{"id":36794,"date":"2026-05-10T07:08:48","date_gmt":"2026-05-10T01:38:48","guid":{"rendered":"https:\/\/atsixty.com\/?p=36794"},"modified":"2026-05-10T07:09:23","modified_gmt":"2026-05-10T01:39:23","slug":"cms-2018-p1-part-b","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/10\/cms-2018-p1-part-b\/","title":{"rendered":"CMS 2018 P1 Part-B"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2018 Paper I \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: cms18p1b \u2500\u2500 *\/\n#cms18p1b *,#cms18p1b *::before,#cms18p1b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms18p1b{\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#cms18p1b .cq-sentinel{height:1px}\n#cms18p1b .cq-statusbar{\n position:fixed;top:0;left:0;right:0;z-index:99999;\n background:var(--white);border-bottom:2px solid var(--line);\n border-left:4px solid var(--ter);box-shadow:0 2px 12px rgba(0,0,0,0.11);\n opacity:0;pointer-events:none;transform:translateY(-110%);\n transition:opacity 0.22s ease,transform 0.22s ease;\n}\n#cms18p1b .cq-statusbar.visible{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms18p1b .cq-sb-stats{display:flex;align-items:center;padding:0.38rem 0.7rem;font-size:0.73rem;color:var(--ink-soft);}\n#cms18p1b .cq-sb-item{display:flex;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1;}\n#cms18p1b .cq-sb-item:last-child{border-right:none}\n#cms18p1b .cq-sb-item strong{color:var(--ink);font-size:0.8rem;font-weight:700}\n#cms18p1b .cq-sb-sep{flex:1}\n#cms18p1b .cq-sb-progress{height:4px;background:var(--line);overflow:hidden}\n#cms18p1b .cq-sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width 0.4s ease;}\n#cms18p1b .cq-timer-item{display:none;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1;font-size:0.73rem;}\n#cms18p1b .cq-timer-item.active{display:flex}\n#cms18p1b .cq-timer-item strong{font-size:0.8rem;font-weight:700;color:var(--teal);font-variant-numeric:tabular-nums}\n#cms18p1b .cq-timer-item.warning strong{color:var(--wrong)}\n#cms18p1b .cq-grace{display:none;position:fixed;top:0;right:0;bottom:0;left:0;z-index:999999;background:rgba(0,0,0,0.55);align-items:center;justify-content:center;}\n#cms18p1b .cq-grace.show{display:flex}\n#cms18p1b .cq-grace-box{background:var(--white);border-radius:12px;border-top:5px solid var(--wrong);padding:32px 28px;text-align:center;max-width:320px;width:90%;box-shadow:0 8px 40px rgba(0,0,0,0.25);}\n#cms18p1b .cq-grace-box h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wrong);margin-bottom:10px;}\n#cms18p1b .cq-grace-box p{font-size:0.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms18p1b .cq-grace-count{font-family:'Playfair Display',serif;font-size:2.8rem;font-weight:700;color:var(--wrong);line-height:1;margin-bottom:18px;}\n#cms18p1b .cq-grace-btn{background:var(--wrong);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s;}\n#cms18p1b .cq-grace-btn:hover{background:#c62828}\n#cms18p1b .cq-header{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center;}\n#cms18p1b .cq-header h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;letter-spacing:0.01em;line-height:1.3;}\n#cms18p1b .cq-header p{font-size:0.85rem;opacity:0.85;margin-top:6px;font-style:italic}\n#cms18p1b .cq-meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms18p1b .cq-badge{background:rgba(255,255,255,0.15);border:1px solid rgba(255,255,255,0.3);border-radius:20px;padding:4px 14px;font-size:0.78rem;letter-spacing:0.03em;}\n#cms18p1b .cq-timer-btn{background:transparent;border:1.5px solid rgba(255,255,255,0.7);color:var(--white);border-radius:20px;padding:4px 14px;font-family:'Source Serif 4',serif;font-size:0.78rem;cursor:pointer;letter-spacing:0.03em;transition:background 0.2s,border-color 0.2s;display:flex;align-items:center;gap:6px;}\n#cms18p1b .cq-timer-btn:hover{background:rgba(255,255,255,0.15)}\n#cms18p1b .cq-timer-btn.running{background:rgba(255,255,255,0.2);border-color:var(--white);}\n#cms18p1b .cq-body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms18p1b .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#cms18p1b .cq-card:hover{box-shadow:0 2px 12px rgba(192,96,58,0.1)}\n#cms18p1b .cq-qhead{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start;}\n#cms18p1b .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#cms18p1b .cq-qnum.ans-c{background:var(--correct-border)}\n#cms18p1b .cq-qnum.ans-w{background:var(--wrong-border)}\n#cms18p1b .cq-qtext{font-size:0.93rem;color:var(--ink);line-height:1.65}\n#cms18p1b .cq-options{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms18p1b .cq-opt{display:flex;align-items:flex-start;gap:10px;padding:10px 14px;border:1.5px solid var(--line);border-radius:8px;cursor:pointer;transition:border-color 0.15s,background 0.15s;background:var(--white);-webkit-tap-highlight-color:transparent;}\n#cms18p1b .cq-opt:hover:not(.cq-locked){border-color:var(--teal);background:var(--teal-pale)}\n#cms18p1b .cq-opt-letter{flex-shrink:0;width:20px;height:20px;border-radius:50%;border:1.5px solid var(--line);display:flex;align-items:center;justify-content:center;font-size:0.65rem;font-weight:700;color:var(--ink-soft);transition:all 0.15s;margin-top:1px;}\n#cms18p1b .cq-opt-text{font-size:0.89rem;color:var(--ink-mid);line-height:1.55}\n#cms18p1b .cq-opt.cq-correct{border-color:var(--correct-border);background:var(--correct-bg);cursor:default}\n#cms18p1b .cq-opt.cq-correct .cq-opt-letter{background:var(--correct-border);border-color:var(--correct-border);color:#fff}\n#cms18p1b .cq-opt.cq-correct .cq-opt-text{color:var(--correct);font-weight:600}\n#cms18p1b .cq-opt.cq-wrong{border-color:var(--wrong-border);background:var(--wrong-bg);cursor:default}\n#cms18p1b .cq-opt.cq-wrong .cq-opt-letter{background:var(--wrong-border);border-color:var(--wrong-border);color:#fff}\n#cms18p1b .cq-opt.cq-wrong .cq-opt-text{color:var(--wrong)}\n#cms18p1b .cq-opt.cq-dimmed{opacity:0.42;cursor:default}\n#cms18p1b .cq-opt.cq-locked{cursor:default}\n#cms18p1b .cq-explanation{display:none;background:var(--teal-pale);border-top:1px solid #b2d8d3;padding:10px 18px 12px;font-size:0.82rem;color:#1a4f49;line-height:1.62;}\n#cms18p1b .cq-exp-label{font-size:0.7rem;font-weight:700;letter-spacing:0.08em;text-transform:uppercase;color:var(--teal);margin-bottom:4px;}\n#cms18p1b .cq-submit-wrap{text-align:center;padding:28px 16px 8px}\n#cms18p1b .cq-btn{background:var(--teal);color:var(--white);border:none;border-radius:8px;padding:13px 36px;font-family:'Playfair Display',serif;font-size:1rem;font-weight:700;cursor:pointer;letter-spacing:0.02em;transition:background 0.2s,transform 0.1s;}\n#cms18p1b .cq-btn:hover{background:var(--teal-light)}\n#cms18p1b .cq-btn:active{transform:scale(0.98)}\n#cms18p1b .cq-score{display:none;background:var(--white);border:2px solid var(--teal);border-radius:var(--radius);margin:28px 0 0;padding:28px 24px;text-align:center;}\n#cms18p1b .cq-score-ring{width:110px;height:110px;border-radius:50%;background:conic-gradient(var(--teal) 0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative;}\n#cms18p1b .cq-score-ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white);}\n#cms18p1b .cq-ring-inner{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms18p1b .cq-ring-pct{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms18p1b .cq-ring-sub{font-size:0.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:0.05em}\n#cms18p1b .cq-score h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms18p1b .cq-net-line{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms18p1b .cq-verdict{font-size:0.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms18p1b .cq-score-bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:0.8rem}\n#cms18p1b .cq-band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms18p1b .cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms18p1b .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms18p1b .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms18p1b .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#cms18p1b .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){\n #cms18p1b .cq-header h1{font-size:1.15rem}\n #cms18p1b .cq-qtext{font-size:0.88rem}\n #cms18p1b .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms18p1b\">\n <div class=\"cq-sentinel\" id=\"cms18p1b-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms18p1b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms18p1b-timer-item\">\u23f1 <strong id=\"cms18p1b-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms18p1b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms18p1b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms18p1b-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms18p1b-sn\">0<\/strong> \/ <strong id=\"cms18p1b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms18p1b-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms18p1b-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=\"cms18p1b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms18p1b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2018<br>Paper I \u00b7 Part B<\/h1>\n <p>Parasitology \u00b7 Microbiology \u00b7 Toxicology \u00b7 Critical Care \u00b7 Gastroenterology \u00b7 Nephrology \u00b7 Neurology \u00b7 Respiratory<\/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=\"cms18p1b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms18p1b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms18p1b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms18p1b-score\">\n <div class=\"cq-score-ring\" id=\"cms18p1b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms18p1b-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=\"cms18p1b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms18p1b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms18p1b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms18p1b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms18p1b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms18p1b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms18p1b', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60, GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:41,\n stem:'All of the following are live attenuated vaccines EXCEPT:',\n correct:'Rabies vaccine',\n options:['MMR (Measles, Mumps, Rubella) vaccine','Rabies vaccine','Oral polio vaccine','BCG vaccine'],\n exp:'Live attenuated vaccines contain weakened but living organisms capable of limited replication \u2014 producing strong, durable immunity. Live attenuated vaccines: MMR \u2714, OPV (oral polio) \u2714, BCG \u2714, Yellow fever, Varicella, Rotavirus, Typhoid (Ty21a oral), Influenza (intranasal LAIV), Smallpox (vaccinia). RABIES VACCINE: All currently used rabies vaccines (human diploid cell vaccine HDCV, purified chick embryo cell PCECV, purified vero cell rabies vaccine PVRV) are INACTIVATED (killed) vaccines \u2014 they contain inactivated rabies virus. Rabies is NOT a live attenuated vaccine. Note: Semple vaccine (older brain-tissue derived) was also inactivated. The exception is Rabies vaccine.'\n },\n {\n id:42,\n stem:'All of the following are soil transmitted nematodes EXCEPT:',\n correct:'Strongyloides stercoralis',\n options:['Ancylostoma duodenale','Strongyloides stercoralis','Necator americanus','Ascaris lumbricoides'],\n exp:'Soil-transmitted helminths (STH) are nematodes that require a period of development in soil before becoming infective. Classic STH: Ascaris lumbricoides \u2714 (ingestion of embryonated eggs from soil), Ancylostoma duodenale \u2714 (hookworm \u2014 filariform larvae in soil penetrate skin), Necator americanus \u2714 (hookworm \u2014 same mechanism), Trichuris trichiura \u2714 (whipworm \u2014 eggs in soil). STRONGYLOIDES STERCORALIS: While larvae do develop in soil, Strongyloides is unique \u2014 it can complete its ENTIRE life cycle within the human host (autoinfection). It can also live as a free-living organism in soil (both parasitic and free-living generations). Strongyloides is generally classified SEPARATELY from the classic \"soil-transmitted nematode\" quartet because of its unique autoinfection cycle. Per standard classification, Strongyloides is the EXCEPT answer.'\n },\n {\n id:43,\n stem:'A veterinary doctor is bitten by a stray dog (Category 3 bite). He completed pre-exposure prophylactic vaccination with human diploid cell Rabies vaccine (3 doses on day 0, 7, 28) about 1 year back. Appropriate treatment would include which of the following?\\n1. Wound care\\n2. Antibiotics\\n3. Booster dose of Anti Rabies vaccine\\n4. Rabies immune globulin at wound site\\n\\nSelect the correct answer using the code given below:',\n correct:'1, 2 and 3',\n options:['1 only','1 and 2 only','1, 2 and 3','2, 3 and 4'],\n exp:'Post-exposure management in a previously vaccinated person (pre-exposure prophylaxis completed): (1) Wound care \u2014 ALWAYS first and most important: wash thoroughly with soap and water for \u226515 minutes, antiseptic application. This is mandatory regardless of vaccination status. (2) Antibiotics \u2014 animal bites carry high infection risk (Pasteurella, Capnocytophaga, etc.); antibiotics (amoxicillin-clavulanate) are indicated for category 3 bites. (3) Booster dose of ARV \u2014 previously vaccinated individuals receive 2 booster doses (day 0 and day 3) \u2014 they do NOT need RIG because pre-existing antibodies provide rapid protection. (4) Rabies Immunoglobulin (RIG) \u2014 NOT required in previously vaccinated individuals (pre-existing antibodies neutralise virus; RIG could interfere). Answer: 1, 2 and 3 (no RIG needed).'\n },\n {\n id:44,\n stem:'Loffler\\'s syndrome is caused due to infection by:',\n correct:'Ascaris',\n options:['Strongyloidiasis','Filariasis','Cysticercosis','Ascaris'],\n exp:'L\u00f6ffler\\'s syndrome (Simple pulmonary eosinophilia) is a transient, self-limiting pulmonary condition caused by migration of LARVAL HELMINTHS through the lungs. The classic cause is ASCARIS LUMBRICOIDES \u2014 during its life cycle, Ascaris larvae (hatched from ingested eggs in the intestine) penetrate the gut wall, enter the bloodstream, travel to the lungs, break into alveoli, ascend the bronchial tree, and are swallowed. During this pulmonary phase, larvae trigger an eosinophilic inflammatory response \u2192 transient pulmonary infiltrates on CXR + peripheral eosinophilia. Other causes: Hookworm (Ancylostoma, Necator), Strongyloides, Toxocara (visceral larva migrans). Filariasis causes lymphoedema (elephantiasis). Cysticercosis affects brain, muscle. Ascaris is the classic and most common cause of L\u00f6ffler\\'s syndrome.'\n },\n {\n id:45,\n stem:'Which of the following is\/are the common infectious syndrome(s) associated with Klebsiella pneumoniae?\\n1. Pneumonia\\n2. Intra-abdominal infections\\n3. Hepatitis\\n\\nSelect the correct answer using the code given below:',\n correct:'1 and 2 only',\n options:['1 only','1 and 2 only','1, 2 and 3','2 only'],\n exp:'Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus. Common infections caused by Klebsiella: (1) Pneumonia \u2714 \u2014 classic \"Friedlander\\'s pneumonia\": lobar\/cavitating, \"currant-jelly\" bloody sputum, alcoholics and hospitalised patients, upper lobe involvement. (2) Intra-abdominal infections \u2714 \u2014 liver abscess (especially in diabetics in South-East Asia \u2014 hypervirulent Klebsiella), intra-abdominal sepsis, peritonitis. (3) UTI, bacteraemia, nosocomial infections (ESKAPE pathogen), neonatal sepsis, meningitis. HEPATITIS: Klebsiella does NOT cause hepatitis (viral hepatic parenchymal inflammation). Klebsiella liver abscess is a suppurative infection \u2014 abscess formation, NOT hepatitis. Statements 1 (pneumonia) and 2 (intra-abdominal infections) are correct.'\n },\n {\n id:46,\n stem:'Differential diagnosis of dysenteric syndrome includes which of the following?\\n1. Salmonella infection\\n2. Campylobacter infection\\n3. Shigella infection\\n4. Clostridium infection\\n\\nSelect the correct answer using the code given below:',\n correct:'1, 2, 3 and 4',\n options:['1, 2 and 4 only','2, 3 and 4 only','1 and 3 only','1, 2, 3 and 4'],\n exp:'Dysenteric syndrome = bloody, mucoid diarrhoea with tenesmus and fever \u2014 due to colonic mucosal invasion\/inflammation. Differential diagnoses include ALL four: (1) Salmonella \u2714 \u2014 non-typhoidal Salmonella (S. typhimurium, S. enteritidis) causes inflammatory diarrhoea, occasionally bloody. (2) Campylobacter \u2714 \u2014 C. jejuni is a major cause of bloody diarrhoea worldwide; inflammatory colitis with mucus and blood. (3) Shigella \u2714 \u2014 the classic dysentery organism; all species (especially S. dysenteriae) cause classic dysenteric syndrome. (4) Clostridium \u2714 \u2014 C. difficile causes pseudomembranous colitis with bloody\/mucoid diarrhoea; C. perfringens can cause haemorrhagic colitis. All four are valid differential diagnoses for dysenteric syndrome. Answer: 1, 2, 3 and 4.'\n },\n {\n id:47,\n stem:'Antifungal agent of choice for the treatment of mucormycosis is:',\n correct:'Amphotericin-B',\n options:['Voriconazole','Intraconazole','Amphotericin-B','Fluconazole'],\n exp:'Mucormycosis (Zygomycosis) \u2014 caused by Rhizopus, Mucor, Cunninghamella, Lichtheimia \u2014 is an aggressive angioinvasive fungal infection occurring in immunocompromised hosts, diabetics (especially ketoacidosis), and iron-overloaded states. Treatment: LIPOSOMAL AMPHOTERICIN B (AmBisome) is the drug of choice \u2014 first-line at high doses (5\u201310 mg\/kg\/day). Standard Amphotericin B deoxycholate is also effective but more nephrotoxic. SURGICAL DEBRIDEMENT is mandatory alongside antifungal therapy. Voriconazole: excellent for Aspergillus but has NO activity against Mucorales \u2014 notably, prophylactic voriconazole in stem cell transplant patients increases risk of mucormycosis breakthrough. Itraconazole and fluconazole: limited\/no role in mucormycosis. Posaconazole and isavuconazole are alternatives. Amphotericin-B = drug of choice for mucormycosis.'\n },\n {\n id:48,\n stem:'What drug therapy would be appropriate for management of UTI in a pregnant patient?',\n correct:'Ampicillin',\n options:['Trimethoprim-sulfamethoxazole','Ciprofloxacin','Ampicillin','All of these'],\n exp:'UTI in pregnancy requires safe antibiotics \u2014 the developing foetus limits many options: AMPICILLIN \u2714 \u2014 Beta-lactam, safe in pregnancy (Category B), widely used for UTI; however increasing E. coli resistance limits empirical use \u2014 often combined with sulbactam. TRIMETHOPRIM-SULFAMETHOXAZOLE: Avoid in 1st trimester (folate antagonist \u2192 neural tube defects) and near term\/3rd trimester (neonatal kernicterus from sulfonamide displacing bilirubin). Not routinely recommended. CIPROFLOXACIN (fluoroquinolone): CONTRAINDICATED in pregnancy \u2014 causes cartilage damage in developing joints (arthropathy in animal studies; Category C\/D). Safe options: Amoxicillin, Ampicillin, Cephalexin, Nitrofurantoin (avoid near term \u2014 haemolytic anaemia in G6PD-deficient neonate), Fosfomycin. Among the given options, AMPICILLIN is the appropriate answer.'\n },\n {\n id:49,\n stem:'Which one of the following conditions is NOT associated with lymphocytosis?',\n correct:'Leptospirosis',\n options:['Infectious mononucleosis','Viral fevers','Rickettsial fevers','Leptospirosis'],\n exp:'Lymphocytosis (absolute lymphocyte count >4000\/\u00b5L in adults) is associated with: Viral infections: Infectious mononucleosis (EBV) \u2714 \u2014 classic atypical lymphocytosis. Viral fevers (most viral illnesses) \u2714 \u2014 mumps, rubella, CMV, viral hepatitis, HIV. Rickettsial fevers \u2714 \u2014 relative lymphocytosis seen in some Rickettsia infections (though neutrophilia is common early). Whooping cough (Bordetella pertussis) \u2014 marked absolute lymphocytosis. Chronic lymphocytic leukaemia, ALL. LEPTOSPIROSIS: caused by Leptospira interrogans. The haematological finding is typically NEUTROPHILIA (polymorphonuclear leukocytosis) \u2014 not lymphocytosis. Leptospirosis is a bacterial spirochaetal infection causing leucocytosis with a neutrophilic predominance, thrombocytopenia, and elevated ESR\/CRP. Lymphocytosis is NOT a feature. Leptospirosis is the exception.'\n },\n {\n id:50,\n stem:'Which of the following is NOT a diagnostic criterion of Kwashiorkor?',\n correct:'Triceps skinfold thickness < 3 mm',\n options:['Serum albumin < 2.8 g\/dl','Triceps skinfold thickness < 3 mm','Easy hair pluckability','Edema'],\n exp:'Kwashiorkor is protein-energy malnutrition with predominantly protein deficiency, characterised by: OEDEMA \u2714 (hallmark \u2014 pitting oedema, due to hypoalbuminaemia \u2192 reduced oncotic pressure). HYPOALBUMINAEMIA \u2714 \u2014 serum albumin <2.8 g\/dL (or <3.0 g\/dL per some criteria) \u2014 key diagnostic criterion. EASY HAIR PLUCKABILITY \u2714 \u2014 flag sign (alternating light\/dark bands), sparse\/silky\/easily plucked hair \u2014 due to protein deficiency affecting hair follicle growth cycles. Skin changes: depigmentation, \"flaky paint\" dermatosis. TRICEPS SKINFOLD THICKNESS <3 mm is a criterion for MARASMUS (pure caloric deficiency \u2192 wasting of fat stores). In Kwashiorkor, fat stores are relatively PRESERVED (fat is mobilised less than in marasmus because caloric intake may be adequate). Triceps skinfold <3 mm is a marasmus criterion, NOT Kwashiorkor.'\n },\n {\n id:51,\n stem:'Which one of the following drugs does NOT have any action against Salmonella typhi?',\n correct:'Erythromycin',\n options:['Erythromycin','Amoxicillin','Co-trimoxazole','Doxycycline'],\n exp:'Typhoid fever (Salmonella typhi) treatment options: First-line (sensitive strains): Fluoroquinolones (ciprofloxacin, ofloxacin), Azithromycin (especially for uncomplicated typhoid, drug of choice in children and in areas with fluoroquinolone resistance), Ceftriaxone (IV for severe disease). Older effective drugs: Chloramphenicol, Amoxicillin \u2714 (effective against sensitive strains), Co-trimoxazole \u2714 (trimethoprim-sulfamethoxazole \u2014 effective though resistance increasing), Doxycycline \u2714 (effective against Salmonella). ERYTHROMYCIN: a macrolide that has NO significant clinical activity against Salmonella typhi. Unlike azithromycin (which has excellent intracellular penetration and is highly effective), erythromycin does not achieve adequate intracellular concentrations for typhoid treatment. Erythromycin = no action against S. typhi.'\n },\n {\n id:52,\n stem:'All of the following drugs are used for the treatment of influenza EXCEPT:',\n correct:'Tenofovir',\n options:['Zanamivir','Rimantadine','Oseltamivir','Tenofovir'],\n exp:'Anti-influenza drugs: NEURAMINIDASE INHIBITORS (active against both Influenza A and B): Oseltamivir (Tamiflu) \u2714 \u2014 oral, first-line, seasonal prophylaxis and treatment. Zanamivir (Relenza) \u2714 \u2014 inhaled, active against A and B. Peramivir \u2714 \u2014 IV. Baloxavir \u2714 \u2014 cap-dependent endonuclease inhibitor (newer). M2 ION CHANNEL BLOCKERS (Adamantanes \u2014 active against Influenza A only): Amantadine \u2714, Rimantadine \u2714 \u2014 now rarely used due to widespread resistance in Influenza A(H3N2) and H1N1. TENOFOVIR: a nucleotide reverse transcriptase inhibitor (NRTI) used for HIV and Hepatitis B \u2014 it has absolutely NO activity against influenza virus. Tenofovir is an antiretroviral drug. It is the EXCEPT answer.'\n },\n {\n id:53,\n stem:'Diagnostic accuracy has been enhanced by the ability to detect specific DNA sequences in all of the following infectious micro-organisms EXCEPT:',\n correct:'Staphylococcus aureus',\n options:['Cytomegalovirus (CMV)','Human Immunodeficiency virus (HIV)','Mycobacterium tuberculosis','Staphylococcus aureus'],\n exp:'Molecular diagnostics (PCR\/NAAT \u2014 nucleic acid amplification tests) have revolutionised detection of organisms that are difficult to culture or identify by conventional methods: CMV \u2714 \u2014 PCR is essential for CMV viral load monitoring in immunocompromised patients; culture is slow and insensitive. HIV \u2714 \u2014 HIV RNA PCR (viral load) and HIV DNA PCR (for early infant diagnosis) are cornerstones of HIV management; serology alone is insufficient in window period and infants. Mycobacterium tuberculosis \u2714 \u2014 Xpert MTB\/RIF (GeneXpert) PCR provides rapid diagnosis and rifampicin resistance detection within 2 hours, overcoming the weeks-long culture wait. STAPHYLOCOCCUS AUREUS: easily grown on standard blood agar within 24\u201348 hours \u2014 routine culture is highly sensitive and specific. PCR adds less diagnostic value compared to the other organisms. The question asks where PCR has most ENHANCED diagnostic accuracy \u2014 S. aureus is the exception.'\n },\n {\n id:54,\n stem:'Hip Flexor Spasm is characteristic of:',\n correct:'Psoas abscess',\n options:['Osteomyelitis femur','Septic arthritis hip joint','Psoas abscess','Deep vein thrombosis'],\n exp:'PSOAS ABSCESS \u2014 collection of pus in the psoas muscle sheath. The psoas muscle is a powerful hip FLEXOR. When an abscess forms within it, the muscle adopts its position of maximum comfort: HIP FLEXION. Clinical sign: the patient lies with the hip held in FLEXION, and passive extension is painful (psoas sign\/hip flexor spasm). This is pathognomonic of psoas irritation. Causes: Primary (haematogenous \u2014 S. aureus), Secondary (from adjacent structures \u2014 vertebral TB\/Pott\\'s disease, Crohn\\'s disease, appendicitis, perinephric abscess). Presentation: fever, flank\/back\/groin pain, limp, hip held in flexion. Septic arthritis: pain on all hip movements. Osteomyelitis femur: localised bone tenderness, not specifically hip flexor spasm. DVT: leg swelling, calf pain. Hip flexor spasm = psoas abscess.'\n },\n {\n id:55,\n stem:'Gastroenteritis associated with eating raw eggs is usually attributed to:',\n correct:'Salmonella species',\n options:['E. coli','Norovirus','Salmonella species','Clostridium botulinum'],\n exp:'Raw or undercooked eggs (and poultry) are the classic vehicle for SALMONELLA infections. Salmonella enteritidis can colonise the ovaries of hens and contaminate the egg content before shell formation (transovarian transmission) \u2014 meaning even an intact, uncracked egg can harbour Salmonella. Additionally, egg shells can be contaminated with Salmonella from faeces. This is why raw eggs, raw cookie dough, Caesar salad dressing (with raw egg), and runny omelettes are high-risk foods. Clinical: non-typhoidal salmonellosis \u2014 nausea, vomiting, diarrhoea (watery, sometimes bloody), fever within 6\u201348 hours of ingestion, lasts 3\u20137 days, self-limiting in immunocompetent. E. coli: contaminated water, meat. Norovirus: cruise ships, shellfish. C. botulinum: canned\/preserved foods. Raw eggs = Salmonella.'\n },\n {\n id:56,\n stem:'Which one of the following diseases is NOT caused by protozoa?',\n correct:'Schistosomiasis',\n options:['Trypanosomiasis','Leishmaniasis','Amoebiasis','Schistosomiasis'],\n exp:'Protozoa are single-celled eukaryotic organisms. Protozoan diseases: Trypanosomiasis \u2714 (Trypanosoma brucei \u2014 African sleeping sickness; T. cruzi \u2014 Chagas\\' disease \u2014 both protozoa). Leishmaniasis \u2714 (Leishmania species \u2014 protozoa transmitted by sandfly). Amoebiasis \u2714 (Entamoeba histolytica \u2014 protozoan causing amoebic dysentery and liver abscess). Malaria (Plasmodium), Giardiasis, Toxoplasmosis, Cryptosporidiosis \u2014 all protozoan. SCHISTOSOMIASIS: caused by Schistosoma (S. mansoni, S. haematobium, S. japonicum) \u2014 these are HELMINTHS (flatworms\/trematodes\/flukes). Schistosoma are blood flukes \u2014 complex multicellular organisms, NOT protozoa. Schistosomiasis is NOT a protozoan disease. It is caused by a helminth (trematode).'\n },\n {\n id:57,\n stem:'An adult with fever and right sided chest pain is found to have a moderate right sided pleural effusion. A diagnostic thoracocentesis reveals straw coloured exudates with 50 mg% of sugar and lymphocytic pleocytosis. ADA levels are borderline. What investigation would be most likely to confirm a diagnosis of tuberculosis?',\n correct:'Needle Biopsy of the Pleura',\n options:['Needle Biopsy of the Pleura','Pleural Fluid Xpert MTB\/RIF assay','Pleural Fluid AFB smear','Pleural Fluid AFB-culture'],\n exp:'Tuberculous pleural effusion \u2014 diagnostic challenge: Pleural fluid AFB smear: very low sensitivity (<10%) \u2014 paucibacillary. Pleural fluid AFB culture: sensitivity ~40%, but takes 4\u20138 weeks \u2014 slow. Xpert MTB\/RIF on pleural fluid: sensitivity ~50% (better than smear but still moderate for pleural TB). ADA (Adenosine Deaminase): >40 U\/L strongly suggests TB (sensitivity ~90%, specificity ~85%) \u2014 but here ADA is borderline. NEEDLE BIOPSY OF THE PLEURA (Abrams\/Cope): sensitivity 75\u201380% \u2014 pleural biopsy shows CASEATING GRANULOMAS (pathognomonic of TB) AND allows culture of biopsy tissue. Combination of histology (granuloma) + culture from biopsy is the most sensitive single procedure for confirming pleural TB. Thoracoscopic biopsy (VATS) is even better (sensitivity >90%). Among listed options, needle pleural biopsy is the best for confirming TB diagnosis.'\n },\n {\n id:58,\n stem:'Consider the following statements with regard to acute anterior poliomyelitis:\\n1. It is caused by a virus belonging to picornavirus family\\n2. Muscle pain and cramps may be associated with diffuse transient fasciculations at the onset\\n3. Tonsillectomy reduces the risk of bulbar poliomyelitis\\n4. Cerebrospinal fluid may show mild pleocytosis with increase polymorphonuclear cells in early course of disease\\n\\nWhich of the above statements are correct?',\n correct:'1, 2 and 4',\n options:['1, 2 and 3','2, 3 and 4','1, 2 and 4','1, 3 and 4'],\n exp:'(1) TRUE \u2014 Poliovirus belongs to the Enterovirus genus of the PICORNAVIRIDAE family (small RNA viruses). (2) TRUE \u2014 during the preparalytic stage, muscle pain, cramps, and transient fasciculations occur due to anterior horn cell irritation before neuronal death. (3) FALSE \u2014 TONSILLECTOMY INCREASES the risk of bulbar poliomyelitis. The oropharyngeal lymphoid tissue acts as a barrier; after tonsillectomy, the virus has easier access to the brainstem via cranial nerve pathways. This is why tonsillectomy and IM injections are avoided during polio epidemics (provocation polio). (4) TRUE \u2014 early in poliovirus CNS infection, CSF shows mild pleocytosis, initially with POLYMORPHONUCLEAR cells (neutrophils), shifting to lymphocytic predominance after 48\u201372 hours. Elevated protein follows. Statements 1, 2, and 4 are correct.'\n },\n {\n id:59,\n stem:'Which one of the following is NOT seen in case of Marasmus?',\n correct:'Easy hair pluckability',\n options:['Reduced triceps skinfold thickness','Normal serum albumin','Easy hair pluckability','Decreased mid arm circumference'],\n exp:'Marasmus is severe protein-energy malnutrition predominantly from caloric (energy) deficiency. Features of Marasmus: Severe wasting \u2014 loss of muscle and subcutaneous fat. Reduced triceps skinfold thickness \u2714 (fat depleted). Decreased mid-arm circumference \u2714 (muscle + fat both wasted). Normal or near-normal serum albumin \u2714 \u2014 the body catabolises fat and muscle for energy; hepatic albumin synthesis is maintained until very late. Weight severely reduced (<60% expected). \"Old man face\" (loss of buccal fat pads), \"skin and bones\" appearance. No oedema. EASY HAIR PLUCKABILITY is a feature of KWASHIORKOR (protein deficiency) \u2014 not marasmus. In marasmus, hair may be sparse and thin but is not as easily plucked as in Kwashiorkor where protein deficiency severely compromises hair follicle growth. Easy hair pluckability = Kwashiorkor, NOT marasmus.'\n },\n {\n id:60,\n stem:'Perception of an object in absence of stimulus is:',\n correct:'Hallucination',\n options:['Illusions','Delusions','Hallucination','Psychosis'],\n exp:'Perceptual disturbances \u2014 definitions: HALLUCINATION: perception in the ABSENCE of an external stimulus \u2014 the person perceives something (sees, hears, smells, tastes, or feels) when nothing is there. This is the textbook definition. ILLUSION: MISPERCEPTION of a real external stimulus \u2014 a genuine stimulus exists but is misinterpreted (e.g., seeing a rope as a snake). DELUSION: a fixed, false belief that is unshakeable despite evidence to the contrary \u2014 this is a thought disorder, not a perceptual disturbance. PSYCHOSIS: a broad term for a break from reality \u2014 encompasses hallucinations, delusions, and disorganised thinking, but is not a specific perceptual phenomenon. \"Perception of an object in the absence of a stimulus\" = definition of HALLUCINATION.'\n },\n {\n id:61,\n stem:'All of the following drugs can be used for the treatment for cessation of smoking EXCEPT:',\n correct:'Clonazepam',\n options:['Nicotine gum','Clonazepam','Bupropion','Varenicline'],\n exp:'Pharmacotherapy for smoking cessation: NICOTINE REPLACEMENT THERAPY (NRT) \u2714 \u2014 nicotine gum, patch, inhaler, lozenge, nasal spray \u2014 first-line options, reduce withdrawal symptoms. BUPROPION (Wellbutrin, Zyban) \u2714 \u2014 atypical antidepressant; inhibits dopamine and norepinephrine reuptake; reduces nicotine craving and withdrawal; first approved non-nicotine pharmacotherapy for smoking cessation. VARENICLINE (Champix\/Chantix) \u2714 \u2014 partial agonist at nicotinic acetylcholine receptors (\u03b14\u03b22); reduces craving (partial stimulation) and pleasure from smoking (competitive antagonism); most effective single agent for cessation. CLONAZEPAM: a benzodiazepine (long-acting) used for seizures, panic disorder, anxiety \u2014 it has NO role in smoking cessation. In fact, benzodiazepines are avoided in addiction medicine. Clonazepam is the EXCEPT answer. Note: The PDF lists \"Bapropion\" which is a typo for Bupropion.'\n },\n {\n id:62,\n stem:'All of the following features are present in Organophosphorus poisoning EXCEPT:',\n correct:'Hypertonia',\n options:['Bronchorrhea','Hypertonia','Confusion','Fasciculations'],\n exp:'Organophosphorus (OP) compounds inhibit acetylcholinesterase \u2192 accumulation of ACh at muscarinic and nicotinic synapses + CNS. Features by receptor type: MUSCARINIC (DUMBELS): Diarrhoea\/Defecation, Urination, Miosis, Bradycardia\/Bronchospasm\/Bronchorrhoea \u2714, Emesis, Lacrimation, Salivation\/Sweating. NICOTINIC: Muscle fasciculations \u2714, weakness, paralysis (flaccid \u2014 due to nicotinic receptor depolarisation blockade at NMJ). CNS: Confusion \u2714, seizures, coma. HYPOTONIA (flaccid paralysis) \u2014 NOT hypertonia. OP poisoning causes FLACCID paralysis (depolarisation block at neuromuscular junction \u2192 muscle weakness \u2192 respiratory failure). Hypertonia (increased muscle tone\/spasticity) is seen in strychnine poisoning or UMN lesions \u2014 NOT in OP poisoning. Bronchorrhoea \u2714, Confusion \u2714, Fasciculations \u2714 are all seen. HYPERTONIA is NOT seen \u2014 the exception.'\n },\n {\n id:63,\n stem:'Small sized pupils are seen in poisoning with all EXCEPT:',\n correct:'Cocaine',\n options:['Organophosphorous compounds','Opioids','Clonidine','Cocaine'],\n exp:'MIOSIS (small\/constricted pupils) \u2014 causes: OPIOIDS \u2714 \u2014 classic \"pinpoint pupils\" (miosis due to stimulation of Edinger-Westphal nucleus via \u03bc-receptors). ORGANOPHOSPHORUS compounds \u2714 \u2014 muscarinic effects \u2192 miosis (from unopposed parasympathetic stimulation of sphincter pupillae). CLONIDINE \u2714 \u2014 \u03b12 agonist; central sympatholytic effect \u2192 miosis (reduced sympathetic tone). Others: barbiturates, pilocarpine, phencyclidine (PCP) in some cases, pontine lesions. COCAINE: \u03b11 + \u03b2 agonist (indirect sympathomimetic via catecholamine reuptake inhibition) \u2192 MYDRIASIS (DILATED pupils). Cocaine causes sympathetic stimulation \u2192 mydriasis, tachycardia, hypertension, hyperthermia \u2014 opposite of miosis. Cocaine is the EXCEPT \u2014 it causes dilated, not small, pupils.'\n },\n {\n id:64,\n stem:'A 24 year old male presents with consumption of an unknown substance. His respiratory rate is 22\/minute, pulse rate is 110\/minute, BP is 150\/94 mmHg and he has 2 episodes of seizures. There are tremors and hallucinations. The substance ingested most likely is:',\n correct:'Amphetamines',\n options:['Amphetamines','Diazepam','Oxycodone','Ethanol'],\n exp:'Clinical picture: Tachycardia (110\/min), Hypertension (150\/94), Tachypnoea (22\/min), Seizures, Tremors, Hallucinations. This is a classic SYMPATHOMIMETIC TOXIDROME (adrenergic toxidrome). AMPHETAMINES (and cocaine, MDMA, ephedrine) cause catecholamine excess: \u2191 HR, \u2191 BP, \u2191 RR, hyperthermia, diaphoresis, mydriasis, agitation, hallucinations (especially visual\/tactile), seizures, tremors. Diazepam (benzodiazepine): CNS depressant \u2192 sedation, respiratory depression, bradycardia, hypotension \u2014 opposite picture. Oxycodone (opioid): CNS\/respiratory depression, miosis, bradycardia \u2014 not this picture. Ethanol: at toxic levels \u2192 CNS depression, hypotension, hypothermia, respiratory depression \u2014 not sympathomimetic. The combination of hypertension + tachycardia + seizures + hallucinations + tremors = AMPHETAMINE (sympathomimetic) toxidrome.'\n },\n {\n id:65,\n stem:'The toxic effects of aluminium phosphide is due to the release of:',\n correct:'Phosphine',\n options:['Phosgene','Chlorine','Inorganic phosphates','Phosphine'],\n exp:'Aluminium phosphide (AlP) \u2014 a commonly used rodenticide and grain fumigant (Celphos, Quickphos). When AlP comes into contact with moisture (atmospheric humidity, gastric acid, water): AlP + 3H\u2082O \u2192 Al(OH)\u2083 + PH\u2083 (Phosphine gas). PHOSPHINE (PH\u2083) is the toxic agent \u2014 a colourless, highly toxic gas with a garlic\/fish-like odour. Mechanism: inhibits mitochondrial cytochrome c oxidase (Complex IV) \u2192 cellular hypoxia; also damages mitochondrial membranes. Effects: severe cardiac toxicity (myocardial depression, refractory hypotension, arrhythmias), pulmonary oedema, hepatic and renal failure, CNS depression. There is NO specific antidote. Phosgene (COCl\u2082): from chlorinated solvent combustion. Chlorine: industrial\/chemical warfare. Inorganic phosphates: not the mechanism. Phosphine = toxic agent of AlP.'\n },\n {\n id:66,\n stem:'An 18 year old boy was brought to the emergency department after being bitten by a saw-scaled viper. The monitoring which is most crucial in this patient is:',\n correct:'Whole blood clotting time',\n options:['Single breath count','Neck flop','Whole blood clotting time','Creatine phosphokinase'],\n exp:'Saw-scaled viper (Echis carinatus) \u2014 the most dangerous snake in terms of mortality in India. Its venom is predominantly HAEMOTOXIC\/COAGULOPATHIC \u2014 it contains procoagulant enzymes (prothrombin activators, phospholipases) that cause CONSUMPTION COAGULOPATHY (disseminated intravascular coagulation, DIC-like state). This leads to: incoagulable blood, spontaneous bleeding (gums, haemoptysis, haematuria, intracranial haemorrhage). The most CRUCIAL monitoring parameter is WHOLE BLOOD CLOTTING TIME (WBCT\/20-MWBCT): If blood fails to clot within 20 minutes = venom-induced consumption coagulopathy \u2192 urgent antivenom needed. Single breath count and neck flop: monitor for neurotoxicity (cobra, krait bites). CPK: for myotoxicity (sea snake, Russell\\'s viper). WBCT is the key test for saw-scaled viper envenomation.'\n },\n {\n id:67,\n stem:'Bite of cobra is likely to result in:',\n correct:'Flaccid paralysis',\n options:['Flaccid paralysis','Coagulopathy','Myolysis','Cardiotoxicity'],\n exp:'Cobra (Naja species) venom is predominantly NEUROTOXIC \u2014 contains post-synaptic \u03b1-neurotoxins that bind nicotinic acetylcholine receptors at the neuromuscular junction (competitive antagonism, like curare). This blocks neuromuscular transmission \u2192 FLACCID PARALYSIS. Clinical progression: ptosis \u2192 ophthalmoplegia \u2192 facial palsy \u2192 bulbar palsy (dysarthria, dysphagia) \u2192 limb weakness \u2192 respiratory muscle paralysis \u2192 death from respiratory failure. Other features: local tissue necrosis (cytotoxins in some cobra species), cardiovascular effects (mild). Coagulopathy: saw-scaled viper, Russell\\'s viper (haemotoxic). Myolysis: sea snakes, Russell\\'s viper. Cardiotoxicity: prominent with Australian elapids (not mainly cobra). FLACCID PARALYSIS is the cardinal feature of cobra bite (post-synaptic neurotoxicity).'\n },\n {\n id:68,\n stem:'Hematuria is a prominent symptom with infection due to:',\n correct:'Schistosoma haematobium',\n options:['Strongyloides stercoralis','Schistosoma haematobium','Toxocara spp.','Gnathostomiasis'],\n exp:'SCHISTOSOMA HAEMATOBIUM \u2014 the blood fluke responsible for urogenital schistosomiasis \u2014 causes HAEMATURIA as its cardinal symptom. Life cycle: cercariae (in freshwater) penetrate skin \u2192 schistosomula \u2192 migrate to portal system \u2192 adult worms migrate to vesical (bladder) venous plexus \u2192 females lay eggs in bladder wall \u2192 eggs cause granulomatous inflammation \u2192 haematuria, dysuria, bladder fibrosis \u2192 \"sandy patches\" on cystoscopy \u2192 squamous cell carcinoma of bladder (long-term). The classic presentation is painless terminal haematuria (blood at the end of urination). Endemic: Africa, Middle East. Strongyloides: intestinal infection, cutaneous larva currens. Toxocara: visceral\/ocular larva migrans \u2014 fever, hepatomegaly, eosinophilia. Gnathostomiasis: migratory subcutaneous swellings. Haematuria = Schistosoma haematobium.'\n },\n {\n id:69,\n stem:'Bite of the Tsetse Fly transmits:',\n correct:'African Trypanosomiasis',\n options:['Leishmaniasis','Chaga\\'s disease','Dengue fever','African Trypanosomiasis'],\n exp:'Vector-disease associations: TSETSE FLY (Glossina species) \u2192 AFRICAN TRYPANOSOMIASIS (Sleeping Sickness) \u2014 Trypanosoma brucei gambiense (West\/Central Africa \u2014 chronic) and T. brucei rhodesiense (East Africa \u2014 acute). Causes progressive CNS involvement \u2192 somnolence, confusion, coma. SANDFLY (Phlebotomus\/Lutzomyia) \u2192 Leishmaniasis (Leishmania species). TRIATOMINE BUG (Reduviid\/Kissing bug) \u2192 CHAGAS\\' DISEASE (T. cruzi \u2014 American Trypanosomiasis) \u2014 NOT tsetse fly. AEDES MOSQUITO \u2192 Dengue fever (Dengue virus). Anopheles mosquito \u2192 Malaria. Body louse \u2192 Epidemic typhus (R. prowazekii). Deer tick \u2192 Lyme disease. Tsetse fly transmits African Trypanosomiasis. Chagas\\' disease is American trypanosomiasis transmitted by the reduviid bug \u2014 a common distractor.'\n },\n {\n id:70,\n stem:'A 60 year old man with pneumonia is unconscious and has a PaO\u2082 of 50 mm Hg. The preferred modality of treatment for him is:',\n correct:'Invasive mechanical ventilation',\n options:['Oxygen through nasal cannula','Non invasive ventilation','Invasive mechanical ventilation','No respiratory support is indicated'],\n exp:'Assessment: PaO\u2082 = 50 mmHg (severe hypoxaemia \u2014 normal 80\u2013100 mmHg), UNCONSCIOUS patient. Indications for INVASIVE MECHANICAL VENTILATION (IMV) via endotracheal intubation: Inability to protect airway (unconsciousness, absent gag reflex) \u2014 this is the key contraindication to non-invasive ventilation (NIV). Severe hypoxaemia (PaO\u2082 <60 mmHg despite high-flow O\u2082). Respiratory failure with reduced consciousness. NIV CONTRAINDICATIONS include: unconsciousness, inability to protect airway, copious secretions, facial trauma. Nasal cannula: max FiO\u2082 ~0.44 \u2014 insufficient for PaO\u2082 of 50 mmHg. NIV (BiPAP\/CPAP): contraindicated \u2014 patient is unconscious, cannot protect airway, aspiration risk. An unconscious patient with severe hypoxaemia requires IMMEDIATE INTUBATION AND INVASIVE MECHANICAL VENTILATION.'\n },\n {\n id:71,\n stem:'Oliguria is defined as a reduction in urine output',\n correct:'Less than 0.5 ml\/kg\/hour',\n options:['Less than 1 ml\/kg\/hour','Less than 0.5 ml\/kg\/hour','Less than 200 ml in 24 hours','Any decrease over previous urine output'],\n exp:'OLIGURIA is defined as urine output of LESS THAN 0.5 mL\/kg\/hour (in adults) \u2014 equivalent to <400\u2013500 mL\/day in a 70 kg adult. This threshold is used universally in ICU monitoring and KDIGO\/AKIN criteria for Acute Kidney Injury (AKI) staging: Stage 1 AKI: UO <0.5 mL\/kg\/h for 6\u201312 hours. Stage 2 AKI: UO <0.5 mL\/kg\/h for \u226512 hours. Stage 3 AKI: UO <0.3 mL\/kg\/h for \u226524 hours, or anuria \u226512 hours. <1 mL\/kg\/h: reduced urine output, but not the definition of oliguria. <200 mL\/day would be closer to anuria. Normal urine output: 0.5\u20131 mL\/kg\/h (minimum 0.5 mL\/kg\/h for adequate renal perfusion). Oliguria = <0.5 mL\/kg\/hour.'\n },\n {\n id:72,\n stem:'All of the following are signs of Brain death EXCEPT:',\n correct:'Bilateral plantar response \u2013 Mute or Absent',\n options:['Pupils fixed and unresponsive to light','Corneal reflexes absent','Bilateral plantar response \u2013 Mute or Absent','No gag reflex'],\n exp:'Brain death = irreversible cessation of all brain functions including the brainstem. Confirmatory clinical tests for brain death: PUPILS \u2014 fixed, dilated, unresponsive to light \u2714 (CN II\/III \u2014 midbrain brainstem). CORNEAL REFLEXES absent \u2714 (CN V\/VII \u2014 pontine brainstem). GAG REFLEX absent \u2714 (CN IX\/X \u2014 medullary brainstem). Cough reflex absent, Oculocephalic reflex absent (doll\\'s eye), Oculovestibular reflex absent (caloric testing), Apnoea test positive (no respiratory effort). PLANTAR RESPONSE: In brain death, spinal cord reflexes may be PRESERVED even when the brain is dead \u2014 plantar responses can be PRESENT (including extensor\/Babinski) or absent. A \"mute or absent\" plantar response is NOT a reliable brain death criterion because spinal reflexes are subsumed under spinal cord function, not brainstem. Bilateral plantar response being mute\/absent does NOT confirm brain death.'\n },\n {\n id:73,\n stem:'A 35 year old man with history of alcoholism presents with ophthalmoplegia, ataxia and global confusion. The treatment of choice for this patient is:',\n correct:'I.V. Thiamine',\n options:['I.V. Glucose','I.V. Thiamine','I.V. Mannitol','I.V. Immunoglobulin'],\n exp:'Classic WERNICKE\\'S ENCEPHALOPATHY \u2014 the triad: (1) Ophthalmoplegia (especially 6th nerve palsy \u2014 lateral rectus weakness, nystagmus). (2) Cerebellar Ataxia (wide-based gait, truncal ataxia). (3) Global Confusion (disorientation, apathy, altered consciousness). Caused by THIAMINE (Vitamin B1) DEFICIENCY \u2014 most commonly from alcoholism, but also malnutrition, hyperemesis, bariatric surgery, malabsorption. TREATMENT: IV THIAMINE (100\u2013500 mg) IMMEDIATELY \u2014 before any glucose administration. CRITICAL RULE: NEVER give IV glucose to a suspected Wernicke\\'s patient without first giving thiamine \u2014 glucose metabolism consumes the last remaining thiamine and precipitates acute Wernicke\\'s\/Korsakoff syndrome. Mannitol: for raised ICP. IV Immunoglobulin: for GBS, myasthenia gravis. IV Thiamine = treatment of choice for Wernicke\\'s encephalopathy.'\n },\n {\n id:74,\n stem:'Most common form of paroxysmal supraventricular Tachycardia is:',\n correct:'AV Nodal Reentry Tachycardia (AVNRT)',\n options:['Junctional Ectopic Tachycardia','AV Nodal Reentry Tachycardia (AVNRT)','Accessory Pathways','Accelerated junctional rhythm'],\n exp:'Paroxysmal Supraventricular Tachycardia (PSVT) \u2014 mechanisms and relative frequency: AV NODAL REENTRY TACHYCARDIA (AVNRT) \u2014 60\u201370% of PSVT \u2014 most common. Uses two pathways within\/near the AV node (fast and slow); the reentry circuit is within the AV node. ECG: narrow QRS, retrograde P waves hidden in or just after QRS (short RP tachycardia). AVRT via ACCESSORY PATHWAY (Wolff-Parkinson-White) \u2014 20\u201330% \u2014 second most common. Uses the AV node in one direction and an accessory pathway (Bundle of Kent) in the other. Atrial Tachycardia \u2014 ~10%. Junctional Ectopic Tachycardia: uncommon, seen in post-cardiac surgery or digitalis toxicity. Accelerated Junctional Rhythm: not a paroxysmal SVT. AVNRT is the most common form of PSVT, accounting for the majority of cases.'\n },\n {\n id:75,\n stem:'The primary therapeutic intervention in symptomatic Sino atrial node dysfunction is:',\n correct:'Permanent pacemaker',\n options:['I.V. Atropine','I.V. Isoprenaline','Permanent pacemaker','I.V. Theophylline'],\n exp:'Sinoatrial (SA) Node Dysfunction (Sick Sinus Syndrome) \u2014 includes: Sinus bradycardia, Sinus pauses\/arrests, Sinoatrial block, Tachycardia-Bradycardia syndrome. SYMPTOMATIC SA Node Dysfunction = symptoms of low cardiac output (syncope, pre-syncope, dizziness, fatigue, exercise intolerance) attributable to bradycardia or pauses. PRIMARY TREATMENT: PERMANENT PACEMAKER implantation \u2014 the definitive, curative treatment. It is the only proven therapy that improves symptoms and prevents syncope in symptomatic SSS. Class I indication per ACC\/AHA\/ESC guidelines. IV Atropine: temporary measure for acute symptomatic bradycardia \u2014 not primary treatment. IV Isoprenaline: also temporary bridge. Theophylline (oral): used occasionally in patients unsuitable for pacing \u2014 NOT primary therapy. For symptomatic SA node dysfunction, PERMANENT PACEMAKER is the definitive primary intervention.'\n },\n {\n id:76,\n stem:'Which of the following are the Indications for lung transplantation?\\n1. Emphysema\\n2. Primary pulmonary hypertension\\n3. Obliterative bronchiolitis\\n\\nSelect the correct answer using the code given below:',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Lung transplantation indications \u2014 all three are valid: (1) Emphysema\/COPD \u2714 \u2014 the MOST COMMON indication for lung transplantation worldwide (~30\u201335% of all lung transplants). Advanced COPD with FEV1 <25% predicted, BODE index \u22657, PCO2 >50 mmHg \u2014 bilateral sequential lung transplant preferred. (2) Primary\/Idiopathic Pulmonary Hypertension \u2714 \u2014 severe PAH unresponsive to medical therapy; bilateral lung transplant (or heart-lung transplant in Eisenmenger\\'s). PAH was historically a common transplant indication. (3) Obliterative bronchiolitis \u2714 \u2014 progressive airflow obstruction from bronchiolar fibrosis (post-infectious, post-transplant \u2014 BOS, or idiopathic). A valid indication for re-transplantation and primary transplantation. Other indications: Idiopathic pulmonary fibrosis (IPF \u2014 fastest growing indication), Cystic fibrosis, Alpha-1 antitrypsin deficiency, Sarcoidosis. All three statements are correct \u2014 answer: 1, 2 and 3.'\n },\n {\n id:77,\n stem:'Which one of the following is used to distinguish narrowing of large airway from small airway?',\n correct:'Flow\/volume loops are recorded',\n options:['Peak expiratory flow rate is measured','Flow\/volume loops are recorded','Forced expiratory volume in one second is measured','Flow\/time loops are recorded'],\n exp:'FLOW-VOLUME LOOPS (spirometry plotted as flow vs volume rather than flow vs time) are uniquely capable of distinguishing LARGE\/CENTRAL airway obstruction from SMALL\/PERIPHERAL airway disease: Variable intrathoracic large airway obstruction: flattening of the expiratory limb of the flow-volume loop. Variable extrathoracic large airway obstruction: flattening of the inspiratory limb. Fixed large airway obstruction: flattening of both inspiratory and expiratory limbs (plateau). Small airway disease (COPD, asthma): \"scooping\" of the expiratory limb (concave appearance). PEFR: reflects large airway function and effort-dependent phase \u2014 not diagnostic for distinguishing large vs small airway. FEV1: a single number, cannot distinguish the site of obstruction. Flow\/time loops: same as spirometry \u2014 does not demonstrate the characteristic shapes. Flow-volume loops = used to distinguish large from small airway narrowing.'\n },\n {\n id:78,\n stem:'The most common cause of chronic relapsing diarrhoea is:',\n correct:'Irritable bowel syndrome',\n options:['Inflammatory bowel disease','Coeliac disease','Microscopic colitis','Irritable bowel syndrome'],\n exp:'IRRITABLE BOWEL SYNDROME (IBS) is the most common cause of chronic relapsing diarrhoea (and the most common functional GI disorder overall). IBS-D (diarrhoea-predominant): recurrent episodes of loose\/watery stools, urgency, abdominal pain relieved by defecation, absence of organic disease. Prevalence: 10\u201315% of the population. Functional disorder \u2014 no structural\/inflammatory abnormality on investigations. Rome IV criteria: recurrent abdominal pain \u22651 day\/week for the last 3 months + \u22652 of: related to defecation, associated with change in stool frequency, associated with change in stool form. IBD (Crohn\\'s\/UC): important but far less common (prevalence ~0.3%). Coeliac disease: less common, specific antibody\/biopsy diagnosis. Microscopic colitis: affects older women, specific histological diagnosis. IBS is by far the most prevalent cause of chronic relapsing diarrhoea.'\n },\n {\n id:79,\n stem:'The most common cause of severe acute lower gastrointestinal bleeding is:',\n correct:'Diverticular disease',\n options:['Angiodysplasia of colon','Diverticular disease','Ischaemia of bowel','Inflammatory bowel disease'],\n exp:'LOWER GI BLEEDING (LGIB) \u2014 causes by frequency in severe\/massive acute bleeding: DIVERTICULAR DISEASE \u2014 most common cause of severe acute LGIB (accounts for 30\u201350% of major haematochezia). Diverticula (false diverticula in the sigmoid\/right colon) can bleed massively when the artery at the diverticular neck ruptures \u2014 typically painless, large-volume bright red\/maroon rectal bleeding. Often self-limiting (80%) but recurs in 25%. ANGIODYSPLASIA: second most common (10\u201340%), especially in elderly \u2014 arteriovenous malformations usually in caecum\/right colon. IBD: causes chronic blood loss or moderate acute bleeding, rarely massive. Bowel ischaemia: causes bloody diarrhoea but is usually not the most common cause of massive acute LGIB. Diverticular disease is the most common cause of severe acute lower GI bleeding.'\n },\n {\n id:80,\n stem:'Risk scoring system used to stratify the patients of acute upper gastrointestinal bleeding to predict the need for intervention to treat bleeding is:',\n correct:'Modified Blatchford score',\n options:['Modified Blatchford score','Modified Child Pugh score','Balthazar score','Meld score'],\n exp:'RISK SCORING IN UPPER GI BLEEDING: GLASGOW-BLATCHFORD SCORE (GBS) \/ MODIFIED BLATCHFORD SCORE: pre-endoscopy risk stratification tool for acute UGIB. Parameters: Blood urea, Haemoglobin, Systolic BP, Pulse rate, Presence of melaena, Syncope, Hepatic disease, Cardiac failure. Score >0 = likely need for endoscopic intervention; score = 0 = very low risk (can manage as outpatient). Specifically predicts NEED FOR INTERVENTION (blood transfusion, endoscopic treatment, surgery). Rockall Score: pre- and post-endoscopy scoring \u2014 predicts rebleeding and mortality. MODIFIED CHILD-PUGH SCORE: severity of hepatic cirrhosis \u2014 NOT for GI bleeding intervention. BALTHAZAR SCORE: CT grading of acute pancreatitis. MELD SCORE (Model for End-stage Liver Disease): liver transplant prioritisation, cirrhosis prognosis. Modified Blatchford score = correct answer for predicting intervention need in UGIB.'\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 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Submitting in 10 Submit Now Combined Medical Services Examination 2018Paper I \u00b7 Part B Parasitology \u00b7 Microbiology \u00b7 Toxicology \u00b7 Critical Care \u00b7 Gastroenterology \u00b7 Nephrology \u00b7 Neurology \u00b7 Respiratory Questions 41 \u2013 80 Options reshuffled \u23f1 Start Timed Mode… <\/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-36794","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CMS 2018 P1 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\/10\/cms-2018-p1-part-b\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2018 P1 Part-B - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2018 Paper I \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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