standard schedule. Next dose: at 9 months of age.'},\n{id:102,s:'Which of the following is\/are the methods of assessment of nutritional status?\\n1. Clinical examination\\n2. Anthropometry\\n3. Biochemical evaluation\\n4. Orthotolidine test',a:'1, 2 and 3 only',o:['1 only','1 and 3 only','1, 2 and 3 only','1, 2, 3 and 4'],e:'Nutritional assessment (ABCDE): Anthropometry (2), Biochemical tests (3), Clinical examination (1), Dietary surveys, Ecological data. Orthotolidine test (4) detects RESIDUAL CHLORINE in water \u2014 it is NOT a nutritional assessment method. Only 1, 2, and 3 are methods of nutritional assessment.'},\n{id:103,s:'Retrospective cohort studies have the following features EXCEPT:',a:'Generally more expensive than prospective studies',o:['Outcomes have occurred before the start of the study','Generally more expensive than prospective studies','Results are obtained more quickly','Investigator goes back in time to select study groups'],e:'Retrospective cohort features: outcomes already occurred (a-true), results obtained quickly (c-true), investigator goes back in time using historical records (d-true). Retrospective cohort studies are generally LESS expensive than prospective studies because they use existing data without years of follow-up costs. Statement (b) is FALSE.'},\n{id:104,s:'What is the correct sequence of the following levels of prevention?\\n1. Specific protection\\n2. Early diagnosis and prompt treatment\\n3. Disability limitation and rehabilitation\\n4. Health promotion',a:'4, 1, 2, 3',o:['1, 2, 3, 4','4, 1, 2, 3','2, 3, 4, 1','3, 4, 1, 2'],e:'Leavell and Clark levels of prevention: PRIMARY = (4) Health Promotion then (1) Specific Protection. SECONDARY = (2) Early Diagnosis and Prompt Treatment. TERTIARY = (3) Disability Limitation and Rehabilitation. Correct chronological sequence: 4, 1, 2, 3.'},\n{id:105,s:'Which of the following items are among the uses of epidemiology?',a:'All of these',o:['To study historically the rise and fall of diseases','To arrive at community diagnosis','To identify syndromes','All of these'],e:'Uses of epidemiology (MacMahon and Pugh) include: historical trends (rise\/fall of diseases), community diagnosis (health status of populations), identifying syndromes (AIDS was first identified epidemiologically), evaluating interventions, identifying risk factors, and guiding health policy. All three options are recognised uses.'},\n{id:106,s:'Consider the following statements regarding folic acid:\\n1. It is needed for normal development of blood cells in the marrow\\n2. It has a role in synthesis of nucleic acids\\n3. It is resistant to boiling',a:'1 and 2',o:['1 only','1 and 2','1 and 3','2 and 3'],e:'Folic acid: (1) Essential for haematopoiesis \u2014 deficiency causes megaloblastic anaemia (correct). (2) Cofactor for purine and thymidylate synthesis (DNA\/RNA) (correct). (3) Folic acid is HEAT-LABILE \u2014 destroyed by boiling. Extensive cooking destroys 50-90% of dietary folate. Statement 3 is FALSE. Statements 1 and 2 are correct.'},\n{id:107,s:'The MCH indicator that gives a good indicator of the extent of pregnancy wastage as well as the quantity and quality of health care available to the mother and newborn is:',a:'Perinatal Mortality Rate',o:['Maternal Mortality Rate','Still Birth Rate','Infant Mortality Rate','Perinatal Mortality Rate'],e:'Perinatal Mortality Rate (PMR) = (Late foetal deaths + Early neonatal deaths 0-7 days) \/ (Live births + Late foetal deaths) x 1000. PMR captures BOTH pregnancy wastage (stillbirths) AND neonatal deaths \u2014 a comprehensive indicator of obstetric and neonatal care quality. PMR is the best combined indicator.'},\n{id:108,s:'To control Mansonioides mosquitoes, the most effective method is:',a:'Removal of water plants',o:['Oiling of water','Larvicidal insecticides','Avoidance of water collections','Removal of water plants'],e:'Mansonia larvae and pupae ATTACH to roots of aquatic plants (Pistia, Salvinia) to obtain oxygen \u2014 bypassing the water surface. Oiling is therefore INEFFECTIVE. The most effective control is REMOVAL OF AQUATIC PLANTS \u2014 without host plants, larvae cannot attach and suffocate. This is the unique feature of Mansonia control.'},\n{id:109,s:'What is the fertility indicator that gives the approximate magnitude of completed family size?',a:'Total Fertility Rate',o:['General Fertility Rate','Age Specific Fertility Rate','Total Fertility Rate','Gross Reproduction Rate'],e:'TOTAL FERTILITY RATE (TFR) = average number of children a woman would have if she lived through all reproductive years (15-49) at current age-specific fertility rates. TFR represents COMPLETED FAMILY SIZE. Replacement level TFR = 2.1. TFR is the most used summary fertility indicator.'},\n{id:110,s:'For a child aged four years, an Anganwadi Worker detects that the weight is lower than expected. What should the AWW do FIRST?',a:'Give nutritional counselling to the mother',o:['Refer the child to the nearby Health Centre','Refer the child to a nearby nutritional rehabilitation centre','Give nutritional counselling to the mother','Start fortnightly deworming'],e:'When AWW detects lower-than-expected weight (moderate malnutrition), the FIRST ACTION is NUTRITIONAL COUNSELLING TO THE MOTHER about proper feeding practices. Referral to Health Centre or NRC is for SAM with complications. Deworming is periodic. Counselling first = empowerment at community level.'},\n{id:111,s:'Which of the following anthropometrical measurements is\/are carried out to assess the growth of children under five years of age?\\n1. Weight measurement\\n2. Height measurement\\n3. Mid upper arm circumference',a:'1, 2 and 3',o:['1 only','1 and 2 only','2 and 3 only','1, 2 and 3'],e:'Anthropometric measurements for under-5 growth: Weight for weight-for-age and weight-for-height indices (1), Height\/length for height-for-age\/stunting (2), MUAC for rapid SAM screening with colour-coded tape (3). All three are used in ICDS, IMNCI, and WHO growth monitoring. All three are correct.'},\n{id:112,s:'Which of the following is included in detecting a child with severe acute malnutrition?\\n1. Weight-for-age Z-score less than minus 3 SD\\n2. Bilateral pitting oedema\\n3. Weight-for-height Z-score less than minus 3 SD\\n4. Mid upper arm circumference of less than 12 cm',a:'2 and 3 only',o:['1 and 3 only','2 and 3 only','3 and 4 only','1, 2, 3 and 4'],e:'WHO SAM criteria: Weight-for-HEIGHT (WHZ) less than minus 3 SD (3 = correct) and Bilateral pitting oedema (2 = correct). Weight-for-AGE (WAZ) reflects chronic undernutrition, NOT SAM. MUAC less than 11.5 cm (not 12 cm) is the current WHO cut-off. Statements 2 and 3 correctly identify SAM by current WHO standards.'},\n{id:113,s:'Which of the following statements is\/are correct regarding Essential Obstetric Care under RMNCH+A?\\n1. Early registration of pregnancy\\n2. Provision of first referral units\\n3. Provision of safe delivery practices\\n4. Provision of at least four postnatal checkups',a:'1 and 3 only',o:['1 and 2 only','1 and 3 only','2 and 3 only','1, 2, 3 and 4'],e:'Essential Obstetric Care components: Early ANC registration (1 = correct), safe delivery practices with skilled birth attendance (3 = correct). First Referral Units (FRUs) are infrastructure for Emergency Obstetric Care, not specifically listed as EOC components. Four postnatal checkups is not a standard EOC specification. Statements 1 and 3 best represent EOC.'},\n{id:114,s:'A pregnant woman received two doses of TT vaccine four years ago. Which step should the medical officer take regarding TT vaccine?',a:'Only one dose of Tetanus Toxoid vaccine is required',o:['Tetanus Immunoglobulin in the third trimester','Two doses of TT with four-week interval','Only one dose of Tetanus Toxoid vaccine is required','No Tetanus Toxoid vaccine is required'],e:'If a woman received 2 TT doses more than 3 years ago (here 4 years), ONE BOOSTER dose is required. Complete re-immunisation (2 doses) is only for never-vaccinated or unknown status. No vaccine is incorrect (4-year gap exceeds protection window). TIG is not indicated. One booster dose is the correct answer.'},\n{id:115,s:'With reference to quarantine measures, which of the following statements is\/are correct?\\n1. Quarantine measures are at times also applied to aircraft, trains, or containers\\n2. The duration of quarantine period is equivalent to the minimum incubation period',a:'1 only',o:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],e:'(1) IHR 2005 allows quarantine of conveyances (aircraft, ships, trains), baggage, cargo, and containers \u2014 CORRECT. (2) Quarantine duration equals the MAXIMUM incubation period (not minimum) \u2014 to ensure all potentially exposed persons are past the maximum time they could develop symptoms. Statement 2 is FALSE. Only statement 1 is correct.'},\n{id:116,s:'Which is the first step in carrying out an Adverse Event Following Immunisation (AEFI)?',a:'Confirm information in report',o:['Formulate a working hypothesis','Observe the immunisation service in action','Confirm information in report','Collect data about the suspected vaccine'],e:'AEFI investigation steps: (1) CONFIRM the information in the report \u2014 verify the event occurred, obtain case details, confirm diagnosis. (2) Collect data about vaccine. (3) Observe immunisation service. (4) Formulate working hypothesis. Confirming the reported event is the FIRST step \u2014 without confirmation, subsequent steps are meaningless.'},\n{id:117,s:'At the end of an immunisation session, a reconstituted BCG vial has two doses left. What should be done?',a:'Discard the vial in a red coloured bin',o:['Reuse the remaining two doses during the next immunisation session','Discard the vial in a black coloured bin','Discard the vial in a red coloured bin','Take decision depending upon the VVM status'],e:'BCG is a live vaccine \u2014 once reconstituted, it MUST be used within 4 hours and any remaining vaccine DISCARDED at session end (cannot be saved). Dispose as per BMW rules: RED BIN for contaminated\/potentially infectious biological waste containing live organisms. VVM status is irrelevant \u2014 reconstituted BCG must be discarded regardless.'},\n{id:118,s:'With reference to Vaccine Vial Monitors (VVM), which of the following statements is\/are correct?\\n1. It gives information about heat exposure over a period of time\\n2. It directly indicates vaccine potency',a:'1 only',o:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],e:'VVM is a heat-sensitive label attached to vaccine vials. It records CUMULATIVE HEAT EXPOSURE over time \u2014 a square inside a circle changes colour as heat accumulates (statement 1 = CORRECT). VVM does NOT directly indicate vaccine potency \u2014 it provides a PROXY indicator of likely potency based on heat exposure history, but cannot directly test vaccine potency. Statement 2 is FALSE. Only statement 1 is correct.'},\n{id:119,s:'Why is matching done in a case-control study?\\n1. To remove the effect of known confounders\\n2. To remove the effect of unknown confounders\\n3. To eliminate selection bias\\n4. To eliminate interviewer\\'s bias',a:'1 only',o:['1 only','2 and 3','1, 3 and 4','4 only'],e:'Matching in case-control studies is done specifically to REMOVE THE EFFECT OF KNOWN CONFOUNDERS (statement 1 = correct) by selecting controls who are similar to cases on matched variables (age, sex). Matching does NOT control unknown confounders (2 = wrong). Matching reduces selection bias partially but is not primarily for eliminating it (3 = wrong). Matching does not address interviewer bias (4 = wrong). Only statement 1 correctly states the purpose of matching.'},\n{id:120,s:'Which of the following vaccines has NOT been introduced in the Universal Immunisation Programme in India?',a:'Cervical cancer vaccine',o:['Pentavalent vaccine','MMR vaccine','Injectable polio vaccine','Cervical cancer vaccine'],e:'UIP vaccines: OPV, BCG, DPT, Hepatitis B, Hib (combined as Pentavalent), IPV (introduced 2015), Measles\/MR (now MR vaccine), MMR (introduced 2017 in some states), PCV (pneumococcal), Rotavirus vaccine. Cervical cancer vaccine (HPV vaccine) has NOT been introduced in India\\'s Universal Immunisation Programme \u2014 it remains in pilot\/demonstration phase and is not part of the national UIP schedule as of the exam year. 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