CMS 2018 Paper II \u2013 Part A (Q1\u2013Q40)<\/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#cms18p2a*,#cms18p2a *::before,#cms18p2a *::after{box-sizing:border-box;margin:0;padding:0}\n#cms18p2a{--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:#fff;--cb:#43a047;--cb-bg:#eaf7ef;--wb:#e53935;--wb-bg:#fdf0f0;--r: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#cms18p2a .sen{height:1px}\n#cms18p2a .sb{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px solid var(--ter);box-shadow:0 2px 12px 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id=\"cms18p2a-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms18p2a-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms18p2a-sn\">0<\/strong> \/ <strong id=\"cms18p2a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms18p2a-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms18p2a-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms18p2a-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms18p2a-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2018<br>Paper II \u00b7 Part A<\/h1>\n <p>Preventive & Social Medicine \u00b7 Epidemiology \u00b7 Community Health \u00b7 Obstetrics & Gynaecology<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 1 \u2013 40<\/span>\n <span class=\"bdg\">Options reshuffled<\/span>\n <button class=\"tbtn\" id=\"cms18p2a-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms18p2a-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms18p2a-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms18p2a-sc-box\">\n <div class=\"ring\" id=\"cms18p2a-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms18p2a-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms18p2a-nl\"><\/div>\n <div class=\"vd\" id=\"cms18p2a-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms18p2a-bc\"><\/span>\n <span class=\"band bw\" id=\"cms18p2a-bw\"><\/span>\n <span class=\"band bs\" id=\"cms18p2a-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms18p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms18p2a',TOTAL=40,MAX=160,TSECS=2400,GSECS=10;\nvar QS=[\n{id:1,stem:'What are the characteristics of ideal health indicators?',correct:'They should be valid, reliable, sensitive, specific, feasible and relevant',options:['They should be valid, reliable, sensitive, specific, feasible and relevant','They should be mainly valid, reliable and sensitive but need not be specific','They should be mainly valid, reliable and feasible but need not be sensitive','They should be mainly valid, reliable and relevant but need not be feasible'],exp:'Ideal health indicators must satisfy ALL six criteria \u2014 mnemonic VRSSFR: Valid (measures what it purports to measure), Reliable\/Reproducible (consistent results across observers and time), Sensitive (detects changes in health status), Specific (reflects changes only in the situation concerned), Feasible (data collection is practical), Relevant (pertinent to the health problem). No criterion is optional. WHO and Park\\'s Textbook of Preventive & Social Medicine emphasise all six as mandatory.'},\n{id:2,stem:'Which one of the following statements regarding predictive value of a positive test is true?',correct:'It tells the probability that a patient with positive test has the disease in question',options:['It does not tell about diagnostic power of test','The more prevalent the disease, the less accurate the test is','It tells the probability that a patient with positive test has the disease in question','It tells the probability that a patient with positive test does not have the disease in question'],exp:'Positive Predictive Value (PPV) = True Positives \/ (True Positives + False Positives). It answers: given a POSITIVE test, what is the probability that the patient actually HAS the disease? PPV INCREASES with higher disease prevalence \u2014 more prevalent disease \u2192 more likely a positive test is a true positive (option b is wrong). PPV directly reflects diagnostic utility of a positive result in clinical practice.'},\n{id:3,stem:'The yield of a screening test CANNOT be increased by which of the following?',correct:'Improved specificity',options:['Including entire population','Including high risk population','Improved sensitivity','Improved specificity'],exp:'Yield = number of previously unrecognised cases detected per unit screening effort. Yield is INCREASED by: high-risk group targeting (higher prevalence \u2192 more true positives), including the whole population (more total cases found), and improved sensitivity (detects more true cases). SPECIFICITY improvement reduces false positives \u2014 i.e., fewer positive results overall \u2192 LOWER yield, though higher PPV. Specificity is about correctly ruling out disease in the healthy; it does not increase case detection. Answer: Improved specificity.'},\n{id:4,stem:'Which one of the following statements regarding the growth chart is NOT true?',correct:'It is used as tool for action against the Anganwadi worker',options:['It is used as a tool for growth monitoring and diagnosis','It is used for planning and policy making','It is used as tool for action against the Anganwadi worker','It is used as tool for teaching and evaluation of effectiveness of programme'],exp:'Growth chart uses: growth monitoring and diagnosis \u2714, planning and policy making \u2714, teaching mothers \u2714, evaluating programme effectiveness \u2714. Using it for punitive action against an Anganwadi worker is NOT a purpose \u2014 the growth chart is a health promotion tool, not an administrative disciplinary instrument. This misrepresents its philosophy. Answer: Action against Anganwadi worker \u2014 NOT true.'},\n{id:5,stem:'Flattening of the growth curve in the growth chart signifies:',correct:'Child is showing signs of growth failure',options:['Child is on a healthy path','Child is severely malnourished','Child is showing signs of growth failure','Child does not need special care'],exp:'Interpreting growth chart curves: UPWARD (parallel to reference) = healthy growth. FLAT (horizontal plateau) = GROWTH FAILURE \u2014 child gaining no weight; early warning requiring intervention. DOWNWARD = severe\/acute malnutrition. A flat curve \u2260 severely malnourished (that is a downward curve). A flat curve = growth faltering\/failure, needing immediate attention and supplementary feeding \u2014 NOT \"does not need care.\" Answer: Child is showing signs of growth failure.'},\n{id:6,stem:'A well of contaminated water resulted in an outbreak of diarrhoea in a community. Which type of epidemic will this exposure present with?\\n1. Propagated epidemic\\n2. Common source \u2013 continuous exposure\\n3. Common source \u2013 point exposure',correct:'2 only',options:['1 and 2 only','3 only','1, 2 and 3','2 only'],exp:'A contaminated WELL = ongoing daily exposure as long as people draw water \u2192 COMMON SOURCE \u2013 CONTINUOUS EXPOSURE epidemic (sustained plateau curve). Point source = single, brief exposure \u2192 all cases in one incubation period (e.g., a wedding meal) \u2014 NOT applicable here. Propagated = person-to-person spread with multiple peaks \u2014 NOT applicable. A contaminated well produces a plateau epidemic curve characteristic of continuous common source exposure. Answer: 2 only.'},\n{id:7,stem:'Which one of the following experiments\/trials is NOT a part of non-randomized trial?',correct:'Risk factor trial',options:['Uncontrolled trial','Risk factor trial','Natural experiment','Before and after comparison studies'],exp:'Non-randomised trials: Uncontrolled trial \u2714 (no control group), Natural experiment \u2714 (exposure determined by circumstances), Before-and-after comparison studies \u2714 (same population pre\/post intervention). RISK FACTOR TRIAL: subjects are RANDOMLY ALLOCATED to modification\/elimination of a risk factor vs control \u2014 this IS a randomised trial. Randomisation is required to establish causality between risk factor change and disease outcome. Risk factor trial belongs to RANDOMISED trials, not non-randomised. Answer: Risk factor trial.'},\n{id:8,stem:'What is the relative risk of developing tuberculosis among tobacco users?\\n\\nTobacco user | TB Yes | TB No | Total\\nYes | 40 | 80 | 120\\nNo | 10 | 70 | 80\\nTotal | 50 | 150 | 200',correct:'2.67',options:['0.48','1.33','2.67','3.90'],exp:'RR = Incidence in exposed \/ Incidence in unexposed. Incidence in tobacco users = 40\/120 = 0.333. Incidence in non-tobacco users = 10\/80 = 0.125. RR = 0.333\/0.125 = 2.67. Verification: (40\u00d780)\/(10\u00d7120) = 3200\/1200 = 2.67 \u2714. Tobacco users are 2.67\u00d7 more likely to develop TB than non-users. Answer: 2.67.'},\n{id:9,stem:'What is the attributable risk of tobacco for developing tuberculosis?\\n\\nTobacco users | TB Present | TB Absent | Total\\nYes | 40 | 80 | 120\\nNo | 10 | 70 | 80\\nTotal | 50 | 150 | 200',correct:'62.5%',options:['50.5%','62.5%','70.6%','80.6%'],exp:'Attributable Risk % (in exposed) = [(Risk exposed \u2013 Risk unexposed) \/ Risk exposed] \u00d7 100. Risk in exposed = 40\/120 = 0.3333. Risk in unexposed = 10\/80 = 0.125. AR% = (0.3333 \u2013 0.125)\/0.3333 \u00d7 100 = 0.2083\/0.3333 \u00d7 100 = 62.5%. Alternatively: (RR\u20131)\/RR \u00d7 100 = 1.67\/2.67 \u00d7 100 = 62.5% \u2714. 62.5% of TB among tobacco users is attributable to tobacco. Answer: 62.5%.'},\n{id:10,stem:'What is the sensitivity of EEG for detecting brain tumours?\\n\\nEEG Result | Tumour Absent | Tumour Present\\nPositive | 54,000 | 36\\nNegative | 3,06,000 | 4\\nTotal | 3,60,000 | 40',correct:'90%',options:['90%','85%','0.07%','99.99%'],exp:'Sensitivity = TP \/ (TP + FN). TP (EEG positive, tumour present) = 36. FN (EEG negative, tumour present) = 4. Total with tumour = 40. Sensitivity = 36\/40 = 90%. This means 90% of people who truly have a brain tumour are correctly identified by EEG. Note: Specificity = 306,000\/360,000 = 85%. PPV = 36\/54,036 = 0.07% (very low \u2014 low disease prevalence). Answer: Sensitivity = 90%.'},\n{id:11,stem:'Which sign is most important in deciding severe pneumonia in a child?',correct:'Chest indrawing',options:['Fast breathing','Nasal flaring','Chest indrawing','Grunting'],exp:'IMCI classification: Pneumonia (non-severe) = fast breathing alone (\u226560\/min <2 months; \u226550\/min 2\u201312 months; \u226540\/min 1\u20135 years). SEVERE pneumonia = CHEST INDRAWING (subcostal\/lower chest wall retractions on inspiration \u2014 indicates increased work of breathing). Very severe = cyanosis, unable to feed, stridor, convulsions. Per IMCI: chest indrawing is the single defining criterion distinguishing pneumonia from SEVERE pneumonia. Fast breathing = pneumonia; Chest indrawing = severe pneumonia. Answer: Chest indrawing.'},\n{id:12,stem:'Varicella-Zoster Immunoglobulin (VZIG) is NOT recommended for which of the exposed susceptible individuals?',correct:'Healthy sibling',options:['Newborn','HIV\/AIDS positive','Healthy sibling','Pregnant women'],exp:'VZIG is indicated for HIGH-RISK susceptible individuals after VZV exposure: Newborns \u2714 (especially perinatally exposed), HIV\/AIDS positive \u2714 (severe disseminated disease risk), Pregnant women \u2714 (severe pneumonia + fetal risk), immunocompromised patients. HEALTHY SIBLING = immunocompetent child \u2014 varicella is generally mild and self-limiting in immunocompetent individuals. VZIG is NOT indicated; the varicella vaccine (within 5 days of exposure) is preferred instead. Answer: Healthy sibling.'},\n{id:13,stem:'Carriers of avirulent organism are called:',correct:'Pseudo carriers',options:['Incubatory carriers','Convalescent carriers','Healthy carrier','Pseudo carriers'],exp:'Carrier classification: Incubatory carrier = spreads organism during incubation period. Convalescent carrier = continues shedding during recovery. Healthy (symptomless) carrier = harbours virulent organism but never develops illness. PSEUDO CARRIER = temporarily harbours an AVIRULENT (non-disease-causing) strain \u2014 the organism cannot cause disease by definition. Key distinction: healthy carrier has virulent organism; pseudo carrier has avirulent organism. Answer: Pseudo carriers.'},\n{id:14,stem:'A cohort study in Rampur village: 120 tobacco users, 80 non-users; after 1 year, 40 tobacco users and 10 non-users developed tuberculosis. The incidence of tuberculosis among tobacco users is:',correct:'33.3 per 100 men\/year',options:['12.5 per 100 men\/year','25.0 per 100 men\/year','30.0 per 100 men\/year','33.3 per 100 men\/year'],exp:'Incidence = (New cases \/ Population at risk) \u00d7 100. Among tobacco users: 40\/120 \u00d7 100 = 33.33 per 100 men\/year. Non-users: 10\/80 \u00d7 100 = 12.5\/100\/year. Overall: 50\/200 \u00d7 100 = 25\/100\/year. In a cohort study, incidence can be directly calculated from exposed and unexposed groups. Answer: 33.3 per 100 men\/year.'},\n{id:15,stem:'Given data: Exposure A has RR=5, AR=80%, PAR=70%. Exposure B has RR=10, AR=90%, PAR=50%. Which control strategy is preferable?',correct:'Preference to control exposure A, because it has a higher population attributable risk',options:['Preference to control exposure B as it has a higher relative risk','Preference to control exposure A, because it has a higher population attributable risk','Preference to control exposure B, because it has a higher attributable risk','Cannot decide, as the precedence of exposure in the community has not been mentioned'],exp:'For public health decision-making, POPULATION ATTRIBUTABLE RISK (PAR%) is most relevant \u2014 it quantifies how much disease in the TOTAL POPULATION is due to a given exposure, accounting for both the strength of association AND prevalence of exposure. Exposure A PAR=70% \u2192 controlling A would prevent 70% of all cases. Exposure B PAR=50% \u2192 only 50% prevented. RR reflects individual risk but not population impact. AR% is exposure-specific \u2014 not population-level. PAR is the key criterion for priority-setting. Answer: Control Exposure A (PAR=70%).'},\n{id:16,stem:'Which study design is most appropriate to find the association between mobile phone radiation and cancer?',correct:'Case-control',options:['Cross-sectional','Case-control','Single-arm interventional','Case-series'],exp:'Cancer is a RARE outcome with LONG LATENCY (years of exposure before cancer). CASE-CONTROL study is most appropriate: (1) Efficient for rare outcomes \u2014 starts with existing cancer cases, then looks back at radiation exposure retrospectively. (2) Overcomes latency \u2014 can assess years of prior exposure efficiently. (3) Economical. Cross-sectional: cannot establish temporality; impractical for rare disease. Cohort: needs massive numbers followed for decades. Single-arm interventional: unethical. Case-series: no comparison group. Case-control = ideal for rare disease with long latency.'},\n{id:17,stem:'Villages A and B have very different age compositions. Which is the best indicator for comparing their death rates?',correct:'Age standardized death rate',options:['Crude death rate','Age standardized death rate','Specific death rate','Proportional mortality rate'],exp:'When comparing mortality between populations with DIFFERENT AGE STRUCTURES, crude death rate is misleading \u2014 a population with more elderly will have a higher crude death rate due to age composition alone, not worse health. AGE STANDARDIZED (Age-adjusted) DEATH RATE uses a standard reference population to control for age differences \u2014 allows fair comparison of underlying mortality. Village A is younger; Village B is older \u2014 crude rates are confounded. Standardisation removes this confounding. Specific death rate = one age group, not overall. PMR = proportional cause of death. Answer: Age standardized death rate.'},\n{id:18,stem:'Which of the following is\/are suggested by rising incidence rates of any disease?\\n1. Need for a new disease control programme\\n2. Improvement in reporting practices\\n3. Change in the etiology of the disease',correct:'1, 2 and 3',options:['1 and 3 only','1 only','1, 2 and 3','2 and 3 only'],exp:'A rising incidence rate can result from multiple explanations \u2014 all three are valid: (1) True increase \u2192 existing control measures inadequate \u2192 need new programme \u2714. (2) Improved surveillance\/reporting \u2192 apparent increase without true change \u2714 (e.g., better TB notification). (3) New pathogen, emerging risk factor, environmental change \u2192 true aetiological shift \u2714. Epidemiologists must distinguish artefactual from true increases. All three are plausible. Answer: 1, 2 and 3.'},\n{id:19,stem:'What constitutes the denominator in \"Total Dependency Ratio\"?',correct:'Population 15\u201364 years of age',options:['Population 15\u201345 years of age','Mid year population','Population 15\u201364 years of age','Population less than 14 and more than 65 years of age'],exp:'Total Dependency Ratio = (Pop <15 + Pop \u226565) \/ (Pop 15\u201364) \u00d7 100. DENOMINATOR = WORKING-AGE POPULATION = 15\u201364 years (economically productive). NUMERATOR = dependants = <15 + \u226565. The numerator represents those not expected to be economically active. Youth dependency = <15 \/ 15\u201364. Old-age dependency = \u226565 \/ 15\u201364. Denominator = Population 15\u201364 years.'},\n{id:20,stem:'A pregnant woman in 2nd trimester from a North Eastern State is diagnosed with uncomplicated P. falciparum. She should be treated with:',correct:'Artesunate, Sulphadoxine and Pyrimethamine',options:['Artemether and Lumefantrine','Artesunate and Sulphadoxine','Artesunate, Sulphadoxine and Pyrimethamine','Chloroquine and Primaquine'],exp:'Treatment of uncomplicated P. falciparum in pregnancy \u2014 India NVBDCP: 1st trimester: Quinine + Clindamycin (artemisinins avoided). 2nd and 3rd trimesters: ACT is safe and recommended. For NORTH EASTERN India (where chloroquine and SP resistance is prevalent), the recommended ACT is ARTESUNATE + SULPHADOXINE-PYRIMETHAMINE (AS+SP). Primaquine is CONTRAINDICATED in pregnancy. Chloroquine is ineffective (resistance). AL (Artemether-Lumefantrine) is used in other parts of India but AS+SP is the NE India guideline recommendation. Answer: Artesunate + Sulphadoxine + Pyrimethamine.'},\n{id:21,stem:'By which one of the following studies can relative risk be best calculated?',correct:'Cohort study',options:['Cohort study','Correlation study','Case-control study','Randomised control trial'],exp:'RR = Incidence in exposed \/ Incidence in unexposed. To calculate RR directly, you need INCIDENCE RATES in both exposed and unexposed groups \u2014 requiring follow-up of initially disease-free subjects over time. COHORT STUDY: directly calculates incidence in both groups \u2192 RR calculated accurately and directly. Case-control: cannot directly calculate incidence \u2192 uses Odds Ratio (approximates RR when disease is rare). Correlation study: population-level data, not individual RR. RCT: also calculates RR but is primarily for interventions. Cohort study = best for calculating RR.'},\n{id:22,stem:'Orthotolidine (OT) test determines residual free chlorine. What colour indicates presence of free chlorine?',correct:'Yellow',options:['Red','Yellow','Blue','Green'],exp:'OT (Orthotolidine) Test: OT reagent + water containing free chlorine \u2192 YELLOW colour (pale to deep amber depending on concentration). Colourless = no free chlorine. Interpretation: residual free chlorine should be \u22650.2 mg\/L at consumer level. DPD test produces PINK\/RED colour (more accurate). Starch-iodide: BLUE (for high concentrations). For OT test specifically: YELLOW = free chlorine present. Answer: Yellow.'},\n{id:23,stem:'Consider Navjat Shishu Suraksha Karyakram (NSSK):\\n1. Trains health personnel in basic newborn care and resuscitation\\n2. Addresses care at birth \u2014 prevention of hypothermia, infection, early breastfeeding, basic resuscitation\\n3. Objective: trained person in basic newborn care at every delivery point\\nWhich are correct?',correct:'1, 2 and 3',options:['1 and 2 only','1 and 3 only','1, 2 and 3','2 and 3 only'],exp:'NSSK (launched 2009): (1) \u2714 Trains ALL health personnel (doctors, nurses, ANMs, SBAs) in basic newborn care and resuscitation using standardised curriculum. (2) \u2714 Specifically addresses the 4 pillars of care at birth: prevention of hypothermia, prevention of infection, early initiation of breastfeeding (within 1 hour), and basic newborn resuscitation (bag-mask PPV). (3) \u2714 Programme objective: at every delivery point in India, at least ONE trained person for basic newborn care and resuscitation. All three are correct. Answer: 1, 2 and 3.'},\n{id:24,stem:'The most important indicator for assessment of impact in Salt Iodization Programme is:',correct:'Testing median urinary Iodine excretion',options:['Testing Iodine content of salt at consumer level','Testing Iodine content of salt at production level','Testing median urinary Iodine excretion','Testing serum Iodine levels'],exp:'Assessment levels in iodisation programmes: PROCESS: iodine at production level. OUTPUT\/COVERAGE: iodine at consumer\/household level (\u226515 ppm). IMPACT: MEDIAN URINARY IODINE EXCRETION (UIE) \u2014 the WHO-recommended gold standard impact indicator. 90% of iodine is excreted in urine; UIE directly reflects body iodine status. Median UIE >100 \u00b5g\/L = adequate; 50\u201399 = mild deficiency; <50 = moderate\/severe. Serum iodine: not practical for population monitoring. UIE = most important impact indicator. Answer: Median urinary iodine excretion.'},\n{id:25,stem:'Caisson\\'s disease is usually seen in which group of workers?',correct:'Construction workers under sea level',options:['Cotton field agricultural workers','Construction workers under sea level','Workers in manufacture of gas','Workers in radiation units'],exp:'CAISSON\\'S DISEASE (Decompression Sickness \/ \"The Bends\"): occurs when workers in HIGH-PRESSURE environments (compressed air) return to normal pressure too rapidly. Nitrogen dissolves in blood under pressure; rapid decompression \u2192 nitrogen bubbles in blood, joints, tissues \u2192 pain, neurological symptoms, air embolism. Workers affected: UNDERWATER TUNNEL\/CAISSON construction workers, divers, hyperbaric chamber workers. Cotton workers: byssinosis. Gas manufacture: various gas exposures. Radiation workers: radiation sickness. Answer: Construction workers under sea level.'},\n{id:26,stem:'Toxic effects of abdominal colic, obstinate constipation, anorexia, anaemia, stippling of red cells and blue line on gums are due to exposure to:',correct:'Lead',options:['Carbon monoxide','Asbestos','Lead','Radiation'],exp:'LEAD POISONING (Plumbism) \u2014 classic features: ABDOMINAL: lead colic, obstinate constipation, anorexia. HAEMATOLOGICAL: microcytic hypochromic anaemia, BASOPHILIC STIPPLING of RBCs (pathognomonic). GINGIVAL: BURTON\\'S LINE \u2014 blue-black line at the gum-tooth junction (lead sulfide deposition). Peripheral neuropathy (wrist\/foot drop), encephalopathy in severe cases. Raised blood\/urine ALA, raised FEP. CO: cherry-red skin, headache. Asbestos: mesothelioma, asbestosis. The full triad of stippled RBCs + Burton\\'s line + colic = Lead. Answer: Lead.'},\n{id:27,stem:'Which one of the following conditions can be screened during neonatal screening by biochemical tests?',correct:'Congenital hypothyroidism',options:['Congenital dislocation of hip','Congenital hypothyroidism','Chromosomal abnormalities','Congenital rubella'],exp:'Neonatal BIOCHEMICAL screening (heel-prick\/Guthrie card): CONGENITAL HYPOTHYROIDISM \u2714 \u2014 TSH (\u00b1T4) from blood spot; most common and cost-effective neonatal screen; early thyroxine treatment prevents intellectual disability. Also: PKU (phenylalanine), galactosaemia, CAH (17-OH progesterone), G6PD. CDH: clinical (Barlow\/Ortolani) + hip ultrasound. Chromosomal abnormalities: prenatal (NIPT\/amniocentesis\/karyotype) or clinical postnatally. Congenital rubella: serological\/clinical. Answer: Congenital hypothyroidism.'},\n{id:28,stem:'Which of the following is NOT a mass approach in health communication?',correct:'Role play',options:['Folk methods','Role play','Posters','Health exhibition'],exp:'Health communication approaches: MASS approaches (reach large audiences simultaneously): Posters \u2714, Health exhibitions \u2714, Folk\/traditional methods \u2714 (street plays, puppet shows, folk songs), radio, TV, social media. GROUP approaches (small, interactive): ROLE PLAY \u2014 participants actively simulate health situations in small groups; inherently limited in numbers, cannot reach large populations simultaneously. Role play is a GROUP educational method, not a mass approach. Answer: Role play.'},\n{id:29,stem:'Which of the following are non-modifiable risk factors for hypertension?\\n1. Age\\n2. Sex\\n3. Genetic factors',correct:'1, 2 and 3',options:['1 only','1 and 2 only','1, 2 and 3','2 and 3 only'],exp:'Non-modifiable risk factors for hypertension: AGE \u2714 (BP rises with age; cannot reverse ageing). SEX \u2714 (males higher risk pre-menopause; females higher post-menopause; determined at birth). GENETIC FACTORS \u2714 (inherited RAAS polymorphisms, family history; genetic constitution cannot be changed). Modifiable: obesity, physical inactivity, high salt intake, alcohol, smoking, dyslipidaemia, diabetes, stress. All three listed are non-modifiable. Answer: 1, 2 and 3.'},\n{id:30,stem:'What is the correct daily dose of Iron and Folic acid for a child aged 12 years?',correct:'60 mg elemental Iron and 300 mcg folic acid',options:['20 mg elemental Iron and 100 mcg folic acid','30 mg elemental Iron and 250 mcg folic acid','60 mg elemental Iron and 300 mcg folic acid','100 mg elemental Iron and 500 mcg folic acid'],exp:'National Iron Plus Initiative (NIPI) \u2014 IFA supplementation for prevention and treatment: Children 6\u201360 months: 25 mg iron + 100 mcg folic acid (syrup). Children 5\u201310 years: 45 mg iron + 400 mcg folic acid. ADOLESCENTS\/children \u226510 years (including 12-year-olds): 60 mg elemental iron + 300\u2013500 mcg folic acid (daily therapeutic \/ weekly preventive). Per standard UPSC PSM exam answer for a 12-year-old: 60 mg elemental iron + 300 mcg folic acid. Answer: 60 mg iron and 300 mcg folic acid.'},\n{id:31,stem:'When should breastfeeding be initiated to an infant born via a normal delivery?',correct:'Within one hour of birth',options:['Within half an hour','Within one hour of birth','Within 2\u20134 hours of birth','After 4 hours of birth'],exp:'WHO, UNICEF, and Government of India (NHM\/IMNCI) recommendation: Breastfeeding should be initiated WITHIN ONE HOUR OF BIRTH \u2014 defined as \"early initiation.\" Key benefits: colostrum (IgA, lactoferrin, growth factors \u2014 \"first vaccine\"), oxytocin release \u2192 uterine contraction \u2192 reduces PPH, bonding, prevents hypothermia and hypoglycaemia. Historical note: older guidelines said \"within 30 minutes\" \u2014 updated WHO recommendation: WITHIN 1 HOUR. Current standard = within one hour. Answer: Within one hour of birth.'},\n{id:32,stem:'As per Biomedical Waste Management Rules 2016, metallic body implants should be discarded in which of the following?',correct:'Separate collection system',options:['Yellow colored non-chlorinated plastic bag','Red colored non-chlorinated plastic bag','Card board box with blue colored marking','Separate collection system'],exp:'BMW Rules 2016 \u2014 colour coding: Yellow bag: anatomical waste, soiled waste, discarded medicines, chemical\/cytotoxic waste. Red bag: contaminated recyclable plastic (IV sets, syringes without needles). Blue\/white puncture-proof: glass, metallic sharps (needles, blades). METALLIC BODY IMPLANTS (orthopaedic implants, stents, metal prostheses) recovered during surgery\/post-mortem: special category \u2014 collected in a SEPARATE COLLECTION SYSTEM for smelting\/recycling; not in standard colour-coded bags. Answer: Separate collection system.'},\n{id:33,stem:'Which of the following is NOT a quantitative method in the management of health services?',correct:'Management by objectives',options:['Network analysis','Management by objectives','System analysis','Planning programming budgeting system'],exp:'Quantitative methods in health management use mathematical\/operational research techniques: Network analysis \u2714 (PERT\/CPM \u2014 mathematical project scheduling), System analysis \u2714 (mathematical modelling of health system inputs\/outputs), PPBS \u2714 (Planning Programming Budgeting System \u2014 quantitative resource allocation). MANAGEMENT BY OBJECTIVES (MBO): a management philosophy\/process (Peter Drucker) where managers and staff jointly set goals and evaluate performance \u2014 this is a QUALITATIVE\/ORGANISATIONAL approach focusing on goal-setting and motivation, not mathematical quantification. Answer: Management by objectives.'},\n{id:34,stem:'India is in which stage of the demographic cycle?',correct:'Late expanding',options:['High stationary','Early expanding','Late expanding','Low stationary'],exp:'Demographic Transition stages: Stage 1 (High Stationary): high birth + high death rate. Stage 2 (Early Expanding): high birth + falling death \u2192 rapid growth. Stage 3 (LATE EXPANDING): falling birth + low death \u2192 still growing but rate slowing. Stage 4 (Low Stationary): low birth + low death \u2192 stable. Stage 5: declining. India: death rates have fallen significantly; birth rates declining but still above replacement (TFR ~2.0\u20132.1). Population still growing but rate of growth declining. India = LATE EXPANDING (Stage 3). Answer: Late expanding.'},\n{id:35,stem:'Manual Vacuum Aspiration (MVA) introduced in primary health centres helps in reducing which index?',correct:'Maternal mortality',options:['Infant mortality','Neonatal mortality','Preterm mortality','Maternal mortality'],exp:'MVA = safe, WHO-recommended procedure for uterine evacuation (incomplete\/induced abortion up to 10\u201312 weeks). Unsafe\/illegal abortions are a major cause of MATERNAL MORTALITY in India (~8\u201310% of maternal deaths). Introducing MVA at PHCs enables: safe management of incomplete abortions (prevents sepsis from retained products), safe first-trimester MTP (avoids unsafe practices at peripheral level). Result: fewer deaths from septic abortion and haemorrhage. MVA directly reduces MATERNAL MORTALITY, not infant\/neonatal\/preterm mortality. Answer: Maternal mortality.'},\n{id:36,stem:'The agreement (yes\/no) between two observers is statistically measured by:',correct:'Kappa coefficient',options:['Specificity','Sensitivity','Correlation coefficient','Kappa coefficient'],exp:'Inter-rater reliability for CATEGORICAL (yes\/no) data: KAPPA COEFFICIENT (Cohen\\'s \u03ba) = standard measure. It corrects for chance agreement. Formula: \u03ba = (Observed \u2013 Expected agreement) \/ (1 \u2013 Expected agreement). Interpretation: <0.20 = poor; 0.21\u20130.40 = fair; 0.41\u20130.60 = moderate; 0.61\u20130.80 = good; 0.81\u20131.00 = excellent. Sensitivity\/Specificity: test performance vs gold standard \u2014 not observer agreement. Pearson\/Spearman correlation: continuous variables. Kappa is specifically designed for categorical inter-observer agreement. Answer: Kappa coefficient.'},\n{id:37,stem:'How many postnatal visits should be made by the ANM to the house of a low birth weight baby?',correct:'6',options:['2','4','6','8'],exp:'Home-Based Newborn Care (HBNC) schedule: Normal weight babies: 7 ASHA visits (days 1, 3, 7, 14, 21, 28, and within 42 days). LOW BIRTH WEIGHT babies: increased frequency \u2014 6 ANM visits within the first 28 days (days 1, 3, 7, 14, 21, 28). Rationale: LBW babies (<2500 g) are at higher risk for hypothermia, hypoglycaemia, infection, poor feeding, and mortality \u2014 requiring more intensive monitoring. Per Government of India HBNC guidelines: 6 postnatal visits for LBW babies. Answer: 6.'},\n{id:38,stem:'The difference between Type A and Type B sub centre as per Indian Public Health Standards is in terms of:',correct:'Staffing pattern',options:['Labour room or delivery facility','Staffing pattern','Location','Availability of drugs'],exp:'Sub-centres \u2014 IPHS: TYPE A: ONE ANM + one MPW (male). TYPE B: TWO ANMs + one MPW \u2014 for areas with higher workload (tribal\/hard-to-reach areas). The key difference = STAFFING PATTERN (number of ANMs). Labour room: not standard at sub-centre level (PHC has this). Drug availability: same formulary both types. Location: both can be anywhere. Answer: Staffing pattern.'},\n{id:39,stem:'Which of the following Screening methods for Disease is the least useful?',correct:'Mass screening',options:['Mass screening','High risk group screening','Multiphasic screening','Selective screening'],exp:'Screening efficiency comparison: High-risk group screening: most efficient \u2014 targets high pre-test probability groups \u2192 high yield per person. Selective screening: targeted by specific criteria \u2014 efficient. Multiphasic screening: multiple tests simultaneously \u2192 cost-effective. MASS SCREENING: entire population regardless of risk \u2192 very low yield per screened person (most do not have the disease), expensive, least efficient. Justified only when disease is very common and cheap tests exist. In terms of efficiency and yield per individual, mass screening is LEAST USEFUL. Answer: Mass screening.'},\n{id:40,stem:'Which one of the following is an indicator for evaluation of impact of family planning?',correct:'Family size',options:['Family size','Number of postpartum services availed','Change in behaviour of people','Community needs assessment'],exp:'Evaluation hierarchy: Input: resources allocated. Process: services delivered (postpartum services availed \u2014 process indicator). Output: CPR, contraceptive acceptance. IMPACT: measures the ultimate demographic goal \u2014 FAMILY SIZE (average number of children per couple) is the most direct measure of family planning programme impact. Also: TFR, crude birth rate, IMR. Community needs assessment = planning tool (input). Change in behaviour = outcome indicator. Number of postpartum services availed = process. Family size directly measures whether the programme achieved its demographic goal. 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Submitting in 10 Submit Now Combined Medical Services Examination 2018Paper II \u00b7 Part A Preventive & Social Medicine \u00b7 Epidemiology \u00b7 Community Health \u00b7 Obstetrics & Gynaecology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score… <\/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":[18,55,54],"tags":[],"class_list":["post-36809","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg","category-psm"],"yoast_head":"\n<title>CMS 2018 P2 Part-A - 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\/11\/cms-2018-p2-part-a\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2018 P2 Part-A - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2018 Paper II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! 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var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms18p2a .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms18p2a .hdr h1{font-size:1.15rem}#cms18p2a .qt{font-size:.88rem}#cms18p2a .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms18p2a\">\n<div class=\"sen\" id=\"cms18p2a-sen\"><\/div>\n<div class=\"sb\" id=\"cms18p2a-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms18p2a-ti\">\u23f1 <strong id=\"cms18p2a-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms18p2a-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms18p2a-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms18p2a-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms18p2a-sn\">0<\/strong> \/ <strong id=\"cms18p2a-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms18p2a-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms18p2a-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms18p2a-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms18p2a-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2018<br>Paper II \u00b7 Part A<\/h1>\n <p>Preventive & Social Medicine \u00b7 Epidemiology \u00b7 Community Health \u00b7 Obstetrics & Gynaecology<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 1 \u2013 40<\/span>\n <span class=\"bdg\">Options reshuffled<\/span>\n <button class=\"tbtn\" id=\"cms18p2a-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms18p2a-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms18p2a-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms18p2a-sc-box\">\n <div class=\"ring\" id=\"cms18p2a-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms18p2a-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms18p2a-nl\"><\/div>\n <div class=\"vd\" id=\"cms18p2a-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms18p2a-bc\"><\/span>\n <span class=\"band bw\" id=\"cms18p2a-bw\"><\/span>\n <span class=\"band bs\" id=\"cms18p2a-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms18p2a-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms18p2a',TOTAL=40,MAX=160,TSECS=2400,GSECS=10;\nvar QS=[\n{id:1,stem:'What are the characteristics of ideal health indicators?',correct:'They should be valid, reliable, sensitive, specific, feasible and relevant',options:['They should be valid, reliable, sensitive, specific, feasible and relevant','They should be mainly valid, reliable and sensitive but need not be specific','They should be mainly valid, reliable and feasible but need not be sensitive','They should be mainly valid, reliable and relevant but need not be feasible'],exp:'Ideal health indicators must satisfy ALL six criteria \u2014 mnemonic VRSSFR: Valid (measures what it purports to measure), Reliable\/Reproducible (consistent results across observers and time), Sensitive (detects changes in health status), Specific (reflects changes only in the situation concerned), Feasible (data collection is practical), Relevant (pertinent to the health problem). No criterion is optional. WHO and Park\\'s Textbook of Preventive & Social Medicine emphasise all six as mandatory.'},\n{id:2,stem:'Which one of the following statements regarding predictive value of a positive test is true?',correct:'It tells the probability that a patient with positive test has the disease in question',options:['It does not tell about diagnostic power of test','The more prevalent the disease, the less accurate the test is','It tells the probability that a patient with positive test has the disease in question','It tells the probability that a patient with positive test does not have the disease in question'],exp:'Positive Predictive Value (PPV) = True Positives \/ (True Positives + False Positives). It answers: given a POSITIVE test, what is the probability that the patient actually HAS the disease? PPV INCREASES with higher disease prevalence \u2014 more prevalent disease \u2192 more likely a positive test is a true positive (option b is wrong). PPV directly reflects diagnostic utility of a positive result in clinical practice.'},\n{id:3,stem:'The yield of a screening test CANNOT be increased by which of the following?',correct:'Improved specificity',options:['Including entire population','Including high risk population','Improved sensitivity','Improved specificity'],exp:'Yield = number of previously unrecognised cases detected per unit screening effort. Yield is INCREASED by: high-risk group targeting (higher prevalence \u2192 more true positives), including the whole population (more total cases found), and improved sensitivity (detects more true cases). SPECIFICITY improvement reduces false positives \u2014 i.e., fewer positive results overall \u2192 LOWER yield, though higher PPV. Specificity is about correctly ruling out disease in the healthy; it does not increase case detection. Answer: Improved specificity.'},\n{id:4,stem:'Which one of the following statements regarding the growth chart is NOT true?',correct:'It is used as tool for action against the Anganwadi worker',options:['It is used as a tool for growth monitoring and diagnosis','It is used for planning and policy making','It is used as tool for action against the Anganwadi worker','It is used as tool for teaching and evaluation of effectiveness of programme'],exp:'Growth chart uses: growth monitoring and diagnosis \u2714, planning and policy making \u2714, teaching mothers \u2714, evaluating programme effectiveness \u2714. Using it for punitive action against an Anganwadi worker is NOT a purpose \u2014 the growth chart is a health promotion tool, not an administrative disciplinary instrument. This misrepresents its philosophy. Answer: Action against Anganwadi worker \u2014 NOT true.'},\n{id:5,stem:'Flattening of the growth curve in the growth chart signifies:',correct:'Child is showing signs of growth failure',options:['Child is on a healthy path','Child is severely malnourished','Child is showing signs of growth failure','Child does not need special care'],exp:'Interpreting growth chart curves: UPWARD (parallel to reference) = healthy growth. FLAT (horizontal plateau) = GROWTH FAILURE \u2014 child gaining no weight; early warning requiring intervention. DOWNWARD = severe\/acute malnutrition. A flat curve \u2260 severely malnourished (that is a downward curve). A flat curve = growth faltering\/failure, needing immediate attention and supplementary feeding \u2014 NOT \"does not need care.\" Answer: Child is showing signs of growth failure.'},\n{id:6,stem:'A well of contaminated water resulted in an outbreak of diarrhoea in a community. Which type of epidemic will this exposure present with?\\n1. Propagated epidemic\\n2. Common source \u2013 continuous exposure\\n3. Common source \u2013 point exposure',correct:'2 only',options:['1 and 2 only','3 only','1, 2 and 3','2 only'],exp:'A contaminated WELL = ongoing daily exposure as long as people draw water \u2192 COMMON SOURCE \u2013 CONTINUOUS EXPOSURE epidemic (sustained plateau curve). Point source = single, brief exposure \u2192 all cases in one incubation period (e.g., a wedding meal) \u2014 NOT applicable here. Propagated = person-to-person spread with multiple peaks \u2014 NOT applicable. A contaminated well produces a plateau epidemic curve characteristic of continuous common source exposure. Answer: 2 only.'},\n{id:7,stem:'Which one of the following experiments\/trials is NOT a part of non-randomized trial?',correct:'Risk factor trial',options:['Uncontrolled trial','Risk factor trial','Natural experiment','Before and after comparison studies'],exp:'Non-randomised trials: Uncontrolled trial \u2714 (no control group), Natural experiment \u2714 (exposure determined by circumstances), Before-and-after comparison studies \u2714 (same population pre\/post intervention). RISK FACTOR TRIAL: subjects are RANDOMLY ALLOCATED to modification\/elimination of a risk factor vs control \u2014 this IS a randomised trial. Randomisation is required to establish causality between risk factor change and disease outcome. Risk factor trial belongs to RANDOMISED trials, not non-randomised. Answer: Risk factor trial.'},\n{id:8,stem:'What is the relative risk of developing tuberculosis among tobacco users?\\n\\nTobacco user | TB Yes | TB No | Total\\nYes | 40 | 80 | 120\\nNo | 10 | 70 | 80\\nTotal | 50 | 150 | 200',correct:'2.67',options:['0.48','1.33','2.67','3.90'],exp:'RR = Incidence in exposed \/ Incidence in unexposed. Incidence in tobacco users = 40\/120 = 0.333. Incidence in non-tobacco users = 10\/80 = 0.125. RR = 0.333\/0.125 = 2.67. Verification: (40\u00d780)\/(10\u00d7120) = 3200\/1200 = 2.67 \u2714. Tobacco users are 2.67\u00d7 more likely to develop TB than non-users. Answer: 2.67.'},\n{id:9,stem:'What is the attributable risk of tobacco for developing tuberculosis?\\n\\nTobacco users | TB Present | TB Absent | Total\\nYes | 40 | 80 | 120\\nNo | 10 | 70 | 80\\nTotal | 50 | 150 | 200',correct:'62.5%',options:['50.5%','62.5%','70.6%','80.6%'],exp:'Attributable Risk % (in exposed) = [(Risk exposed \u2013 Risk unexposed) \/ Risk exposed] \u00d7 100. Risk in exposed = 40\/120 = 0.3333. Risk in unexposed = 10\/80 = 0.125. AR% = (0.3333 \u2013 0.125)\/0.3333 \u00d7 100 = 0.2083\/0.3333 \u00d7 100 = 62.5%. Alternatively: (RR\u20131)\/RR \u00d7 100 = 1.67\/2.67 \u00d7 100 = 62.5% \u2714. 62.5% of TB among tobacco users is attributable to tobacco. Answer: 62.5%.'},\n{id:10,stem:'What is the sensitivity of EEG for detecting brain tumours?\\n\\nEEG Result | Tumour Absent | Tumour Present\\nPositive | 54,000 | 36\\nNegative | 3,06,000 | 4\\nTotal | 3,60,000 | 40',correct:'90%',options:['90%','85%','0.07%','99.99%'],exp:'Sensitivity = TP \/ (TP + FN). TP (EEG positive, tumour present) = 36. FN (EEG negative, tumour present) = 4. Total with tumour = 40. Sensitivity = 36\/40 = 90%. This means 90% of people who truly have a brain tumour are correctly identified by EEG. Note: Specificity = 306,000\/360,000 = 85%. PPV = 36\/54,036 = 0.07% (very low \u2014 low disease prevalence). Answer: Sensitivity = 90%.'},\n{id:11,stem:'Which sign is most important in deciding severe pneumonia in a child?',correct:'Chest indrawing',options:['Fast breathing','Nasal flaring','Chest indrawing','Grunting'],exp:'IMCI classification: Pneumonia (non-severe) = fast breathing alone (\u226560\/min <2 months; \u226550\/min 2\u201312 months; \u226540\/min 1\u20135 years). SEVERE pneumonia = CHEST INDRAWING (subcostal\/lower chest wall retractions on inspiration \u2014 indicates increased work of breathing). Very severe = cyanosis, unable to feed, stridor, convulsions. Per IMCI: chest indrawing is the single defining criterion distinguishing pneumonia from SEVERE pneumonia. Fast breathing = pneumonia; Chest indrawing = severe pneumonia. Answer: Chest indrawing.'},\n{id:12,stem:'Varicella-Zoster Immunoglobulin (VZIG) is NOT recommended for which of the exposed susceptible individuals?',correct:'Healthy sibling',options:['Newborn','HIV\/AIDS positive','Healthy sibling','Pregnant women'],exp:'VZIG is indicated for HIGH-RISK susceptible individuals after VZV exposure: Newborns \u2714 (especially perinatally exposed), HIV\/AIDS positive \u2714 (severe disseminated disease risk), Pregnant women \u2714 (severe pneumonia + fetal risk), immunocompromised patients. HEALTHY SIBLING = immunocompetent child \u2014 varicella is generally mild and self-limiting in immunocompetent individuals. VZIG is NOT indicated; the varicella vaccine (within 5 days of exposure) is preferred instead. Answer: Healthy sibling.'},\n{id:13,stem:'Carriers of avirulent organism are called:',correct:'Pseudo carriers',options:['Incubatory carriers','Convalescent carriers','Healthy carrier','Pseudo carriers'],exp:'Carrier classification: Incubatory carrier = spreads organism during incubation period. Convalescent carrier = continues shedding during recovery. Healthy (symptomless) carrier = harbours virulent organism but never develops illness. PSEUDO CARRIER = temporarily harbours an AVIRULENT (non-disease-causing) strain \u2014 the organism cannot cause disease by definition. Key distinction: healthy carrier has virulent organism; pseudo carrier has avirulent organism. Answer: Pseudo carriers.'},\n{id:14,stem:'A cohort study in Rampur village: 120 tobacco users, 80 non-users; after 1 year, 40 tobacco users and 10 non-users developed tuberculosis. The incidence of tuberculosis among tobacco users is:',correct:'33.3 per 100 men\/year',options:['12.5 per 100 men\/year','25.0 per 100 men\/year','30.0 per 100 men\/year','33.3 per 100 men\/year'],exp:'Incidence = (New cases \/ Population at risk) \u00d7 100. Among tobacco users: 40\/120 \u00d7 100 = 33.33 per 100 men\/year. Non-users: 10\/80 \u00d7 100 = 12.5\/100\/year. Overall: 50\/200 \u00d7 100 = 25\/100\/year. In a cohort study, incidence can be directly calculated from exposed and unexposed groups. Answer: 33.3 per 100 men\/year.'},\n{id:15,stem:'Given data: Exposure A has RR=5, AR=80%, PAR=70%. Exposure B has RR=10, AR=90%, PAR=50%. Which control strategy is preferable?',correct:'Preference to control exposure A, because it has a higher population attributable risk',options:['Preference to control exposure B as it has a higher relative risk','Preference to control exposure A, because it has a higher population attributable risk','Preference to control exposure B, because it has a higher attributable risk','Cannot decide, as the precedence of exposure in the community has not been mentioned'],exp:'For public health decision-making, POPULATION ATTRIBUTABLE RISK (PAR%) is most relevant \u2014 it quantifies how much disease in the TOTAL POPULATION is due to a given exposure, accounting for both the strength of association AND prevalence of exposure. Exposure A PAR=70% \u2192 controlling A would prevent 70% of all cases. Exposure B PAR=50% \u2192 only 50% prevented. RR reflects individual risk but not population impact. AR% is exposure-specific \u2014 not population-level. PAR is the key criterion for priority-setting. Answer: Control Exposure A (PAR=70%).'},\n{id:16,stem:'Which study design is most appropriate to find the association between mobile phone radiation and cancer?',correct:'Case-control',options:['Cross-sectional','Case-control','Single-arm interventional','Case-series'],exp:'Cancer is a RARE outcome with LONG LATENCY (years of exposure before cancer). CASE-CONTROL study is most appropriate: (1) Efficient for rare outcomes \u2014 starts with existing cancer cases, then looks back at radiation exposure retrospectively. (2) Overcomes latency \u2014 can assess years of prior exposure efficiently. (3) Economical. Cross-sectional: cannot establish temporality; impractical for rare disease. Cohort: needs massive numbers followed for decades. Single-arm interventional: unethical. Case-series: no comparison group. Case-control = ideal for rare disease with long latency.'},\n{id:17,stem:'Villages A and B have very different age compositions. Which is the best indicator for comparing their death rates?',correct:'Age standardized death rate',options:['Crude death rate','Age standardized death rate','Specific death rate','Proportional mortality rate'],exp:'When comparing mortality between populations with DIFFERENT AGE STRUCTURES, crude death rate is misleading \u2014 a population with more elderly will have a higher crude death rate due to age composition alone, not worse health. AGE STANDARDIZED (Age-adjusted) DEATH RATE uses a standard reference population to control for age differences \u2014 allows fair comparison of underlying mortality. Village A is younger; Village B is older \u2014 crude rates are confounded. Standardisation removes this confounding. Specific death rate = one age group, not overall. PMR = proportional cause of death. Answer: Age standardized death rate.'},\n{id:18,stem:'Which of the following is\/are suggested by rising incidence rates of any disease?\\n1. Need for a new disease control programme\\n2. Improvement in reporting practices\\n3. Change in the etiology of the disease',correct:'1, 2 and 3',options:['1 and 3 only','1 only','1, 2 and 3','2 and 3 only'],exp:'A rising incidence rate can result from multiple explanations \u2014 all three are valid: (1) True increase \u2192 existing control measures inadequate \u2192 need new programme \u2714. (2) Improved surveillance\/reporting \u2192 apparent increase without true change \u2714 (e.g., better TB notification). (3) New pathogen, emerging risk factor, environmental change \u2192 true aetiological shift \u2714. Epidemiologists must distinguish artefactual from true increases. All three are plausible. Answer: 1, 2 and 3.'},\n{id:19,stem:'What constitutes the denominator in \"Total Dependency Ratio\"?',correct:'Population 15\u201364 years of age',options:['Population 15\u201345 years of age','Mid year population','Population 15\u201364 years of age','Population less than 14 and more than 65 years of age'],exp:'Total Dependency Ratio = (Pop <15 + Pop \u226565) \/ (Pop 15\u201364) \u00d7 100. DENOMINATOR = WORKING-AGE POPULATION = 15\u201364 years (economically productive). NUMERATOR = dependants = <15 + \u226565. The numerator represents those not expected to be economically active. Youth dependency = <15 \/ 15\u201364. Old-age dependency = \u226565 \/ 15\u201364. Denominator = Population 15\u201364 years.'},\n{id:20,stem:'A pregnant woman in 2nd trimester from a North Eastern State is diagnosed with uncomplicated P. falciparum. She should be treated with:',correct:'Artesunate, Sulphadoxine and Pyrimethamine',options:['Artemether and Lumefantrine','Artesunate and Sulphadoxine','Artesunate, Sulphadoxine and Pyrimethamine','Chloroquine and Primaquine'],exp:'Treatment of uncomplicated P. falciparum in pregnancy \u2014 India NVBDCP: 1st trimester: Quinine + Clindamycin (artemisinins avoided). 2nd and 3rd trimesters: ACT is safe and recommended. For NORTH EASTERN India (where chloroquine and SP resistance is prevalent), the recommended ACT is ARTESUNATE + SULPHADOXINE-PYRIMETHAMINE (AS+SP). Primaquine is CONTRAINDICATED in pregnancy. Chloroquine is ineffective (resistance). AL (Artemether-Lumefantrine) is used in other parts of India but AS+SP is the NE India guideline recommendation. Answer: Artesunate + Sulphadoxine + Pyrimethamine.'},\n{id:21,stem:'By which one of the following studies can relative risk be best calculated?',correct:'Cohort study',options:['Cohort study','Correlation study','Case-control study','Randomised control trial'],exp:'RR = Incidence in exposed \/ Incidence in unexposed. To calculate RR directly, you need INCIDENCE RATES in both exposed and unexposed groups \u2014 requiring follow-up of initially disease-free subjects over time. COHORT STUDY: directly calculates incidence in both groups \u2192 RR calculated accurately and directly. Case-control: cannot directly calculate incidence \u2192 uses Odds Ratio (approximates RR when disease is rare). Correlation study: population-level data, not individual RR. RCT: also calculates RR but is primarily for interventions. Cohort study = best for calculating RR.'},\n{id:22,stem:'Orthotolidine (OT) test determines residual free chlorine. What colour indicates presence of free chlorine?',correct:'Yellow',options:['Red','Yellow','Blue','Green'],exp:'OT (Orthotolidine) Test: OT reagent + water containing free chlorine \u2192 YELLOW colour (pale to deep amber depending on concentration). Colourless = no free chlorine. Interpretation: residual free chlorine should be \u22650.2 mg\/L at consumer level. DPD test produces PINK\/RED colour (more accurate). Starch-iodide: BLUE (for high concentrations). For OT test specifically: YELLOW = free chlorine present. Answer: Yellow.'},\n{id:23,stem:'Consider Navjat Shishu Suraksha Karyakram (NSSK):\\n1. Trains health personnel in basic newborn care and resuscitation\\n2. Addresses care at birth \u2014 prevention of hypothermia, infection, early breastfeeding, basic resuscitation\\n3. Objective: trained person in basic newborn care at every delivery point\\nWhich are correct?',correct:'1, 2 and 3',options:['1 and 2 only','1 and 3 only','1, 2 and 3','2 and 3 only'],exp:'NSSK (launched 2009): (1) \u2714 Trains ALL health personnel (doctors, nurses, ANMs, SBAs) in basic newborn care and resuscitation using standardised curriculum. (2) \u2714 Specifically addresses the 4 pillars of care at birth: prevention of hypothermia, prevention of infection, early initiation of breastfeeding (within 1 hour), and basic newborn resuscitation (bag-mask PPV). (3) \u2714 Programme objective: at every delivery point in India, at least ONE trained person for basic newborn care and resuscitation. All three are correct. Answer: 1, 2 and 3.'},\n{id:24,stem:'The most important indicator for assessment of impact in Salt Iodization Programme is:',correct:'Testing median urinary Iodine excretion',options:['Testing Iodine content of salt at consumer level','Testing Iodine content of salt at production level','Testing median urinary Iodine excretion','Testing serum Iodine levels'],exp:'Assessment levels in iodisation programmes: PROCESS: iodine at production level. OUTPUT\/COVERAGE: iodine at consumer\/household level (\u226515 ppm). IMPACT: MEDIAN URINARY IODINE EXCRETION (UIE) \u2014 the WHO-recommended gold standard impact indicator. 90% of iodine is excreted in urine; UIE directly reflects body iodine status. Median UIE >100 \u00b5g\/L = adequate; 50\u201399 = mild deficiency; <50 = moderate\/severe. Serum iodine: not practical for population monitoring. UIE = most important impact indicator. Answer: Median urinary iodine excretion.'},\n{id:25,stem:'Caisson\\'s disease is usually seen in which group of workers?',correct:'Construction workers under sea level',options:['Cotton field agricultural workers','Construction workers under sea level','Workers in manufacture of gas','Workers in radiation units'],exp:'CAISSON\\'S DISEASE (Decompression Sickness \/ \"The Bends\"): occurs when workers in HIGH-PRESSURE environments (compressed air) return to normal pressure too rapidly. Nitrogen dissolves in blood under pressure; rapid decompression \u2192 nitrogen bubbles in blood, joints, tissues \u2192 pain, neurological symptoms, air embolism. Workers affected: UNDERWATER TUNNEL\/CAISSON construction workers, divers, hyperbaric chamber workers. Cotton workers: byssinosis. Gas manufacture: various gas exposures. Radiation workers: radiation sickness. Answer: Construction workers under sea level.'},\n{id:26,stem:'Toxic effects of abdominal colic, obstinate constipation, anorexia, anaemia, stippling of red cells and blue line on gums are due to exposure to:',correct:'Lead',options:['Carbon monoxide','Asbestos','Lead','Radiation'],exp:'LEAD POISONING (Plumbism) \u2014 classic features: ABDOMINAL: lead colic, obstinate constipation, anorexia. HAEMATOLOGICAL: microcytic hypochromic anaemia, BASOPHILIC STIPPLING of RBCs (pathognomonic). GINGIVAL: BURTON\\'S LINE \u2014 blue-black line at the gum-tooth junction (lead sulfide deposition). Peripheral neuropathy (wrist\/foot drop), encephalopathy in severe cases. Raised blood\/urine ALA, raised FEP. CO: cherry-red skin, headache. Asbestos: mesothelioma, asbestosis. The full triad of stippled RBCs + Burton\\'s line + colic = Lead. Answer: Lead.'},\n{id:27,stem:'Which one of the following conditions can be screened during neonatal screening by biochemical tests?',correct:'Congenital hypothyroidism',options:['Congenital dislocation of hip','Congenital hypothyroidism','Chromosomal abnormalities','Congenital rubella'],exp:'Neonatal BIOCHEMICAL screening (heel-prick\/Guthrie card): CONGENITAL HYPOTHYROIDISM \u2714 \u2014 TSH (\u00b1T4) from blood spot; most common and cost-effective neonatal screen; early thyroxine treatment prevents intellectual disability. Also: PKU (phenylalanine), galactosaemia, CAH (17-OH progesterone), G6PD. CDH: clinical (Barlow\/Ortolani) + hip ultrasound. Chromosomal abnormalities: prenatal (NIPT\/amniocentesis\/karyotype) or clinical postnatally. Congenital rubella: serological\/clinical. Answer: Congenital hypothyroidism.'},\n{id:28,stem:'Which of the following is NOT a mass approach in health communication?',correct:'Role play',options:['Folk methods','Role play','Posters','Health exhibition'],exp:'Health communication approaches: MASS approaches (reach large audiences simultaneously): Posters \u2714, Health exhibitions \u2714, Folk\/traditional methods \u2714 (street plays, puppet shows, folk songs), radio, TV, social media. GROUP approaches (small, interactive): ROLE PLAY \u2014 participants actively simulate health situations in small groups; inherently limited in numbers, cannot reach large populations simultaneously. Role play is a GROUP educational method, not a mass approach. Answer: Role play.'},\n{id:29,stem:'Which of the following are non-modifiable risk factors for hypertension?\\n1. Age\\n2. Sex\\n3. Genetic factors',correct:'1, 2 and 3',options:['1 only','1 and 2 only','1, 2 and 3','2 and 3 only'],exp:'Non-modifiable risk factors for hypertension: AGE \u2714 (BP rises with age; cannot reverse ageing). SEX \u2714 (males higher risk pre-menopause; females higher post-menopause; determined at birth). GENETIC FACTORS \u2714 (inherited RAAS polymorphisms, family history; genetic constitution cannot be changed). Modifiable: obesity, physical inactivity, high salt intake, alcohol, smoking, dyslipidaemia, diabetes, stress. All three listed are non-modifiable. Answer: 1, 2 and 3.'},\n{id:30,stem:'What is the correct daily dose of Iron and Folic acid for a child aged 12 years?',correct:'60 mg elemental Iron and 300 mcg folic acid',options:['20 mg elemental Iron and 100 mcg folic acid','30 mg elemental Iron and 250 mcg folic acid','60 mg elemental Iron and 300 mcg folic acid','100 mg elemental Iron and 500 mcg folic acid'],exp:'National Iron Plus Initiative (NIPI) \u2014 IFA supplementation for prevention and treatment: Children 6\u201360 months: 25 mg iron + 100 mcg folic acid (syrup). Children 5\u201310 years: 45 mg iron + 400 mcg folic acid. ADOLESCENTS\/children \u226510 years (including 12-year-olds): 60 mg elemental iron + 300\u2013500 mcg folic acid (daily therapeutic \/ weekly preventive). Per standard UPSC PSM exam answer for a 12-year-old: 60 mg elemental iron + 300 mcg folic acid. Answer: 60 mg iron and 300 mcg folic acid.'},\n{id:31,stem:'When should breastfeeding be initiated to an infant born via a normal delivery?',correct:'Within one hour of birth',options:['Within half an hour','Within one hour of birth','Within 2\u20134 hours of birth','After 4 hours of birth'],exp:'WHO, UNICEF, and Government of India (NHM\/IMNCI) recommendation: Breastfeeding should be initiated WITHIN ONE HOUR OF BIRTH \u2014 defined as \"early initiation.\" Key benefits: colostrum (IgA, lactoferrin, growth factors \u2014 \"first vaccine\"), oxytocin release \u2192 uterine contraction \u2192 reduces PPH, bonding, prevents hypothermia and hypoglycaemia. Historical note: older guidelines said \"within 30 minutes\" \u2014 updated WHO recommendation: WITHIN 1 HOUR. Current standard = within one hour. Answer: Within one hour of birth.'},\n{id:32,stem:'As per Biomedical Waste Management Rules 2016, metallic body implants should be discarded in which of the following?',correct:'Separate collection system',options:['Yellow colored non-chlorinated plastic bag','Red colored non-chlorinated plastic bag','Card board box with blue colored marking','Separate collection system'],exp:'BMW Rules 2016 \u2014 colour coding: Yellow bag: anatomical waste, soiled waste, discarded medicines, chemical\/cytotoxic waste. Red bag: contaminated recyclable plastic (IV sets, syringes without needles). Blue\/white puncture-proof: glass, metallic sharps (needles, blades). METALLIC BODY IMPLANTS (orthopaedic implants, stents, metal prostheses) recovered during surgery\/post-mortem: special category \u2014 collected in a SEPARATE COLLECTION SYSTEM for smelting\/recycling; not in standard colour-coded bags. Answer: Separate collection system.'},\n{id:33,stem:'Which of the following is NOT a quantitative method in the management of health services?',correct:'Management by objectives',options:['Network analysis','Management by objectives','System analysis','Planning programming budgeting system'],exp:'Quantitative methods in health management use mathematical\/operational research techniques: Network analysis \u2714 (PERT\/CPM \u2014 mathematical project scheduling), System analysis \u2714 (mathematical modelling of health system inputs\/outputs), PPBS \u2714 (Planning Programming Budgeting System \u2014 quantitative resource allocation). MANAGEMENT BY OBJECTIVES (MBO): a management philosophy\/process (Peter Drucker) where managers and staff jointly set goals and evaluate performance \u2014 this is a QUALITATIVE\/ORGANISATIONAL approach focusing on goal-setting and motivation, not mathematical quantification. Answer: Management by objectives.'},\n{id:34,stem:'India is in which stage of the demographic cycle?',correct:'Late expanding',options:['High stationary','Early expanding','Late expanding','Low stationary'],exp:'Demographic Transition stages: Stage 1 (High Stationary): high birth + high death rate. Stage 2 (Early Expanding): high birth + falling death \u2192 rapid growth. Stage 3 (LATE EXPANDING): falling birth + low death \u2192 still growing but rate slowing. Stage 4 (Low Stationary): low birth + low death \u2192 stable. Stage 5: declining. India: death rates have fallen significantly; birth rates declining but still above replacement (TFR ~2.0\u20132.1). Population still growing but rate of growth declining. India = LATE EXPANDING (Stage 3). Answer: Late expanding.'},\n{id:35,stem:'Manual Vacuum Aspiration (MVA) introduced in primary health centres helps in reducing which index?',correct:'Maternal mortality',options:['Infant mortality','Neonatal mortality','Preterm mortality','Maternal mortality'],exp:'MVA = safe, WHO-recommended procedure for uterine evacuation (incomplete\/induced abortion up to 10\u201312 weeks). Unsafe\/illegal abortions are a major cause of MATERNAL MORTALITY in India (~8\u201310% of maternal deaths). Introducing MVA at PHCs enables: safe management of incomplete abortions (prevents sepsis from retained products), safe first-trimester MTP (avoids unsafe practices at peripheral level). Result: fewer deaths from septic abortion and haemorrhage. MVA directly reduces MATERNAL MORTALITY, not infant\/neonatal\/preterm mortality. Answer: Maternal mortality.'},\n{id:36,stem:'The agreement (yes\/no) between two observers is statistically measured by:',correct:'Kappa coefficient',options:['Specificity','Sensitivity','Correlation coefficient','Kappa coefficient'],exp:'Inter-rater reliability for CATEGORICAL (yes\/no) data: KAPPA COEFFICIENT (Cohen\\'s \u03ba) = standard measure. It corrects for chance agreement. Formula: \u03ba = (Observed \u2013 Expected agreement) \/ (1 \u2013 Expected agreement). Interpretation: <0.20 = poor; 0.21\u20130.40 = fair; 0.41\u20130.60 = moderate; 0.61\u20130.80 = good; 0.81\u20131.00 = excellent. Sensitivity\/Specificity: test performance vs gold standard \u2014 not observer agreement. Pearson\/Spearman correlation: continuous variables. Kappa is specifically designed for categorical inter-observer agreement. Answer: Kappa coefficient.'},\n{id:37,stem:'How many postnatal visits should be made by the ANM to the house of a low birth weight baby?',correct:'6',options:['2','4','6','8'],exp:'Home-Based Newborn Care (HBNC) schedule: Normal weight babies: 7 ASHA visits (days 1, 3, 7, 14, 21, 28, and within 42 days). LOW BIRTH WEIGHT babies: increased frequency \u2014 6 ANM visits within the first 28 days (days 1, 3, 7, 14, 21, 28). Rationale: LBW babies (<2500 g) are at higher risk for hypothermia, hypoglycaemia, infection, poor feeding, and mortality \u2014 requiring more intensive monitoring. Per Government of India HBNC guidelines: 6 postnatal visits for LBW babies. Answer: 6.'},\n{id:38,stem:'The difference between Type A and Type B sub centre as per Indian Public Health Standards is in terms of:',correct:'Staffing pattern',options:['Labour room or delivery facility','Staffing pattern','Location','Availability of drugs'],exp:'Sub-centres \u2014 IPHS: TYPE A: ONE ANM + one MPW (male). TYPE B: TWO ANMs + one MPW \u2014 for areas with higher workload (tribal\/hard-to-reach areas). The key difference = STAFFING PATTERN (number of ANMs). Labour room: not standard at sub-centre level (PHC has this). Drug availability: same formulary both types. Location: both can be anywhere. Answer: Staffing pattern.'},\n{id:39,stem:'Which of the following Screening methods for Disease is the least useful?',correct:'Mass screening',options:['Mass screening','High risk group screening','Multiphasic screening','Selective screening'],exp:'Screening efficiency comparison: High-risk group screening: most efficient \u2014 targets high pre-test probability groups \u2192 high yield per person. Selective screening: targeted by specific criteria \u2014 efficient. Multiphasic screening: multiple tests simultaneously \u2192 cost-effective. MASS SCREENING: entire population regardless of risk \u2192 very low yield per screened person (most do not have the disease), expensive, least efficient. Justified only when disease is very common and cheap tests exist. In terms of efficiency and yield per individual, mass screening is LEAST USEFUL. Answer: Mass screening.'},\n{id:40,stem:'Which one of the following is an indicator for evaluation of impact of family planning?',correct:'Family size',options:['Family size','Number of postpartum services availed','Change in behaviour of people','Community needs assessment'],exp:'Evaluation hierarchy: Input: resources allocated. Process: services delivered (postpartum services availed \u2014 process indicator). Output: CPR, contraceptive acceptance. IMPACT: measures the ultimate demographic goal \u2014 FAMILY SIZE (average number of children per couple) is the most direct measure of family planning programme impact. Also: TFR, crude birth rate, IMR. Community needs assessment = planning tool (input). Change in behaviour = outcome indicator. Number of postpartum services availed = process. Family size directly measures whether the programme achieved its demographic goal. 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Submitting in 10 Submit Now Combined Medical Services Examination 2018Paper II \u00b7 Part A Preventive & Social Medicine \u00b7 Epidemiology \u00b7 Community Health \u00b7 Obstetrics & Gynaecology Questions 1 \u2013 40 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0%score… <\/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":[18,55,54],"tags":[],"class_list":["post-36809","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg","category-psm"],"yoast_head":"\n<title>CMS 2018 P2 Part-A - 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\/11\/cms-2018-p2-part-a\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2018 P2 Part-A - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2018 Paper II \u2013 Part A (Q1\u2013Q40) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! 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