Paper II — Q1
(a) Discuss in brief the role of ultrasound in the investigation of pain in right hypochondrium. (10 marks) (b) Outline the…
Discuss in brief the role of ultrasound in the investigation of pain in right hypochondrium. 10 marks
Outline the pharmacological and non-pharmacological treatment of depressive disorders. 10 marks
A neonate born at 30 weeks of gestation is found to have tachypnea, chest retractions and grunt within 30 minutes of birth. What is the most likely diagnosis? Mention the basis of your diagnosis and state briefly the pathophysiology of the condition.
Describe the management of this condition. (5+5=10 marks)
A 6-month-old infant attending paediatrics OPD is found to have central cyanosis, clubbing and no hepatomegaly. What is the most likely cardiovascular condition? State its cardiovascular examination findings and accompanying haemodynamic changes.
Write about the clinical course and complications related to this condition. (5+5=10 marks)
An adolescent girl fond of wearing artificial jewellery presented with itchy, papulo-vesicular skin lesions on the ears, wrists and neck. What is the likely diagnosis?
Name the gold standard test which you would use for the confirmation of diagnosis.
How would you interpret the test results?
State the complications of this test. (2+2+3+3=10 marks)
हिंदी में प्रश्न पढ़ें
दक्षिण अधःपशुक प्रदेशीय वेदना की जाँच में अल्ट्रासाउंड की भूमिका की संक्षेप में चर्चा कीजिए। (10 अंक)
अवसादी विकारों के फार्माकोलॉजिकल एवं नॉन-फार्माकोलॉजिकल उपचार की रूपरेखा प्रस्तुत कीजिए। (10 अंक)
एक 30 सप्ताह की गर्भावस्था पर जन्मे नवजात में जन्म लेने के 30 मिनट के भीतर श्वासदीर्घता, वक्ष प्रतिगमन तथा ग्रंट के लक्षण पाए जाते हैं। सर्वाधिक संभावित निदान क्या है? आपके इस निदान का क्या आधार है, उल्लेखित कीजिए तथा इस रुग्णता की विकृत-शरीर-क्रिया संक्षेप में बताइए।
इस रुग्णता के प्रबंधन का वर्णन कीजिए। (5+5=10 अंक)
बालचिकित्सा ओ.पी.डी. में आए एक 6-माह के शिशु को केंद्रीय श्यावता (सेंट्रल सायनोसिस) और मुद्रागण (क्लबिंग) है। उसे यकृतवृद्धि नहीं है। सर्वाधिक संभावित हृद्-वाहिकीय विकार कौन-सा है? हृद्-वाहिकीय जाँच करने पर इसमें क्या जानकारियाँ मिलेंगी और उसके साथ क्या-क्या रक्तगतिकी परिवर्तन होंगे?
लिखिए कि इस रुग्णता का रोगलाक्षणिक क्रम क्या होगा और उससे संबंधित जटिलताएँ कौन-कौन सी हो सकती हैं। (5+5=10 अंक)
एक किशोरी कृत्रिम आभूषण पहनने का शौक रखती है। उसके कानों, कलाइयों तथा ग्रीवा की त्वचा पर कण्डूकारी पिटिकीय-जलस्फोट उभर आए हैं। संभावित निदान क्या होगा?
रोगनिदान की पुष्टि के लिए आप कौन-सी स्वर्ण मानक जाँच प्रयुक्त करेंगे, उसका नाम बताइए।
जाँच परिणाम का अर्थनिर्णय आप कैसे निकालेंगे?
इस जाँच से होने वाली जटिलताओं के बारे में बताइए। (2+2+3+3=10 अंक)
Model answer
Drafted with AI by UPSC Answer Check against this question's marking rubric, to the expected length. UPSC does not publish answers for Mains — this is one way to score well, not an official key. How we build rubrics and answers.
(a) Ultrasound in right hypochondrial pain
Ultrasound is the first-line test because it is quick, bedside, radiation-free and repeatable.
- Biliary: gallstones, gallbladder wall thickening, pericholecystic fluid and sonographic Murphy sign (cholecystitis); common bile duct and intrahepatic duct dilatation (obstruction, choledocholithiasis); cholangitis.
- Liver: hepatomegaly, fatty change, cirrhosis, abscess, hydatid cyst, focal masses, hepatic vein or portal vein thrombosis (with Doppler).
- Right kidney and ureter: calculi, hydronephrosis and perinephric collection.
- Others: subphrenic collection, right pleural effusion, pancreatic head masses, appendicitis in a high caecum.
- Image-guided aspiration or drainage of abscesses.
Limits: operator dependence, obesity and bowel gas, and poor view of the distal bile duct; CT, MRCP or EUS then follow.
(b) Treatment of depressive disorders
Pharmacological: choice depends on severity, comorbidity and prior response.
- SSRIs (fluoxetine, sertraline, escitalopram) are first-line; SNRIs (venlafaxine, duloxetine), mirtazapine and bupropion are alternatives.
- TCAs (amitriptyline, nortriptyline) are effective but cardiotoxic in overdose; MAOIs are for atypical or resistant depression (tyramine and serotonin-syndrome cautions).
- Continue for at least 6 months after remission; augment with lithium or an atypical antipsychotic in resistant cases.
- Electroconvulsive therapy: severe, psychotic, catatonic or suicidal depression and when rapid response is needed. Repetitive TMS and esketamine are options in resistant cases.
Non-pharmacological: psychoeducation, cognitive behavioural therapy, interpersonal therapy, behavioural activation and problem-solving therapy; mild depression often needs only these. Support includes exercise, sleep hygiene, avoiding alcohol and family and social support. Assess suicide risk at every visit.
(c)(i) Diagnosis, basis and pathophysiology
Diagnosis: respiratory distress syndrome (hyaline membrane disease) from surfactant deficiency.
Basis: prematurity (30 weeks) with tachypnoea, retractions and grunting beginning within minutes to hours of birth, progressing over 48–72 hours; chest X-ray shows ground-glass haze, air bronchograms and low lung volumes.
Pathophysiology: immature type II pneumocytes make too little surfactant, so alveolar surface tension rises, alveoli collapse and compliance falls. Functional residual capacity drops, ventilation–perfusion mismatch causes hypoxaemia and hypercarbia, and epithelial injury leaks protein-rich fluid that forms hyaline membranes.
(c)(ii) Management
- Antenatal corticosteroids to the mother before preterm delivery.
- Delivery-room care: warmth, gentle handling and early CPAP.
- Surfactant (for example poractant 200 mg/kg) by less invasive administration or after brief intubation, if CPAP needs rise; repeat as needed.
- Mechanical ventilation with lung-protective settings if CPAP fails; target SpO2 90–95% to avoid retinopathy of prematurity.
- Supportive: thermoneutral environment, fluids, glucose and nutrition, caffeine for apnoea, and antibiotics until sepsis is excluded.
- Watch for pneumothorax, patent ductus arteriosus, intraventricular haemorrhage and bronchopulmonary dysplasia.
(d)(i) Diagnosis, examination findings and haemodynamics
Most likely: tetralogy of Fallot (pulmonary stenosis, large VSD, overriding aorta and right ventricular hypertrophy).
Examination: central cyanosis and clubbing; right ventricular heave; a systolic thrill and an ejection systolic murmur at the left sternal border from right ventricular outflow obstruction, softer as obstruction worsens; single loud second sound (pulmonary component soft or absent); no signs of heart failure or hepatomegaly.
Haemodynamics: the large VSD equalises right and left ventricular pressures, and fixed pulmonary stenosis raises resistance to right ventricular outflow. Blood is shunted right to left across the VSD into the aorta, pulmonary blood flow falls and arterial oxygen saturation drops. There is no volume overload, so heart failure is absent.
(d)(ii) Clinical course and complications
Cyanosis is progressive and increases with feeding, crying or exertion; growth is poor. Hypercyanotic (tet) spells occur, relieved by squatting or the knee–chest position, which raises systemic resistance and reduces the shunt.
Complications: hypercyanotic spells and syncope, polycythaemia and hyperviscosity, cerebral thrombosis or stroke (especially with dehydration or iron deficiency), brain abscess, infective endocarditis, paradoxical embolism and sudden death. Treatment is corrective surgery in infancy, with a shunt as palliation when needed.
(e)(i) Diagnosis
Allergic contact dermatitis (nickel) from artificial jewellery, a type IV delayed hypersensitivity.
(e)(ii) Gold standard test
Patch test with nickel sulphate (5% in petrolatum) from the standard series, applied on the upper back for 48 hours, done when the dermatitis is quiescent.
(e)(iii) Interpretation
Read at 48 hours and again at 72–96 hours. Grade as doubtful (faint erythema), + (erythema and infiltration), ++ (papules or vesicles) and +++ (bullae or ulcer). A reaction that fades by day 4 suggests irritancy, while a persistent or increasing one indicates allergy. Positive results must be correlated with exposure.
(e)(iv) Complications of patch testing
Active sensitisation, flare of the dermatitis, irritant or pustular reactions, pigment change, scarring or keloid at the site, and rarely anaphylaxis.
How this answer will be evaluated
Framework: Clinical Sequence (Definition > Aetiology/Pathophysiology > Features > Investigation/Management)
What earns full marks: Accurate diagnosis, detailed pathophysiology, prioritized management, specific clinical details.
Evaluation rubric
Each sub-part is marked on its own, against the marks and word limit printed on the paper.
- (a) Discuss in brief the role of ultrasound in investigating pain in the right hypochondrium 10 marks
discuss— intro → 3-4 dimensions → example → balanced close
Must cover
- Biliary findings: stones, cholecystitis and duct dilatation
- Hepatic findings: abscess, masses, cirrhosis and vascular thrombosis
- Right renal causes and ultrasound as the first-line test
Loses marks
- Naming CT as the first-line test
- Listing only gallbladder disease
Earns more
- Sonographic Murphy sign and wall thickening
- Doppler for portal and hepatic veins
- Limitations and need for CT, MRCP or EUS
Extra mark
- Mentions image-guided drainage
- (b) Outline the pharmacological and non-pharmacological treatment of depressive disorders 10 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- SSRIs as first-line with alternatives such as SNRIs, TCAs and MAOIs
- ECT indications
- Psychotherapy: CBT, interpersonal therapy and psychoeducation
Loses marks
- Giving benzodiazepines as definitive treatment
- Omitting non-pharmacological treatment
Earns more
- Duration of at least 6 months after remission
- Augmentation in resistant depression
- Lifestyle measures and suicide-risk assessment
Extra mark
- Mentions rTMS or esketamine
- (c)(i) Give the most likely diagnosis in the preterm neonate with its basis and pathophysiology 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- Diagnosis: respiratory distress syndrome (hyaline membrane disease)
- Basis: prematurity, tachypnoea, retractions, grunt and typical chest X-ray
- Pathophysiology: surfactant deficiency, raised surface tension and atelectasis
Loses marks
- Diagnosing transient tachypnoea of the newborn or meconium aspiration
- Omitting surfactant deficiency
Earns more
- Type II pneumocyte immaturity
- Reduced compliance with ventilation–perfusion mismatch
- Hyaline membranes from protein-rich exudate
Extra mark
- Describes ground-glass appearance with air bronchograms
- (c)(ii) Describe the management of neonatal respiratory distress syndrome 5 marks
describe— define → structure or process in order → labelled diagram → significance
Must cover
- Antenatal steroids and early CPAP
- Surfactant replacement
- Ventilation if CPAP fails, with supportive care
Loses marks
- Targeting 100% oxygen saturation
- Omitting surfactant
Earns more
- Thermal care, fluids, glucose and nutrition
- SpO2 target 90–95% to avoid retinopathy of prematurity
- Caffeine for apnoea and antibiotics until sepsis excluded
Extra mark
- Mentions less invasive surfactant administration
- (d)(i) Give the most likely cardiovascular condition in the cyanotic infant with its examination findings and haemodynamics 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- Diagnosis: tetralogy of Fallot with its four components
- Findings: cyanosis, clubbing, ejection systolic murmur, single second sound and no failure
- Haemodynamics: right-to-left shunt across VSD with pulmonary stenosis
Loses marks
- Diagnosing a large left-to-right shunt
- Attributing the murmur to the VSD
Earns more
- Right ventricular heave and thrill
- Murmur softer with greater obstruction
- Equal right and left ventricular pressures with no volume overload
Extra mark
- Notes absence of hepatomegaly supports no heart failure
- (d)(ii) Write about the clinical course and complications of tetralogy of Fallot 5 marks
describe— define → structure or process in order → labelled diagram → significance
Must cover
- Progressive cyanosis with hypercyanotic spells and squatting
- Complications: polycythaemia, stroke, brain abscess and endocarditis
- Corrective surgery in infancy or palliative shunt
Loses marks
- Listing congestive heart failure as a typical complication
- Omitting hypercyanotic spells
Earns more
- Mechanism of squatting relief
- Poor growth and exertional limitation
- Role of iron deficiency or dehydration in cerebral thrombosis
Extra mark
- Mentions sudden death or paradoxical embolism
- (e)(i) State the likely diagnosis in the adolescent girl with jewellery-related dermatitis 2 marks
define— precise definition → the distinguishing feature → one example
Must cover
- Allergic contact dermatitis
- Nickel as the allergen
Loses marks
- Diagnosing atopic dermatitis alone
- Calling it type I hypersensitivity
Earns more
- Type IV delayed hypersensitivity
- Distribution on ears, wrists and neck
Extra mark
- Mentions nickel avoidance
- (e)(ii) Name the gold standard test to confirm the diagnosis 2 marks
define— precise definition → the distinguishing feature → one example
Must cover
- Patch test
- Nickel sulphate in the standard series
Loses marks
- Naming a prick test or serum IgE as gold standard
- Doing it during acute dermatitis
Earns more
- 5% in petrolatum on the upper back for 48 hours
- Done when dermatitis is quiescent
Extra mark
- Mentions Finn chambers
- (e)(iii) Explain how the test results are interpreted 3 marks
explain— definition/context → points in order → small example → short close
Must cover
- Reading at 48 hours and again at 72–96 hours
- Grading of reactions from doubtful to +++
- Distinguishing allergic from irritant reactions
Loses marks
- Reading only at 15 minutes
- Treating every positive result as clinically relevant
Earns more
- Persistent or increasing reaction indicates allergy
- Correlation with clinical exposure
Extra mark
- Mentions ICDRG grading
- (e)(iv) State the complications of patch testing 3 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Active sensitisation
- Flare of dermatitis or irritant reactions
- Pigment change or scarring at the test site
Loses marks
- Claiming the test has no risks
- Listing complications of skin prick testing only
Earns more
- Keloid or pustular reactions
- Rare anaphylaxis
Extra mark
- Mentions the angry back syndrome
What "Discuss" is asking you to do
Lay the issue out from more than one side — how it arose, what is claimed for it, what is held against it, and where it now stands. UPSC attaches discuss to broad topics with several live dimensions, so coverage of the dimensions earns more than the strength of your opinion.
Structure that answers it
Set the issue up → the case as it is made → the case against → the dimension both sides leave out → where the balance now lies
Where marks are lost
Listing facts with no thread between them, or arguing one side throughout and calling it a discussion.
Practice this exact question
Write your answer and it is marked point by point against the model answer above — what you covered, what you missed, what you got wrong.
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