Q5
(a) Briefly describe the clinical features, diagnostic workup and management of a patient of choledochal cyst. (3+4+3=10 marks) (b) 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. (i) Briefly write the clinical features of this condition. (5 marks) (ii) Enumerate five complications of this fracture. (5 marks) (5+5=10 marks) (c) (i) Define Foetal Growth Restriction (FGR). (2 marks) (ii) List the common causes of FGR. (4 marks) (iii) 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) (d) (i) Define menopause. (2 marks) (ii) List the medical indications for prescribing Hormone Replacement Therapy (HRT). (4 marks) (iii) State briefly the controversies that have demerited the concept of 'Universal HRT'. (4 marks) (2+4+4=10 marks) (e) 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: (i) What are the reasons which have led to a major shift in the geographic extent of dengue in the country? (5 marks) (ii) How is climatic change impacting the disease? (5 marks) (5+5=10 marks)
हिंदी में प्रश्न पढ़ें
(a) सामान्य पित्तवाहिनी पूटी के रोगी के चिकित्सकीय लक्षण, नैदानिक जाँच-परीक्षण तथा प्रबंधन के विषय में संक्षेप में वर्णन कीजिए। (3+4+3=10) (b) 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। (i) कॉलिस अस्थिभंग की रोगलाक्षणिक विशिष्टताओं के विषय में संक्षेप में लिखिए। (5) (ii) इस अस्थिभंग से होने वाली पाँच जटिलताओं को गिनाइए। (5) (5+5=10) (c) (i) 'गर्भ वृद्धि निर्बंधन' (फीटल ग्रोथ रिस्ट्रिक्शन) को परिभाषित कीजिए। (2) (ii) 'गर्भ वृद्धि निर्बंधन' के सामान्य कारणों को गिनाइए। (4) (iii) 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) (d) (i) रजोनिवृत्ति को परिभाषित कीजिए। (2) (ii) उन चिकित्सकीय संकेतों को गिनाइए जिनमें हार्मोन प्रतिस्थापन चिकित्सा (हार्मोन रिप्लेसमेंट थेरैपी) प्रदत्त की जाती है। (4) (iii) 'सार्वत्रिक हार्मोन रिप्लेसमेंट थेरैपी' का सिद्धांत किन विवादों के कारण बदनाम हुआ, इस विषय पर संक्षेप में लिखिए। (4) (2+4+4=10) (e) 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: (i) वे कौन-से प्रमुख कारक हैं जिनके कारण देश में डेंगू की भौगोलिक सीमा में बड़ा बदलाव आया है? (5) (ii) जलवायु परिवर्तन ने डेंगू को कैसे प्रभावित किया है? (5) (5+5=10)
Directive word: Describe
This question asks you to describe. The directive word signals the depth of analysis expected, the structure of your answer, and the weight of evidence you must bring.
See our UPSC directive words guide for a full breakdown of how to respond to each command word.
How this answer will be evaluated
Approach
The directive 'describe' demands systematic, structured exposition of clinical entities across all sub-parts. Allocate approximately 20% time to (a) choledochal cyst, 20% to (b) Colles' fracture, 20% to (c) FGR, 20% to (d) menopause/HRT, and 20% to (e) dengue epidemiology. Begin each sub-part with definition/classification, proceed to clinical features/pathophysiology, and conclude with management or public health implications. For part (c)(iii), explicitly integrate the high-risk obstetric history (previous CS at 32 weeks, no living issues) into management decisions.
Key points expected
- (a) Choledochal cyst: Todani classification (Types I-V), triad of pain-jaundice-mass, MRCP/ERCP diagnosis, excision with Roux-en-Y hepaticojejunostomy
- (b) Colles' fracture: 'Dinner fork' deformity, posterior displacement, radial shortening; complications including malunion, carpal tunnel syndrome, Sudeck's atrophy, arthritis, tendon rupture
- (c) FGR: Definition as EFW <10th percentile or lagging AC; causes include placental insufficiency, maternal malnutrition, infections (TORCH), chromosomal anomalies; management with Doppler surveillance, steroids, timed delivery balancing prematurity vs. intrauterine demise
- (d) Menopause/HRT: 12 months amenorrhea, indications for vasomotor symptoms, osteoporosis prevention; WHI study controversies regarding breast cancer and cardiovascular risk
- (e) Dengue: Geographic expansion due to urbanization, Aedes aegypti adaptation, serotype shifts (DEN-2 dominance in India); climate change effects on vector breeding temperature range and transmission season extension
Evaluation rubric
| Dimension | Weight | Max marks | Excellent | Average | Poor |
|---|---|---|---|---|---|
| Concept correctness | 20% | 10 | Accurately defines all entities: Todani classification for choledochal cyst, precise anatomical description of Colles' fracture, WHO/ICB criteria for FGR, STRAW criteria for menopause staging, and correctly identifies dengue virus serotypes and vector biology | Basic definitions correct but minor errors in classification systems (e.g.,混淆Todani types) or incomplete FGR diagnostic criteria; vague on dengue serotype specifics | Major conceptual errors such as confusing choledochal cyst with cholecystitis, misidentifying Colles' vs. Smith's fracture, or fundamental misunderstanding of menopause definition |
| Clinical correlation | 20% | 10 | Vividly correlates theory with bedside findings: for (a) describes palpable RUQ mass in infant; for (b) details 'dinner fork' deformity and ulnar styloid prominence; for (c) integrates previous CS scar with delivery planning; for (e) cites Indian urban dengue outbreaks (Delhi 2015, Kerala 2017) | Mentions clinical features in list form without integrative description; generic statements like 'patient presents with pain' without specifying character or associated findings | Clinical features missing or incorrect; fails to mention age/gender relevance (e.g., infant choledochal cyst, postmenopausal osteoporosis context for HRT) |
| Diagram / pathway | 20% | 10 | Includes labeled diagram for Todani classification or Roux-en-Y reconstruction in (a); sketches Colles' deformity in (b); draws FGR management algorithm with Doppler decision tree in (c); flowchart for dengue case classification per WHO 2009 guidelines in (e) | Mentions 'see figure' or describes diagram verbally without clear sketch; incomplete labeling of anatomical structures | No diagrams where expected; no attempt to illustrate surgical anatomy or management pathways despite explicit need in surgical/obstetric components |
| Differential / staging | 20% | 10 | Systematic differentials: for (a) distinguishes from choledocholithiasis, Caroli's disease, biliary atresia; for (b) differentiates Smith's, Barton's, Hutchinson's fractures; for (c) stages FGR as early vs. late onset with corresponding placental histology; for (d) outlines STRAW stages of reproductive aging | Lists 1-2 differentials without justification; mentions staging without criteria; conflates similar entities without distinguishing features | No differentials offered; confuses entirely distinct conditions (e.g., FGR with congenital anomalies); no staging mentioned where relevant |
| Management / public-health angle | 20% | 10 | Evidence-based management: complete cyst excision with biliary reconstruction for (a); closed reduction with cast immobilization and early mobilization protocol for (b); individualized FGR delivery timing at 26 weeks with corticosteroids, magnesium sulfate, and tertiary center referral given scarred uterus; for (e), integrated vector management, NS1 rapid testing, and climate adaptation strategies per NVBDCP guidelines | Generic management statements without specificity; mentions surgery/delivery without timing or technique; public health response limited to 'spraying' without integrated approach | Management dangerously incorrect (e.g., aspiration of choledochal cyst, immediate delivery at 26 weeks without steroids); no public health perspective for dengue; ignores previous CS in obstetric decision-making |
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