{"id":36840,"date":"2026-05-16T00:14:22","date_gmt":"2026-05-15T18:44:22","guid":{"rendered":"https:\/\/atsixty.com\/?p=36840"},"modified":"2026-05-16T00:14:47","modified_gmt":"2026-05-15T18:44:47","slug":"cms-2025-p1-part-c","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/16\/cms-2025-p1-part-c\/","title":{"rendered":"CMS 2025 P1 Part-C"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2025 Paper I \u2013 Part C (Q81\u2013Q120)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#cms25p1c*,#cms25p1c *::before,#cms25p1c 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.ri{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms25p1c .rp{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms25p1c .rs{font-size:.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:.05em}\n#cms25p1c .sc h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms25p1c .nl{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms25p1c .vd{font-size:.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms25p1c .bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:.8rem}\n#cms25p1c .band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms25p1c .bc{background:var(--cb-bg);color:#1e6f46}\n#cms25p1c .bw{background:var(--wb-bg);color:var(--wb)}\n#cms25p1c .bs{background:var(--teal-pale);color:var(--teal)}\n#cms25p1c .rbtn{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:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms25p1c .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms25p1c .hdr h1{font-size:1.15rem}#cms25p1c .qt{font-size:.88rem}#cms25p1c .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms25p1c\">\n<div class=\"sen\" id=\"cms25p1c-sen\"><\/div>\n<div class=\"sb\" id=\"cms25p1c-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms25p1c-ti\">\u23f1 <strong id=\"cms25p1c-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms25p1c-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms25p1c-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms25p1c-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms25p1c-sn\">0.00<\/strong> \/ <strong id=\"cms25p1c-sm\">40<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms25p1c-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms25p1c-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms25p1c-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms25p1c-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2025<br>Paper I \u00b7 Part C<\/h1>\n <p>General Medicine (Q81\u2013Q96) \u00b7 Paediatrics (Q97\u2013Q120)<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 81 \u2013 120<\/span>\n <span class=\"bdg\">+1 correct \u00b7 \u2212\u2153 wrong<\/span>\n <button class=\"tbtn\" id=\"cms25p1c-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms25p1c-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms25p1c-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms25p1c-sc-box\">\n <div class=\"ring\" id=\"cms25p1c-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms25p1c-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms25p1c-nl\"><\/div>\n <div class=\"vd\" id=\"cms25p1c-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms25p1c-bc\"><\/span>\n <span class=\"band bw\" id=\"cms25p1c-bw\"><\/span>\n <span class=\"band bs\" id=\"cms25p1c-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms25p1c-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms25p1c',TOTAL=40,MAX=40,TSECS=2400,GSECS=10;\nvar CU=100,WU=33;\nvar QS=[\n{id:81,stem:'Out of the following areas of brain, which area is most commonly affected on brain imaging in Wilson\\'s disease?',correct:'Basal ganglia',options:['Cerebellum','Sub-cortex','Thalamus','Basal ganglia'],exp:'Wilson\\'s disease \u2014 neuroimaging: Copper deposits preferentially in the BASAL GANGLIA (caudate nucleus and putamen) \u2714 \u2014 most commonly and prominently affected on MRI; T2\/FLAIR hyperintensity in putamen; \"face of the giant panda\" sign in the midbrain (tegmentum) is pathognomonic. Also affected: thalamus, brainstem (midbrain, pons), cerebellum, white matter. Clinical correlate: Basal ganglia involvement \u2192 tremor, rigidity, dysarthria, dystonia (extrapyramidal features). Psychiatric features from frontal-subcortical circuit disruption. MRI finding: T2 hyperintensity in putamen\/basal ganglia is the most consistent finding. Answer: Basal ganglia.'},\n{id:82,stem:'Which of the following are secondary iron overload conditions?\\nI. Transfusion related iron load\\nII. Thalassemia\\nIII. Hepatitis C associated liver disease\\nSelect the correct answer using the code given below:',correct:'I, II and III',options:['I, II and III','I and II only','II and III only','I and III only'],exp:'Secondary iron overload \u2014 causes: TRANSFUSION-RELATED IRON LOAD \u2714 \u2014 each unit of packed RBCs contains ~200\u2013250 mg iron; patients receiving chronic transfusions (e.g., thalassaemia, aplastic anaemia, sickle cell) accumulate iron (no physiological excretion pathway). THALASSAEMIA \u2714 \u2014 double mechanism: (1) chronic transfusion-related iron loading; (2) ineffective erythropoiesis \u2192 increased GI iron absorption (mediated by suppressed hepcidin). HEPATITIS C \u2714 \u2014 chronic HCV infection \u2192 mild-to-moderate hepatic iron overload; HCV downregulates hepcidin \u2192 increased iron absorption; iron worsens hepatic fibrosis. All three are recognised secondary iron overload conditions. Answer: I, II and III.'},\n{id:83,stem:'Which of the following are features of Alzheimer\\'s disease?\\nI. It is a disorder of cerebral cortical function\\nII. Only short term memory is affected\\nIII. Patients deny that there is anything wrong\\nIV. Depression is commonly present\\nSelect the correct answer using the code given below:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Alzheimer\\'s disease features: Statement I \u2714 \u2014 Alzheimer\\'s is primarily a disorder of CEREBRAL CORTICAL function; cortical atrophy (parietal, temporal, frontal); amyloid plaques + neurofibrillary tangles in cortex. Statement II \u2717 \u2014 BOTH short-term AND long-term memory are eventually affected; early disease affects episodic (short-term) memory preferentially; later, remote memory also fails; \"only short-term\" is incorrect. Statement III \u2714 \u2014 ANOSOGNOSIA (lack of awareness of deficits) is characteristic; patients frequently deny or are unaware that anything is wrong with their cognition (unlike depression where insight is preserved). Statement IV \u2714 \u2014 Depression is present in ~30\u201350% of Alzheimer\\'s patients; often an early feature; contributes to functional decline. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:84,stem:'Glymphatics is the lymphatic like structure of which system?',correct:'Central Nervous System',options:['Central Nervous System','Respiratory','Renal','Gastro-intestinal'],exp:'GLYMPHATIC SYSTEM: a waste clearance system of the CENTRAL NERVOUS SYSTEM \u2714. Discovered ~2013 by Maiken Nedergaard. Mechanism: cerebrospinal fluid (CSF) flows along periarterial spaces into brain parenchyma (driven by aquaporin-4 water channels on astrocyte end-feet), exchanges with interstitial fluid, and drains along perivenous spaces \u2192 clears metabolic waste products (including amyloid-beta, tau, lactate). Named \"glymphatic\" = GLIAL + LYMPHATIC (analogous to peripheral lymphatics but mediated by glial cells). Significance: impaired glymphatic clearance implicated in Alzheimer\\'s disease (amyloid accumulation); sleep enhances glymphatic flow. Answer: Central Nervous System.'},\n{id:85,stem:'Which one of the following statements is correct in the diagnosis of Giardiasis?',correct:'Stool sample at 2-3 days interval should be examined for cysts',options:['Stool sample at 2-3 days interval should be examined for cysts','String test is done to find out cysts of Giardia lamblia','Jejunal biopsy samples can show presence of larvae of Giardia lamblia','Cystic form of Giardia lamblia remains viable in water upto 1 week only'],exp:'Giardiasis diagnosis: STOOL EXAMINATION AT 2\u20133 DAY INTERVALS \u2714 \u2014 Giardia cysts are shed intermittently (not continuously); examining 3 stool samples collected 2\u20133 days apart increases sensitivity from ~60% (single sample) to ~90%. Look for: cysts (in formed stool) or trophozoites (in liquid stool\/diarrhoea). STRING TEST (Entero-test) \u2717 \u2014 used to collect TROPHOZOITES from the duodenum (NOT cysts); a gelatin capsule with string is swallowed; bile-stained mucus retrieved and examined. Option b says \"cysts\" \u2014 incorrect. JEJUNAL BIOPSY \u2717 \u2014 shows trophozoites adherent to villi, NOT larvae (Giardia has no larval stage). Option c says \"larvae\" \u2014 incorrect. CYST VIABILITY \u2717 \u2014 cysts remain viable in cold water for MONTHS (up to 2\u20133 months at 4\u00b0C), not just 1 week. Answer: Stool sample at 2-3 days interval should be examined for cysts.'},\n{id:86,stem:'In clinical assessment of an elderly patient, \"the get up and go test\" is used to evaluate which of the following?',correct:'Gait and balance',options:['Gait and balance','Cognition','Driving ability','Urinary incontinence'],exp:'Timed Up and Go (TUG) test \/ \"Get Up and Go\" test: GAIT AND BALANCE \u2714 \u2014 a simple, validated functional mobility test for elderly patients. Method: patient rises from a standard chair, walks 3 metres, turns, walks back, sits down. Timed: >12 seconds = increased fall risk; >20 seconds = impaired mobility. Assesses: lower limb strength, balance, gait, and functional mobility. Used in: fall risk assessment, frailty screening, Parkinson\\'s disease monitoring. NOT for cognition (MMSE, MoCA), NOT driving ability, NOT urinary incontinence (bladder diary, urodynamics). Answer: Gait and balance.'},\n{id:87,stem:'Treatment of first choice in acute Gout is',correct:'Oral Colchicine',options:['Oral Methotrexate','Oral Colchicine','Allopurinol','Sulfasalazine'],exp:'Acute gout treatment: ORAL COLCHICINE \u2714 \u2014 first-line treatment for acute gout attack; mechanism: inhibits tubulin polymerisation \u2192 prevents neutrophil migration and NLRP3 inflammasome activation \u2192 reduces urate crystal-induced inflammation; given as 1 mg stat then 0.5 mg 1 hour later (UK\/European approach) or 0.5\u20130.6 mg 2\u20133 times daily. NSAIDs (indomethacin, naproxen) are equally first-line; choice depends on comorbidities. Corticosteroids: if NSAIDs\/colchicine contraindicated. ALLOPURINOL \u2717 \u2014 urate-lowering therapy (xanthine oxidase inhibitor); used for PREVENTION, NOT acute attack; starting allopurinol during acute attack can prolong\/worsen the flare. METHOTREXATE: DMARDs for RA. SULFASALAZINE: IBD\/RA. Answer: Oral Colchicine.'},\n{id:88,stem:'A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert intercostal drain. Which one of the following sites is suitable for such a procedure?',correct:'Triangle of safety',options:['Hesselbach\\'s triangle','Petilis triangle','Triangle of safety','Triangle of auscultation'],exp:'Intercostal drain (chest tube) insertion site: TRIANGLE OF SAFETY \u2714 \u2014 the recommended safe zone for chest drain insertion. Boundaries: Anterior: lateral border of pectoralis major. Posterior: lateral border of latissimus dorsi. Inferior: horizontal line at the level of the nipple (5th intercostal space). Apex: axilla. Within the 4th or 5th intercostal space, mid-axillary line. Avoids: internal mammary artery (anteriorly), long thoracic nerve, breast tissue, diaphragm (inferiorly). Hesselbach\\'s triangle: inguinal region (direct inguinal hernia). \"Petilis triangle\": not a standard anatomical term. Triangle of auscultation: posterior chest (back), used for auscultation not drainage. Answer: Triangle of safety.'},\n{id:89,stem:'Which one of the following is an antidote for Rivaroxaban and Apixaban, when reversal of anticoagulation is needed due to uncontrolled bleeding?',correct:'Andexanet Alfa',options:['Idarucizumab','Andexanet Alfa','Hydroxocobalamin','Glucarpidase'],exp:'Reversal agents for direct oral anticoagulants (DOACs): ANDEXANET ALFA \u2714 \u2014 recombinant modified Factor Xa decoy protein; specifically reverses FACTOR Xa INHIBITORS: rivaroxaban, apixaban, edoxaban; binds and sequesters Factor Xa inhibitors; approved for life-threatening\/uncontrolled bleeding. IDARUCIZUMAB \u2014 reverses DABIGATRAN (direct thrombin inhibitor, Factor IIa); monoclonal antibody fragment (Fab) against dabigatran. HYDROXOCOBALAMIN \u2014 antidote for CYANIDE poisoning (binds CN\u207b to form cyanocobalamin). GLUCARPIDASE \u2014 carboxypeptidase enzyme; cleaves methotrexate; antidote for methotrexate toxicity. Answer: Andexanet Alfa.'},\n{id:90,stem:'Which of the following are included in common causes of mediastinal masses in superior and anterior mediastinum?\\nI. Goitre\\nII. Thymic tumour\\nIII. Neurogenic tumour\\nSelect the correct answer using the code given below:',correct:'I and II only',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'Mediastinal masses by compartment: SUPERIOR MEDIASTINUM: Goitre (retrosternal thyroid) \u2714, thymic masses, lymphoma, aortic aneurysm, parathyroid tumour. ANTERIOR MEDIASTINUM (4 Ts mnemonic): Thymoma\/Thymic tumour \u2714, Teratoma\/germ cell tumour, Thyroid (retrosternal goitre) \u2714, Terrible lymphoma. POSTERIOR MEDIASTINUM: NEUROGENIC TUMOURS \u2714 \u2014 neurofibroma, schwannoma, ganglioneuroma, neuroblastoma (most common posterior mediastinal mass); posterior \u2014 NOT anterior\/superior. Neurogenic tumours arise from intercostal nerves\/sympathetic chain \u2192 posterior mediastinum. So for SUPERIOR and ANTERIOR mediastinum: Goitre (I) \u2714 and Thymic tumour (II) \u2714; Neurogenic tumour (III) \u2717. Answer: I and II only.'},\n{id:91,stem:'Which one of the following is used to reverse the anticoagulant effects of Dabigatran?',correct:'Idarucizumab',options:['Glucarpidase','Desferrioxamine','Idarucizumab','Protamine'],exp:'Reversal of Dabigatran (direct thrombin inhibitor): IDARUCIZUMAB \u2714 \u2014 humanised monoclonal antibody fragment (Fab); binds dabigatran with ~350\u00d7 greater affinity than thrombin; rapidly and completely reverses dabigatran anticoagulation; FDA approved 2015; given IV 5g in two 2.5g doses. GLUCARPIDASE: methotrexate antidote. DESFERRIOXAMINE (deferoxamine): iron chelation for iron poisoning\/overload. PROTAMINE SULFATE: reverses UNFRACTIONATED HEPARIN (and partially LMWH); positively charged protein binds negatively charged heparin. Answer: Idarucizumab.'},\n{id:92,stem:'Which one of the following is contraindication of doing a wireless capsule endoscopy?',correct:'Small bowel stricture',options:['Coeliac disease','Small bowel stricture','Obscure gastrointestinal bleeding','Small bowel Crohn\\'s disease'],exp:'Wireless capsule endoscopy (WCE) \u2014 contraindications: SMALL BOWEL STRICTURE \u2714 \u2014 the main absolute contraindication; a stricture can cause capsule RETENTION (impaction), potentially requiring surgical\/endoscopic retrieval; patients with known\/suspected strictures (Crohn\\'s, NSAID-induced, radiation) should have patency capsule test first. Also contraindicated: cardiac pacemaker (older models), swallowing disorders, bowel obstruction, pregnancy (relative). INDICATIONS for WCE: COELIAC disease evaluation (villous atrophy beyond reach of OGD) \u2714, OBSCURE GI BLEEDING \u2714 (most common indication), small bowel CROHN\\'S disease assessment \u2714. All three option alternatives are indications, not contraindications. Answer: Small bowel stricture.'},\n{id:93,stem:'Which one of the following is the causative organism of Erythrasma, a mild, localized and superficial skin infection?',correct:'Corynebacterium minutissimum',options:['Corynebacterium pseudo tuberculosis','Corynebacterium minutissimum','Corynebacterium diphthariae','Corynebacterium matruchotii'],exp:'Erythrasma: a superficial bacterial skin infection causing sharply demarcated, brownish-red, mildly scaling patches in intertriginous areas (axillae, groin, toe webs). Causative organism: CORYNEBACTERIUM MINUTISSIMUM \u2714 \u2014 a gram-positive, diphtheroid rod; part of normal skin flora; overgrows in warm, moist, occluded areas. Diagnosis: CORAL RED fluorescence under Wood\\'s lamp (due to coproporphyrin III produced by the organism). Treatment: topical clindamycin\/erythromycin or oral erythromycin. C. pseudotuberculosis: caseous lymphadenitis in animals, rare in humans. C. diphtheriae: diphtheria. C. matruchotii: oral cavity commensal. Answer: Corynebacterium minutissimum.'},\n{id:94,stem:'Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?',correct:'Intrahepatic presinusoidal \u2013 Cirrhosis',options:['Sinusoidal \u2013 Veno-occlusive disease','Pre-hepatic presinusoidal \u2013 Portal vein thrombosis','Intrahepatic presinusoidal \u2013 Cirrhosis','Post-hepatic post sinusoidal \u2013 Schistosomiasis'],exp:'Portal hypertension classification by site: PRE-HEPATIC: Portal vein thrombosis \u2714 \u2014 correctly matched with pre-hepatic. INTRAHEPATIC \u2014 PRESINUSOIDAL: Schistosomiasis (granulomas around portal tracts), primary biliary cholangitis. SINUSOIDAL: CIRRHOSIS \u2714 \u2014 most common cause worldwide; sinusoidal hypertension from architectural distortion. POST-SINUSOIDAL (intrahepatic): Veno-occlusive disease (sinusoidal obstruction syndrome). POST-HEPATIC: Budd-Chiari syndrome, right heart failure, constrictive pericarditis. Now checking the options: Option (c): \"Intrahepatic presinusoidal \u2013 Cirrhosis\" \u2717 \u2014 Cirrhosis is SINUSOIDAL, not presinusoidal; however among the options this is listed as the answer in the official key \u2014 because the question tests matching. Option (b): Pre-hepatic = portal vein thrombosis \u2714 is correct. Option (d): Post-hepatic post sinusoidal = Schistosomiasis \u2717 \u2014 Schistosomiasis is intrahepatic presinusoidal. Option (a): Sinusoidal = veno-occlusive \u2717 \u2014 veno-occlusive is post-sinusoidal. The only correctly matched pair per standard classification is (b). Answer per official key: Intrahepatic presinusoidal \u2013 Cirrhosis (verify against official answer key; note cirrhosis is classically sinusoidal).'},\n{id:95,stem:'Which one of the following is a secondary cause of headache?',correct:'Medication overuse headache',options:['Migraine','Tension-type headache','Trigeminal autonomic cephalalgia','Medication overuse headache'],exp:'Headache classification (ICHD-3): PRIMARY headaches (no underlying cause \u2014 headache IS the disorder): Migraine \u2714, Tension-type headache \u2714, Trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, SUNCT) \u2714. SECONDARY headaches (caused by an underlying condition): MEDICATION OVERUSE HEADACHE (MOH) \u2714 \u2014 caused by overuse of acute headache medications (analgesics, triptans, opioids \u226510\u201315 days\/month for >3 months); the headache is SECONDARY to medication overuse; treatment = medication withdrawal. Other secondary headaches: SAH, meningitis, raised ICP, hypertension, cervicogenic headache, post-traumatic. Answer: Medication overuse headache.'},\n{id:96,stem:'A 32-year-old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?',correct:'Kayser-Fleischer rings in the cornea',options:['Adenoma sebaceum in the mid face','Erythema nodosum on the skin','Kayser-Fleischer rings in the cornea','Olser\\'s nodes at the finger tips'],exp:'WILSON\\'S DISEASE: recurrent jaundice (hepatic involvement) + facial grimacing (dystonia\/dyskinesia from basal ganglia copper deposition) in a young person. KAYSER-FLEISCHER (KF) RINGS \u2714 \u2014 golden-brown rings at the periphery of the cornea (Descemet\\'s membrane); copper deposition; seen in >95% of neurological Wilson\\'s; detected by slit-lamp examination; PATHOGNOMONIC when neurological features are present. Adenoma sebaceum (angiofibromas): tuberous sclerosis (TS); facial butterfly rash. Erythema nodosum: panniculitis (sarcoidosis, IBD, infections). Osler\\'s nodes: painful, tender nodules on finger pads \u2014 infective endocarditis. Recurrent jaundice + facial grimacing (dystonia) + young patient = Wilson\\'s disease \u2192 KF rings. Answer: Kayser-Fleischer rings in the cornea.'},\n\n{id:97,stem:'Which of the following are causes of secondary immunodeficiency in children?\\nI. Diphenylhydantoin\\nII. Severe malnutrition\\nIII. Post-varicella state\\nIV. Nephrotic syndrome\\nSelect the correct answer using the code given below:',correct:'I, II, III and IV',options:['I, II and III','I, II and IV','I, III and IV','I, II, III and IV'],exp:'Secondary immunodeficiency in children \u2014 causes: DIPHENYLHYDANTOIN (phenytoin) \u2714 \u2014 causes IgA deficiency and reduced T-cell function; drug-induced immunodeficiency. SEVERE MALNUTRITION \u2714 \u2014 protein-energy malnutrition severely impairs both cell-mediated and humoral immunity (thymic atrophy, reduced lymphocytes, impaired phagocyte function). POST-VARICELLA STATE \u2714 \u2014 varicella zoster virus infects and depletes T-lymphocytes; post-varicella immunosuppression can last weeks; susceptibility to bacterial superinfection and TB reactivation. NEPHROTIC SYNDROME \u2714 \u2014 urinary loss of immunoglobulins (especially IgG) \u2192 hypogammaglobulinaemia \u2192 susceptibility to encapsulated bacteria (pneumococcus). All four are recognised causes. Answer: I, II, III and IV.'},\n{id:98,stem:'Which of the following statements are correct regarding vaccination routes for children?\\nI. Hepatitis B vaccine given in deltoid region has reduced efficacy\\nII. Two vaccines may be given in the same thigh, but separated by 1 inch\\nIII. Separate sites are used when administering a vaccine and an immunoglobulin\\nIV. Two intramuscular vaccines may be given on the same day but in separate limbs\\nSelect the correct answer using the code given below:',correct:'II and III',options:['III only','I and III','II and III','I and IV'],exp:'Vaccination route and technique: Statement I \u2717 \u2014 Hepatitis B in DELTOID has REDUCED EFFICACY \u2717 \u2014 Actually, in ADULTS the deltoid is the preferred site; in children (infants) it is the anterolateral thigh. Injection into GLUTEAL region (buttock) has reduced efficacy (fat). Deltoid in adults = good efficacy. This statement is incorrect. Statement II \u2714 \u2014 Two vaccines can be given in the SAME thigh, SEPARATED BY AT LEAST 1 INCH (2.5 cm) to avoid local reaction overlap; this is standard practice when multiple injections are needed at same visit. Statement III \u2714 \u2014 Vaccine and immunoglobulin (passive + active immunisation) must be given at SEPARATE SITES; immunoglobulin can interfere with live vaccine replication if given together at the same site. Statement IV \u2717 \u2014 Two IM vaccines on same day in SEPARATE LIMBS is acceptable, but the statement says \"separate limbs\" \u2014 this IS correct practice but the option pairs I and IV; checking: IV alone is correct. However, official answer: II and III. Answer: II and III.'},\n{id:99,stem:'A radiopaque density may be noticed in poisoning by which of the following agents?',correct:'Chloral hydrate',options:['Phenazopyridine','Ethylene glycol','Chloroquine','Chloral hydrate'],exp:'Radiopaque ingestions \u2014 mnemonic CHIPES (or COINS): C \u2014 Chloral hydrate \u2714, Calcium carbonate, Cocaine packets. H \u2014 Heavy metals (arsenic, lead, iron, bismuth). I \u2014 Iron tablets \u2714. P \u2014 Potassium tablets, Phenothiazines (some). E \u2014 Enteric-coated tablets. S \u2014 Slow-release\/sustained-release preparations. CHLORAL HYDRATE \u2714 \u2014 a sedative-hypnotic; radio-opaque on plain X-ray; can be seen in the GI tract after ingestion. Ethylene glycol: produces calcium oxalate crystals in kidneys but the ingested liquid itself is not radio-opaque. Chloroquine: NOT radio-opaque. Phenazopyridine: urinary analgesic; NOT radio-opaque (causes orange urine). Answer: Chloral hydrate.'},\n{id:100,stem:'Which of the following syndromes are caused due to genomic imprinting?\\nI. Rubinstein Taybi syndrome\\nII. Prader-Willi syndrome\\nIII. Angelman syndrome\\nIV. Edward syndrome\\nSelect the correct answer using the code given below:',correct:'II and III',options:['I and III','II and III','II and IV','I and IV'],exp:'Genomic imprinting disorders (parent-of-origin specific gene expression): PRADER-WILLI SYNDROME \u2714 \u2014 chromosome 15q11-q13; PATERNAL copy deleted\/inactivated (maternal imprinting of paternal allele); features: hypotonia, hyperphagia, obesity, intellectual disability, hypogonadism. ANGELMAN SYNDROME \u2714 \u2014 same chromosome 15q11-q13; MATERNAL copy deleted\/inactivated (paternal imprinting of maternal allele); features: severe intellectual disability, absent speech, happy demeanour, seizures, \"puppet-like\" gait. RUBINSTEIN-TAYBI SYNDROME \u2717 \u2014 caused by CREBBP or EP300 gene mutation; NOT an imprinting disorder; autosomal dominant. EDWARD SYNDROME (Trisomy 18) \u2717 \u2014 chromosomal aneuploidy; NOT an imprinting disorder. Correct imprinting disorders: II (PWS) and III (Angelman). Answer: II and III.'},\n{id:101,stem:'As per POCSO (Protection of Children from Sexual Offences) Act 2012, sexual assault is considered aggravated when:\\nI. the abuse involves use of physical violence\\nII. the abused child is disabled\\nIII. the abuse is committed by staff of an educational institution\\nIV. the abuse is committed by an immediate family member\/first degree relative\\nWhich of the above are correct?',correct:'II and IV',options:['I and IV','I and III','II and III','II and IV'],exp:'POCSO Act 2012 \u2014 Aggravated sexual assault (Section 9): Sexual assault is AGGRAVATED when the perpetrator is: a police officer, member of armed forces, public servant, management\/staff of a children\\'s home\/hospital\/educational institution \u2714 (option III \u2714). When victim is: mentally ill, physically disabled, or below 12 years. Abuse by relative (within degree of prohibited relationship) \u2714. HOWEVER \u2014 checking the specific options: The POCSO Act section 9 specifically lists aggravated assault when: child is disabled (Section 9(l)) \u2714 (Statement II), committed by a relative (Section 9(n)) \u2714 (Statement IV). Physical violence per se is part of penetrative vs non-penetrative distinction, not specifically listed as aggravating factor alone. Staff of educational institution \u2714 (Section 9(f)) is also aggravated. Official answer for this question: II and IV. Answer: II and IV.'},\n{id:102,stem:'The mother of a 14-month-old normally developing baby comes to you for feeding advice. Which of the following would be appropriate for her as per the IMNCI Program?\\nI. Breastfeed as often as the child wants\\nII. Keep the child in your lap and feed with your own hands\\nIII. Offer food from the family pot\\nIV. Give 3 to 4 meals each day\\nSelect the correct answer using the code given below:',correct:'I, II and IV',options:['II, III and IV','I, III and IV','I, II and III','I, II and IV'],exp:'IMNCI feeding advice for 12\u201323 months: BREASTFEED as often as the child wants \u2714 (Statement I) \u2014 continue breastfeeding alongside complementary foods up to 2 years or beyond. ACTIVE\/RESPONSIVE FEEDING \u2714 (Statement II) \u2014 keep child in lap, feed with own hands; encourages intake; responsive feeding is a key IMNCI recommendation. OFFER FOOD FROM FAMILY POT \u2717 (Statement III) \u2014 at 14 months, the child should receive specifically prepared, appropriately textured complementary foods, not necessarily directly from the common family pot (which may be too spicy\/inappropriate texture); IMNCI recommends age-appropriate complementary foods. GIVE 3\u20134 MEALS PER DAY \u2714 (Statement IV) \u2014 IMNCI recommends 3\u20134 meals daily at 12\u201323 months plus 1\u20132 nutritious snacks. Correct: I, II and IV. Answer: I, II and IV.'},\n{id:103,stem:'For a sick child aged 4 years, which of the following are signs of \"severe pneumonia or very severe disease\", as per IMNCI Program?\\nI. Fast breathing (\u226540 breaths per minute)\\nII. Child vomits everything\\nIII. Stridor in a calm child\\nIV. Chest indrawing\\nSelect the correct answer using the code given below:',correct:'II and III',options:['I and II','II and III','III and IV','II and IV'],exp:'IMNCI classification for a child aged 2 months\u20135 years with cough\/difficult breathing: SEVERE PNEUMONIA or VERY SEVERE DISEASE \u2014 any danger sign or: CHEST INDRAWING (lower chest wall indrawing) \u2014 classifies as SEVERE PNEUMONIA (not \"very severe disease\"). VERY SEVERE DISEASE (general danger signs): cannot drink\/breastfeed, VOMITS EVERYTHING \u2714 (Statement II), convulsions, abnormally sleepy\/difficult to wake. STRIDOR IN A CALM CHILD \u2714 (Statement III) \u2014 classifies as SEVERE DISEASE; stridor at rest (calm child) indicates significant upper airway obstruction. FAST BREATHING for age 4 years (2\u20135 years): \u226540 breaths\/min (Statement I \u2714 threshold) classifies as PNEUMONIA (not severe pneumonia alone). CHEST INDRAWING alone = Severe pneumonia; requires referral. Official IMNCI: \"very severe disease\" signs include vomiting everything + stridor in calm child. Answer: II and III.'},\n{id:104,stem:'In a child aged 3\u00bd years with an ear problem which one of these situations merits urgent referral to hospital?',correct:'Tender swelling behind the ear',options:['Pus seen draining from the ear, and discharge reported for less than 14 days','Pus seen draining from the ear, and discharge reported for more than or equal to 14 days','Tender swelling behind the ear','Pus seen draining from both ears, irrespective of duration'],exp:'IMNCI ear problem classification: URGENT REFERRAL (mastoiditis\/serious complication): TENDER SWELLING BEHIND THE EAR \u2714 \u2014 indicates MASTOIDITIS (infection spread to mastoid process \u2192 post-auricular swelling, tenderness, pinna displaced forward); requires urgent hospital referral and IV antibiotics\/surgery. ACUTE EAR INFECTION: pus draining <14 days \u2192 treat with antibiotics (no urgent referral). CHRONIC EAR INFECTION: pus draining \u226514 days \u2192 dry ear, refer non-urgently, no systemic antibiotics. Bilateral discharge \u2192 chronic suppurative otitis media \u2192 non-urgent management. Tender post-auricular swelling is the ONLY situation requiring URGENT referral as it signals a potentially serious intracranial\/extracranial complication. Answer: Tender swelling behind the ear.'},\n{id:105,stem:'Upto 10% of cases of Autism Spectrum Disorder (ASD) may be caused by genetic conditions. Which of the following are known to be associated with ASD?\\nI. Tuberous sclerosis\\nII. Fragile X syndrome\\nIII. Prader-Willi syndrome\\nIV. Patau syndrome\\nSelect the correct answer using the code given below:',correct:'I and II',options:['I and II','I and III','II and III','I and IV'],exp:'Genetic conditions associated with Autism Spectrum Disorder: TUBEROUS SCLEROSIS (TSC) \u2714 \u2014 TSC1\/TSC2 mutations; ~25\u201350% of TSC patients have ASD; cortical tubers in speech\/social areas \u2192 autism. FRAGILE X SYNDROME \u2714 \u2014 FMR1 gene (CGG repeat expansion); most common single-gene cause of inherited intellectual disability; ~30% of Fragile X males have ASD; most common identified genetic cause of ASD. PRADER-WILLI SYNDROME \u2717 \u2014 behavioural features include obsessive-compulsive traits but ASD is not a primary association; PWS has specific behavioural phenotype (hyperphagia, temper tantrums) but not typically ASD. PATAU SYNDROME (Trisomy 13) \u2717 \u2014 severe chromosomal disorder; intellectual disability and structural anomalies; not specifically associated with ASD diagnosis (most affected infants do not survive to receive an ASD diagnosis). Answer: I and II.'},\n{id:106,stem:'Which of the following are characteristic features of cerebral palsy?\\nI. Disorder of movement\\nII. Permanent nature\\nIII. Progressive course\\nIV. Disorder of posture\\nSelect the correct answer using the code given below:',correct:'I, II and IV',options:['I, II and III','I, II and IV','II, III and IV','I, III and IV'],exp:'Cerebral Palsy (CP) \u2014 definition and features: DISORDER OF MOVEMENT \u2714 (Statement I) \u2014 motor disorder affecting coordination, tone, movement patterns. PERMANENT \u2714 (Statement II) \u2014 the brain lesion is non-progressive and permanent; the motor impairment is lifelong. PROGRESSIVE COURSE \u2717 (Statement III) \u2014 FALSE. CP is NON-PROGRESSIVE; the underlying brain injury does NOT worsen over time (though functional presentation may change with growth). This is a key distinguishing feature from neurodegenerative conditions. DISORDER OF POSTURE \u2714 (Statement IV) \u2014 postural abnormalities (abnormal tone, asymmetric postures) are characteristic. Definition: \"Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitation, attributed to non-progressive disturbances in the developing fetal or infant brain.\" Correct: I, II, IV. Answer: I, II and IV.'},\n{id:107,stem:'Which of the following are the tools used for classification of spasticity in a child with cerebral palsy?\\nI. Gross Motor Function Classification System\\nII. Medical Research Council System\\nIII. Modified Connors Scale (Connors-II)\\nIV. Modified Ashworth Scale\\nSelect the correct answer using the code given below:',correct:'I and IV',options:['I and II','II and III','III and IV','I and IV'],exp:'Tools in cerebral palsy assessment: GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM (GMFCS) \u2714 \u2014 classifies CP by level of gross motor function (I\u2013V); assesses functional mobility; widely used for CP classification and outcome prediction. MODIFIED ASHWORTH SCALE \u2714 \u2014 specifically measures SPASTICITY (resistance to passive movement); grades 0\u20134; gold standard clinical tool for spasticity assessment in CP and other UMN disorders. MEDICAL RESEARCH COUNCIL (MRC) SCALE \u2717 \u2014 grades MUSCLE WEAKNESS\/POWER (0\u20135); measures voluntary muscle strength, not spasticity. MODIFIED CONNORS SCALE \u2717 \u2014 a behavioural rating scale for ADHD (attention, hyperactivity); completely unrelated to spasticity or CP motor classification. Correct for spasticity classification: I (GMFCS for overall CP classification) and IV (Modified Ashworth for spasticity specifically). Answer: I and IV.'},\n{id:108,stem:'Which of the following medications may be used in a child diagnosed with Attention Deficit Hyperactivity Disorder?\\nI. Carbamazepine\\nII. Methylphenidate\\nIII. Atomoxetine\\nIV. Clonazepam\\nSelect the correct answer using the code given below:',correct:'II and III',options:['I and III','II and III','II and IV','I and IV'],exp:'ADHD pharmacotherapy: METHYLPHENIDATE \u2714 (Statement II) \u2014 first-line stimulant medication for ADHD; dopamine and noradrenaline reuptake inhibitor; Ritalin\/Concerta; effective in ~70\u201380% of cases. ATOMOXETINE \u2714 (Statement III) \u2014 non-stimulant; selective noradrenaline reuptake inhibitor (SNRI); second-line\/alternative when stimulants are contraindicated or not tolerated; also approved for ADHD. CARBAMAZEPINE \u2717 (Statement I) \u2014 antiepileptic drug; NOT approved for ADHD; may be used for mood stabilisation in bipolar disorder but not ADHD. CLONAZEPAM \u2717 (Statement IV) \u2014 benzodiazepine; used for seizures\/anxiety; NOT indicated for ADHD; CNS depressant effects contraindicated. Other ADHD drugs: amphetamines (lisdexamfetamine), clonidine (alpha-2 agonist), guanfacine. Answer: II and III.'},\n{id:109,stem:'Which of the following are included as a \"Deficiency\" under the Rashtriya Bal Swasthya Karyakram (RBSK)?\\nI. Hypothyroidism\\nII. Vitamin A deficiency\\nIII. Anaemia\\nIV. Vitamin D deficiency\\nSelect the correct answer using the code given below:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'RBSK \u2014 4D screening framework for children 0\u201318 years: DEFECTS at birth, DISEASES, DEFICIENCIES, DEVELOPMENTAL DELAYS. DEFICIENCIES specifically screened under RBSK: Anaemia (iron deficiency) \u2714 (Statement III). Vitamin A deficiency \u2714 (Statement II). Hypothyroidism \u2714 (Statement I) \u2014 congenital hypothyroidism and acquired; included as a deficiency\/disorder. Iodine deficiency disorders (goitre). VITAMIN D DEFICIENCY \u2717 (Statement IV) \u2014 Vitamin D deficiency\/rickets is NOT specifically listed as one of the RBSK deficiency targets; while important, it is not included in the official RBSK 4D deficiency list. Correct RBSK deficiencies: I (Hypothyroidism), II (Vitamin A), III (Anaemia). Answer: I, II and III.'},\n{id:110,stem:'Which of the following statements are correct regarding management of hyperkalemia in a child?\\nI. Intravenous calcium (gluconate or chloride) is given to enhance cellular uptake of potassium\\nII. Beta adrenergic agonists (salbutamol or terbutaline) are used to stabilize myocardial cell membrane\\nIII. Regular insulin and glucose given intravenously enhance cellular uptake of potassium\\nIV. Sodium polystyrene sulfonate enhances total body potassium elimination\\nSelect the answer using the code given below:',correct:'III and IV',options:['I and II','II and III','I and IV','III and IV'],exp:'Hyperkalaemia management \u2014 mechanisms: Statement I \u2717 \u2014 IV CALCIUM (gluconate or chloride) does NOT enhance cellular uptake of K+; calcium STABILISES THE MYOCARDIAL CELL MEMBRANE (antagonises the cardiac effects of hyperkalaemia) by raising the threshold potential; it does NOT lower serum K+. Statement II \u2717 \u2014 Beta adrenergic agonists (salbutamol\/nebulised) SHIFT K+ into cells (intracellular uptake via Na+\/K+ ATPase stimulation); they do NOT stabilise myocardial membrane. Membrane stabilisation = calcium. Statement III \u2714 \u2014 Insulin (with glucose to prevent hypoglycaemia) stimulates Na+\/K+ ATPase \u2192 K+ shifts intracellularly \u2192 lowers serum K+. Statement IV \u2714 \u2014 Sodium polystyrene sulphonate (Kayexalate) \u2014 cation exchange resin; exchanges Na+ for K+ in the colon \u2192 eliminates K+ from body via faeces \u2192 reduces total body K+. Correct: III and IV. Answer: III and IV.'},\n{id:111,stem:'Which of the following statements are correct about oral rotavirus vaccines?\\nI. The storage should be at 2-8\u00b0C\\nII. The vaccine should be used within 2 hours of reconstitution or opening\\nIII. Past history of intussusception is a contraindication\\nIV. The vaccine can be given if the baby has ongoing diarrhoea\\nSelect the answer using the code given below:',correct:'I and III',options:['I and II','III and IV','I and III','II and IV'],exp:'Oral rotavirus vaccines (Rotavac, Rotarix, RotaTeq) facts: Statement I \u2714 \u2014 Storage at 2\u20138\u00b0C (cold chain); protect from freezing (liquid vaccines); stable at refrigerator temperature. Statement II \u2717 \u2014 After opening\/reconstitution: Rotarix should be used immediately or within 24 hours if stored in refrigerator; RotaTeq is a ready-to-use liquid; \"2 hours\" is not the standard guideline for rotavirus vaccines specifically (this applies to some reconstituted vaccines like measles). Statement III \u2714 \u2014 PAST HISTORY OF INTUSSUSCEPTION is an ABSOLUTE CONTRAINDICATION; first-generation rotavirus vaccine (RotaShield) was withdrawn due to intussusception risk; current vaccines have very low risk but prior intussusception history remains a contraindication. Statement IV \u2717 \u2014 ONGOING DIARRHOEA is a CONTRAINDICATION (mild diarrhoea may be acceptable, but significant ongoing diarrhoea \u2192 vaccine may not be absorbed\/effective; defer until recovery). Correct: I and III. Answer: I and III.'},\n{id:112,stem:'A child can make a tower of 3 blocks, runs, copies his mother while sweeping and has a vocabulary of 8-10 words. His developmental age is',correct:'18 months',options:['12 months','15 months','18 months','24 months'],exp:'Developmental milestones: TOWER OF 3 BLOCKS: 18 months \u2714 (2 blocks at 15 months, 3 at 18 months, 6 at 2 years, 9\u201310 at 3 years). RUNS: 18 months \u2714 (walks well at 12 months, runs at 18 months). COPIES MOTHER SWEEPING (imitative play\/domestic mimicry): 15\u201318 months \u2714. VOCABULARY 8\u201310 WORDS: 18 months \u2714 (10 words at 18 months; 2-word phrases at 2 years; 3-word sentences at 3 years; 12 months = 1\u20132 meaningful words). All milestones consistently point to 18 months. Answer: 18 months.'},\n{id:113,stem:'A child can ride a tricycle, copies a circle, knows name and gender. The developmental age of this child is',correct:'3 years',options:['2 years','3 years','4 years','5 years'],exp:'Developmental milestones: RIDES TRICYCLE: 3 years \u2714 (pedals tricycle at 3 years; rides bicycle with training wheels at 4\u20135 years). COPIES A CIRCLE: 3 years \u2714 (copies circle at 3 years; copies cross at 4 years; copies triangle at 5 years; copies square at 4.5 years). KNOWS NAME AND GENDER: 3 years \u2714 (states full name and gender at 3 years; knows age at 3 years; knows date of birth at 4\u20135 years). All three milestones = 3 years. Answer: 3 years.'},\n{id:114,stem:'A teen boy with birth weight of 2\u00b78 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth?\\nI. The baby should be initiated on breastfeeding within one hour of birth\\nII. The baby should be kept in a separate area from the mother\\nIII. The baby should be administered with 0\u00b75 mg of vitamin K intramuscularly\\nIV. The baby should be thoroughly examined for congenital malformations from head to toe\\nSelect the answer using the code given below:',correct:'I and III',options:['I and II','I and III','II and III','I and IV'],exp:'Initial newborn care \u2014 evidence-based recommendations: Statement I \u2714 \u2014 EARLY INITIATION OF BREASTFEEDING within ONE HOUR of birth; WHO\/UNICEF Baby-Friendly Hospital Initiative; provides colostrum (first milk rich in IgA, nutrients); promotes bonding. Statement II \u2717 \u2014 Baby should be kept WITH mother (rooming-in\/kangaroo care); separation is NOT recommended for a healthy newborn; skin-to-skin contact promotes breastfeeding and temperature regulation. Statement III \u2714 \u2014 VITAMIN K 1 mg IM (NOT 0.5 mg \u2014 but 0.5 mg is sometimes used for preterm; for term newborns the standard dose is 1 mg IM; however among the options this is closest to correct); given to prevent haemorrhagic disease of newborn (Vitamin K deficiency bleeding). Statement IV \u2014 thorough examination is standard but is not limited to congenital malformations; includes APGAR, tone, reflexes, feeding ability. Official answer: I and III. Answer: I and III.'},\n{id:115,stem:'Which one of the following oral drugs may be used in the management of super-refractory status epilepticus?',correct:'Topiramate',options:['Clonazepam','Clobazam','Lamotrigine','Topiramate'],exp:'Super-refractory status epilepticus (SRSE) \u2014 status epilepticus continuing despite 24 hours of anaesthetic therapy: Management options include: Ketamine (NMDA antagonist), Inhalational anaesthetics (isoflurane), Immunotherapy (steroids, IVIG, plasmapheresis for autoimmune SE), Magnesium sulphate, Hypothermia, Ketogenic diet. ORAL\/ENTERAL options for SRSE: TOPIRAMATE \u2714 \u2014 multiple mechanisms (Na+ channel, GABA enhancement, glutamate antagonism, carbonic anhydrase inhibition); given via NG tube in SRSE; shown to be effective in refractory\/super-refractory SE. CLOBAZAM\/CLONAZEPAM \u2014 benzodiazepines; used earlier in the treatment algorithm but not specifically for super-refractory phase. LAMOTRIGINE \u2014 Na+ channel blocker; maintenance AED; slow uptitration required; not used acutely for SRSE. Answer: Topiramate.'},\n{id:116,stem:'Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus?\\nI. Upto two doses may be used 5 minutes apart, if seizures are not controlled\\nII. For Lorazepam, only a single dose should be used, even if seizures are not controlled\\nIII. Dose of midazolam at this stage is 1-15 \u03bcg\/kg\/min infusion\\nIV. Dose of both lorazepam and midazolam is 0\u00b71 mg\/kg\\nSelect the answer using the code given below:',correct:'I and IV',options:['I and III','I and IV','II and III','II and IV'],exp:'Benzodiazepines in status epilepticus \u2014 initial management: Statement I \u2714 \u2014 Up to TWO doses of benzodiazepine may be given, approximately 5 minutes apart if seizures persist after first dose; standard protocol in most guidelines (APLS, NICE). Statement II \u2717 \u2014 Lorazepam CAN be given as a second dose if seizures continue; \"single dose only\" is incorrect. Statement III \u2717 \u2014 Midazolam 1\u201315 \u03bcg\/kg\/min is the dose for REFRACTORY status epilepticus (anaesthetic infusion phase), NOT the initial bolus phase; initial dose is 0.1\u20130.2 mg\/kg IV\/IM\/buccal. Statement IV \u2714 \u2014 Standard initial bolus dose of BOTH IV lorazepam and IV midazolam is 0.1 mg\/kg (max 4 mg lorazepam; 10 mg midazolam buccal). Correct: I and IV. Answer: I and IV.'},\n{id:117,stem:'Which of the following statements are correct regarding hypernatremia in children?\\nI. Diabetes insipidus due to a deficiency of antidiuretic hormone (ADH) may cause hypernatremia\\nII. Addison disease may be associated with hypernatremia\\nIII. Use of boiled skimmed milk can lead to hypernatremia\\nIV. Use of lactulose can lead to hypernatremia\\nSelect the answer using the code given below:',correct:'I, III and IV',options:['I, III and IV','II, III and IV','I, II and III','I, II and IV'],exp:'Hypernatraemia in children \u2014 causes: Statement I \u2714 \u2014 CENTRAL DIABETES INSIPIDUS (ADH deficiency) \u2192 inability to concentrate urine \u2192 excessive free water loss \u2192 hypernatraemia. Statement II \u2717 \u2014 ADDISON\\'S DISEASE (adrenocortical insufficiency) causes HYPONATRAEMIA (aldosterone deficiency \u2192 Na+ wasting) and HYPERKALAEMIA; NOT hypernatraemia. Statement III \u2714 \u2014 BOILED SKIMMED MILK: high solute load (high protein, high sodium concentrate when water evaporates during boiling) \u2192 hypernatraemic dehydration in infants; a well-known cause of iatrogenic hypernatraemia. Statement IV \u2714 \u2014 LACTULOSE: osmotic laxative; draws water into the colon \u2192 watery stools \u2192 free water loss > sodium loss \u2192 hypernatraemia, especially in infants\/young children if fluid replacement inadequate. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:118,stem:'Which of the following statements are correct regarding the management of gastrointestinal bleeding in children?\\nI. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding\\nII. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N-butyl-2-cyanoacrylate or isobutyl-2-cyanoacrylate\\nIII. EST has upto 90% efficacy in controlling acute bleeding\\nIV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding\\nSelect the answer using the code given below:',correct:'III and IV',options:['I and II','I and III','III and IV','II and IV'],exp:'GI bleeding management in children \u2014 variceal bleeding: Statement I \u2717 \u2014 Octreotide\/somatostatin infusion: given for 2\u20135 DAYS after variceal bleeding (not 7 days); reduces portal pressure; 5 days is typically recommended post-endoscopy. Statement II \u2717 \u2014 EST (Endoscopic Sclerotherapy) involves injection of SCLEROSANTS (ethanolamine oleate, sodium tetradecyl sulphate, absolute alcohol) into or adjacent to varices; N-butyl-2-cyanoacrylate (tissue glue) is used for GASTRIC varices (endoscopic cyanoacrylate injection), not standard sclerotherapy. Statement III \u2714 \u2014 EST has ~85\u201395% efficacy (up to 90%) in controlling acute oesophageal variceal bleeding; combined with vasoactive drugs \u2192 >90% haemostasis. Statement IV \u2714 \u2014 Following acute variceal bleed: ALL patients should receive SECONDARY PROPHYLAXIS (non-selective beta-blockers \u00b1 endoscopic variceal ligation\/sclerotherapy) to prevent rebleeding; rebleeding rate without prophylaxis is very high. Correct: III and IV. Answer: III and IV.'},\n{id:119,stem:'Which of the following are advantages of endotracheal intubation, in a child requiring pediatric advanced life support?\\nI. Inspiratory time can be controlled\\nII. Positive end-expiratory pressure can be provided\\nIII. Peak expiratory pressure can be controlled\\nIV. Reduced risk of aspiration of gastric contents\\nSelect the correct answer using the code given below:',correct:'I, II and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Advantages of endotracheal intubation in PALS: Statement I \u2714 \u2014 INSPIRATORY TIME can be precisely controlled (I:E ratio set on ventilator); allows optimal ventilation strategy. Statement II \u2714 \u2014 POSITIVE END-EXPIRATORY PRESSURE (PEEP) can be applied via ETT and ventilator \u2192 prevents alveolar collapse, improves oxygenation; not possible with bag-mask ventilation. Statement III \u2717 \u2014 \"PEAK EXPIRATORY PRESSURE\" is not a standard ventilator-controlled parameter; ventilators control PEAK INSPIRATORY PRESSURE (PIP), not expiratory pressure. Peak expiratory pressure is passive\/not controlled. Statement IV \u2714 \u2014 REDUCED ASPIRATION RISK: ETT with cuffed tube isolates the airway from the GI tract \u2192 prevents gastric content aspiration (a major advantage over bag-mask ventilation). Correct: I, II, IV. Answer: I, II and IV.'},\n{id:120,stem:'Which of the following are causes of hypocalcemia in a child?\\nI. Hypomagnesemia\\nII. Hypophosphatemia\\nIII. Metabolic acidosis\\nIV. Pseudohypoparathyroidism\\nSelect the correct answer using the code given below:',correct:'I and IV',options:['I and II','II and III','III and IV','I and IV'],exp:'Causes of hypocalcaemia in children: HYPOMAGNESAEMIA \u2714 (Statement I) \u2014 magnesium is required for PTH secretion and PTH action on target organs; hypomagnesaemia \u2192 impaired PTH release + PTH resistance \u2192 hypocalcaemia; refractory hypocalcaemia does not respond until Mg is corrected. PSEUDOHYPOPARATHYROIDISM \u2714 (Statement IV) \u2014 PTH resistance (Albright\\'s hereditary osteodystrophy); PTH levels are HIGH but end-organs do not respond \u2192 hypocalcaemia + hyperphosphataemia. HYPOPHOSPHATAEMIA \u2717 (Statement II) \u2014 LOW phosphate levels are actually associated with HYPERCALCAEMIA (less calcium-phosphate binding \u2192 more free calcium); hypophosphataemia does NOT cause hypocalcaemia (rickets shows low phosphate + low-normal calcium). METABOLIC ACIDOSIS \u2717 (Statement III) \u2014 acidosis INCREASES ionised calcium (H+ displaces Ca2+ from albumin binding \u2192 more free Ca2+); acidosis does NOT cause hypocalcaemia; alkalosis causes hypocalcaemia (by increasing albumin-calcium binding \u2192 reduced ionised Ca). Correct: I and IV. 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Submitting in 10 Submit Now Combined Medical Services Examination 2025Paper I \u00b7 Part C General Medicine (Q81\u2013Q96) \u00b7 Paediatrics (Q97\u2013Q120) Questions 81 \u2013 120 +1 correct \u00b7 \u2212\u2153 wrong \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry… <\/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":[18,19,20],"tags":[],"class_list":["post-36840","post","type-post","status-publish","format-standard","hentry","category-cms","category-general-medicine","category-pediatrics"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CMS 2025 P1 Part-C - 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\/16\/cms-2025-p1-part-c\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2025 P1 Part-C - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2025 Paper I \u2013 Part C (Q81\u2013Q120) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0.00 \/ 40 Time's Up! 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