Paper II — Q5
(a) Briefly describe the clinical features, diagnostic workup and management of a patient of choledochal cyst. (3+4+3=10…
Briefly describe the clinical features, diagnostic workup and management of a patient of choledochal cyst. (3+4+3=10 marks)
A 60-year-old lady presents to the casualty after a fall on her right outstretched hand. X-ray image is suggestive of Colles' fracture. Briefly write the clinical features of this condition. 5 marks
Enumerate five complications of this fracture. (5 marks) (5+5=10 marks)
Define Foetal Growth Restriction (FGR). 2 marks
List the common causes of FGR. 4 marks
Outline the strategy for managing a severely growth restricted pregnancy diagnosed at 26 weeks of gestation. This female has no living issues and has a past history of undergoing Caesarean Section at 32 weeks of pregnancy. (4 marks) (2+4+4=10 marks)
Define menopause. 2 marks
List the medical indications for prescribing Hormone Replacement Therapy (HRT). 4 marks
State briefly the controversies that have demerited the concept of 'Universal HRT'. (4 marks) (2+4+4=10 marks)
Dengue has become a major health problem for the country. The number of cases and disease severity have worsened over the years. Keeping this in context, answer the following questions: What are the reasons which have led to a major shift in the geographic extent of dengue in the country? 5 marks
How is climatic change impacting the disease? (5 marks) (5+5=10 marks)
हिंदी में प्रश्न पढ़ें
सामान्य पित्तवाहिनी पूटी के रोगी के चिकित्सकीय लक्षण, नैदानिक जाँच-परीक्षण तथा प्रबंधन के विषय में संक्षेप में वर्णन कीजिए। (3+4+3=10)
अपने दाहिने पसरे हुए हाथ पर गिरने के पश्चात् एक 60-वर्षीय महिला कैजुअल्टी में पहुँचती है। उसका एक्स-रे बिम्ब कॉलिस अस्थिभंग का संकेतक है। कॉलिस अस्थिभंग की रोगलाक्षणिक विशिष्टताओं के विषय में संक्षेप में लिखिए। 5 अंक
इस अस्थिभंग से होने वाली पाँच जटिलताओं को गिनाइए। (5) (5+5=10)
'गर्भ वृद्धि निर्बंधन' (फीटल ग्रोथ रिस्ट्रिक्शन) को परिभाषित कीजिए। 2 अंक
'गर्भ वृद्धि निर्बंधन' के सामान्य कारणों को गिनाइए। 4 अंक
26 सप्ताह की गर्भावस्था में पहचान में आए गंभीर 'गर्भ वृद्धि निर्बंधन' में प्रबंधन योजना क्या होगी, उसकी रूपरेखा प्रस्तुत कीजिए। इस महिला के इससे पूर्व कोई जीवित संतान नहीं है तथा विगत में वह 32 सप्ताह की गर्भावस्था में सीजेरियन सेक्शन से गुजर चुकी है। (4) (2+4+4=10)
रजोनिवृत्ति को परिभाषित कीजिए। 2 अंक
उन चिकित्सकीय संकेतों को गिनाइए जिनमें हार्मोन प्रतिस्थापन चिकित्सा (हार्मोन रिप्लेसमेंट थेरैपी) प्रदत्त की जाती है। 4 अंक
'सार्वत्रिक हार्मोन रिप्लेसमेंट थेरैपी' का सिद्धांत किन विवादों के कारण बदनाम हुआ, इस विषय पर संक्षेप में लिखिए। (4) (2+4+4=10)
डेंगू देश के लिए एक बड़ी जनस्वास्थ्य समस्या बन गया है। पिछले कुछ वर्षों में उसके मामलों की संख्या और रोग की गंभीरता अधिक बिगड़ी है। इसे संदर्भ में रखते हुए निम्नलिखित प्रश्नों के उत्तर दीजिए: वे कौन-से प्रमुख कारक हैं जिनके कारण देश में डेंगू की भौगोलिक सीमा में बड़ा बदलाव आया है? 5 अंक
जलवायु परिवर्तन ने डेंगू को कैसे प्रभावित किया है? (5) (5+5=10)
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) Choledochal cyst
A choledochal cyst is a congenital cystic dilatation of the bile duct, classified by Todani into types I (fusiform or saccular common duct, commonest), II (diverticulum), III (choledochocele), IV (multiple intra- and extrahepatic) and V (Caroli disease).
Clinical features: infants present with jaundice, an abdominal mass and pale stools; older children and adults with recurrent right upper abdominal pain, intermittent jaundice and a mass (the classic triad is complete in a minority), or with cholangitis, pancreatitis or stones. Long-standing cysts carry a risk of cholangiocarcinoma.
Diagnostic workup: ultrasound first; MRCP defines anatomy and the pancreaticobiliary junction; CT where needed; liver function tests (obstructive pattern), amylase and lipase; ERCP is reserved for therapy.
Management: complete cyst excision with cholecystectomy and Roux-en-Y hepaticojejunostomy (types I, II and IV); endoscopic sphincterotomy or transduodenal excision for type III; hepatic resection or transplant for localised or diffuse type V; antibiotics and drainage first in cholangitis; lifelong follow-up.
(b)(i) Colles' fracture: clinical features
Colles' fracture is a fracture of the distal radius within 2.5 cm of the wrist, with dorsal displacement, dorsal angulation, radial shift and shortening, typically in postmenopausal osteoporotic women. Features: pain, swelling and tenderness over the distal radius; "dinner-fork" deformity in the side view and radial deviation (bayonet appearance) in the front view; prominent ulnar styloid; crepitus and painful, limited wrist and finger movement. Check median nerve function (sensation over the index finger, thumb opposition) and radial pulse, capillary refill and compartments.
(b)(ii) Five complications
- Malunion with dorsal angulation, shortening and weak grip.
- Median nerve compression (acute or delayed carpal tunnel syndrome).
- Rupture of extensor pollicis longus, weeks after injury.
- Complex regional pain syndrome (Sudeck's atrophy) with shoulder, hand and finger stiffness.
- Post-traumatic radiocarpal or distal radio-ulnar arthritis.
Others: compartment syndrome, tendon adhesions and non-union (rare).
(c)(i) Definition
Fetal growth restriction is failure of a fetus to reach its genetic growth potential, defined as estimated fetal weight or abdominal circumference below the 10th centile (severe if below the 3rd centile or with abnormal Doppler), after excluding wrong dates.
(c)(ii) Causes
- Placental: insufficiency, infarcts, abruption, abnormal cord insertion.
- Maternal: hypertension and pre-eclampsia, malnutrition, anaemia, smoking or alcohol, chronic renal or cardiac disease, antiphospholipid syndrome, high altitude.
- Fetal: chromosomal anomalies and structural malformations, congenital infections (TORCH, malaria), multiple pregnancy.
(c)(iii) Management at 26 weeks with previous caesarean at 32 weeks
- Confirm dates, anomaly scan, and screen for infection and, if indicated, karyotype; counsel about viability, prognosis and neonatal care.
- Admit to a centre with a NICU; give antenatal betamethasone, and magnesium sulphate for neuroprotection if delivery before 32 weeks is likely.
- Surveillance: serial growth, liquor volume, umbilical artery, middle cerebral artery and ductus venosus Doppler, and computerised CTG.
- Treat the maternal cause, with aspirin where pre-eclampsia is a risk.
- Timing: deliver for absent or reversed end-diastolic flow (usually by 30–32 weeks), ductus venosus abnormality, or non-reassuring CTG; otherwise continue and deliver by 37 weeks.
- Mode: repeat caesarean section, as the scar type must be checked, the cervix is unfavourable and the fetus tolerates labour poorly; the pregnancy is precious.
(d)(i) Menopause
Permanent cessation of menstruation after loss of ovarian follicular activity, diagnosed after 12 months of amenorrhoea without another cause.
(d)(ii) Medical indications for HRT
- Moderate to severe vasomotor symptoms (hot flushes, night sweats).
- Genitourinary syndrome of menopause (local oestrogen preferred).
- Premature ovarian insufficiency, early or surgical menopause (treat until about the natural menopause age).
- Prevention of osteoporosis when other agents are unsuitable, in women under 60 or within 10 years of menopause.
- Hypoestrogenism from Turner syndrome or hypopituitarism.
(d)(iii) Controversies against universal HRT
The Women's Health Initiative (combined oestrogen–progestogen) found increased breast cancer, stroke, venous thromboembolism and, at older ages, coronary events, with no protection against heart disease or dementia. Unopposed oestrogen increases endometrial cancer, so progestogen is added in women with a uterus. Later analyses (timing hypothesis) show lower risk if started before 60 or within 10 years of menopause. Hence HRT is not given routinely for prevention; it is individualised, at the lowest effective dose for the shortest time, with regular review.
(e)(i) Reasons for geographic spread of dengue in India
- Rapid unplanned urbanisation, overcrowding, poor drainage and waste management that create container-breeding sites (tyres, coolers, construction sites).
- Water storage, due to irregular supply, supporting Aedes aegypti breeding.
- Movement of infected people and goods, including migration, trade and air or rail travel, carrying the virus to new districts.
- Spread of Aedes into peri-urban and rural areas, and into new states and higher altitudes; Aedes albopictus contributes.
- Circulation of all four serotypes and serotype shifts, raising the risk of severe secondary infection.
- Weak vector control and surveillance, with delayed reporting.
(e)(ii) Impact of climate change
Higher temperatures speed mosquito development and biting, increase vector survival and shorten the virus's extrinsic incubation period, so transmission rises and the season lengthens. Warmer, humid conditions allow spread to cooler higher-altitude regions. Altered monsoon, flooding and drought (with household water storage) multiply breeding sites. El Niño years are linked to larger epidemics. The combined effect is more cases, more outbreaks and wider geographic range.
How this answer will be evaluated
Framework: Clinical Sequence (Definition > Aetiology/Pathophysiology > Features > Investigation/Management)
What earns full marks: Precise clinical definitions, correct management protocols, and specific references to guidelines/studies.
Evaluation rubric
Each sub-part is marked on its own, against the marks and word limit printed on the paper.
- (a) Briefly describe the clinical features, diagnostic workup and management of a patient with choledochal cyst 10 marks
describe— define → structure or process in order → labelled diagram → significance
Must cover
- Todani classification and clinical presentation
- MRCP and ultrasound as diagnostic tests
- Complete cyst excision with Roux-en-Y hepaticojejunostomy
Loses marks
- Advising cyst drainage alone as definitive treatment
- Omitting the malignancy risk
Earns more
- Age-wise presentation and cholangiocarcinoma risk
- Type-specific management for types III and V
Extra mark
- Notes ERCP reserved for therapy
- (b)(i) Briefly write the clinical features of Colles' fracture 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- Mechanism and typical patient: fall on outstretched hand in an osteoporotic woman
- Dinner-fork deformity with dorsal displacement and angulation
- Tenderness, swelling and limited wrist movement
Loses marks
- Describing a volar (Smith) displacement
- Omitting the deformity
Earns more
- Radial deviation and prominent ulnar styloid
- Examination of median nerve and neurovascular status
Extra mark
- Notes the fracture is within 2.5 cm of the wrist
- (b)(ii) Enumerate five complications of Colles' fracture 5 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Malunion
- Median nerve compression or carpal tunnel syndrome
- Extensor pollicis longus rupture
Loses marks
- Listing scaphoid avascular necrosis as a typical complication
- Giving fewer than five complications
Earns more
- Complex regional pain syndrome
- Post-traumatic arthritis or stiffness
Extra mark
- Mentions compartment syndrome
- (c)(i) Define foetal growth restriction 2 marks
define— precise definition → the distinguishing feature → one example
Must cover
- Failure to reach genetic growth potential
- Estimated fetal weight or abdominal circumference below the 10th centile
Loses marks
- Confusing FGR with a constitutionally small fetus
- Defining it by birth weight only
Earns more
- Severity criterion of below the 3rd centile or abnormal Doppler
Extra mark
- Excludes wrong dates
- (c)(ii) List the common causes of foetal growth restriction 4 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Placental insufficiency
- Maternal causes: hypertension, malnutrition, anaemia or smoking
- Fetal causes: chromosomal anomalies, malformations and infections
Loses marks
- Listing only maternal causes
- Naming gestational diabetes as a typical cause of FGR
Earns more
- Antiphospholipid syndrome or chronic maternal disease
- Multiple pregnancy
Extra mark
- Mentions TORCH or malaria
- (c)(iii) Outline the strategy for managing severe FGR at 26 weeks with a previous caesarean at 32 weeks and no living child 4 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Antenatal steroids and magnesium sulphate with NICU-level care
- Serial Doppler and CTG surveillance
- Timed delivery for Doppler or CTG deterioration, by repeat caesarean section
Loses marks
- Advising induction of labour in the presence of a scar and abnormal Doppler
- Ignoring the previous caesarean section
Earns more
- Counselling about viability and prognosis
- Anomaly scan, infection screen or karyotype
Extra mark
- Mentions aspirin or treating the maternal cause
- (d)(i) Define menopause 2 marks
define— precise definition → the distinguishing feature → one example
Must cover
- Permanent cessation of menstruation
- Due to loss of ovarian follicular activity
Loses marks
- Defining it by hot flushes
- Using less than 12 months of amenorrhoea
Earns more
- Diagnosed after 12 months of amenorrhoea
Extra mark
- Notes it excludes other causes of amenorrhoea
- (d)(ii) List the medical indications for prescribing hormone replacement therapy 4 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Moderate to severe vasomotor symptoms
- Genitourinary syndrome of menopause
- Premature ovarian insufficiency or early menopause
Loses marks
- Listing primary prevention of heart disease or dementia as an indication
- Listing HRT for all asymptomatic women
Earns more
- Osteoporosis prevention when other agents are unsuitable
- Turner syndrome or hypopituitarism
Extra mark
- Notes local oestrogen for genitourinary symptoms
- (d)(iii) State briefly the controversies that demerited the concept of universal HRT 4 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Women's Health Initiative findings of breast cancer, stroke and venous thromboembolism
- No protection against heart disease or dementia
- Individualised use at the lowest effective dose for the shortest time
Loses marks
- Stating HRT is contraindicated in all women
- Ignoring the timing hypothesis
Earns more
- Unopposed oestrogen and endometrial cancer
- Timing hypothesis
Extra mark
- Mentions Million Women Study
- (e)(i) Give the reasons for the shift in geographic extent of dengue in India 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- Unplanned urbanisation and container breeding
- Water storage practices
- Human movement and spread of Aedes to new areas
Loses marks
- Attributing spread only to improved reporting
- Naming Culex as the vector
Earns more
- Circulation of all four serotypes and serotype shifts
- Weak vector control and surveillance
Extra mark
- Mentions Aedes albopictus
- (e)(ii) Explain how climatic change is impacting dengue 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- Higher temperature increasing vector survival and biting
- Shorter extrinsic incubation period and longer transmission season
- Altered rainfall, flooding and water storage creating breeding sites
Loses marks
- Claiming climate change has no effect
- Ignoring the vector role
Earns more
- Spread to higher altitudes and cooler regions
- El Niño associated epidemics
Extra mark
- Notes combined effect on cases and geographic range
What "Describe" is asking you to do
Give a full, ordered account of the thing named — its parts, stages or mechanism — in the sequence in which it actually exists or occurs. Most describe questions come from the science optionals, where the marks sit in correct technical detail and, where the stem says so, a labelled diagram.
Structure that answers it
One-line identification of the subject → the parts or stages in their real order, each with its defining detail → labelled diagram where the subject is structural → closing line on function or significance
Where marks are lost
Loose general prose where the examiner is ticking named parts, correct terminology and their sequence; and in the General Studies papers, turning to evaluation before the description is finished.
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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