(a) (i) Name the clinical tests for checking sapheno-femoral junction competence and deep venous system patency.
(ii) Enumerate the complications of varicose veins.
(iii) Briefly discuss the management of venous ulcer. 2+4+4=10

(b) A 65 year old mal

Question

(a) (i) Name the clinical tests for checking sapheno-femoral junction competence and deep venous system patency.
(ii) Enumerate the complications of varicose veins.
(iii) Briefly discuss the management of venous ulcer. 2+4+4=10

(b) A 65 year old male came to casualty with acute retention of urine. He also gave history of nocturia, urgency, dribbling and thin stream of urine for two years.
(i) How will you manage acute retention of urine in this patient ?
(ii) Briefly outline the definitive management in this patient. 4+6=10

(c) Outline the management of a 35 year old multigraveda patient who has presented to the emergency department in a state of shock. She has delivered a dead baby at home 2 hours back and the placenta has not delivered. She has a previous history of lower segment caesarean section. 10

(d) (i) Enumerate the contraindications which limit the usage of oral contraceptive pills in a woman.
(ii) Discuss the causes for failure of sterilization procedure in males and in females. 5+5=10

(e) State the National Guidelines on feeding of infant and young child. What are the goals which these guidelines strive to achieve ? 5+5=10

UPSC Answer Check · Accepted Answer

The directive 'outline' demands a structured, systematic presentation of management protocols and clinical reasoning across all five parts. Allocate approximately 20% (10 marks) each to parts (a), (b), (c), (d), and (e), with sub-parts weighted by their mark distribution—e.g., within (a), spend roughly 20% on (i), 40% on (ii), and 40% on (iii). Structure each part as: clinical assessment → diagnostic approach → management steps → complications/prevention. For (e), explicitly cite IAP/NNF or MoHFW guidelines with specific goals like reducing under-5 mortality and malnutrition.
- For (a)(i): Name Trendelenburg test (for SFJ competence) and Perthes test/MODIFIED Perthes test (for deep venous patency); for (a)(ii): List complications—venous eczema, lipodermatosclerosis, ulceration, thrombophlebitis, bleeding; for (a)(iii): Management of venous ulcer—compression therapy (4-layer bandaging), limb elevation, wound debridement, pentoxifylline, skin grafting if needed
- For (b): Acute retention management—urethral catheterization (first attempt), suprapubic catheter if failed; rule out urethral stricture; definitive management—TURP (gold standard for BPH), open prostatectomy if gland >80g, medical therapy (alpha-blockers, 5-ARIs) for poor surgical candidates
- For (c): Postpartum hemorrhage from retained placenta with scarred uterus—resuscitation (IV fluids, blood transfusion), manual removal of placenta under anesthesia, ultrasound to confirm completeness, hysterectomy if placenta accreta/increta with scar rupture, antibiotics and uterotonics
- For (d)(i): OCP contraindications—age >35 with smoking, migraine with aura, history of thromboembolism, breast/liver cancer, severe hypertension, active liver disease, lactation (estrogen-containing pills); for (d)(ii): Female sterilization failure—recanalization, fistula formation, wrong structure ligated; male—recanalization, technical error (incomplete occlusion), spontaneous reanastomosis
- For (e): National guidelines—IYCF (Infant and Young Child Feeding) 2016, early initiation within 1 hour, exclusive breastfeeding 6 months, complementary feeding 6-24 months, continued breastfeeding 2 years; Goals—reduce neonatal mortality, prevent malnutrition, reduce stunting/wasting, improve cognitive development, achieve 90% institutional delivery and early breastfeeding

Dimension	Weight	Max marks	Excellent	Average	Poor
Concept correctness	20%	10	Accurately names Trendelenburg and Perthes tests with correct interpretation; correctly identifies TURP as gold standard for BPH; recognizes placenta accreta risk with prior LSCS; lists WHO Medical Eligibility Criteria categories for OCPs; cites specific IAP 2016 or MoHFW guideline provisions	Identifies most tests and procedures but confuses Perthes with Pratt test; mentions prostatectomy without specifying TURP vs open; recognizes PPH but misses accreta spectrum; lists generic contraindications without WHO categories; mentions breastfeeding guidelines without specificity	Confuses arterial and venous tests; suggests prostatectomy for acute retention; fails to recognize scarred uterus implications; omits major contraindications like migraine with aura; provides outdated or incorrect feeding guidelines
Clinical correlation	20%	10	Links nocturia/urgency in (b) to bladder decompensation from BPH; recognizes shock in (c) as hemorrhagic from atonic uterus + retained placenta; applies age-appropriate surgical risk stratification; correlates OCP contraindications with thromboembolic risk; connects IYCF goals to India's NFHS-5 stunting data	Recognizes clinical presentations but misses progression patterns; identifies shock without quantifying blood loss; mentions surgical options without patient-specific selection; lists contraindications without pathophysiologic rationale; states goals without national data linkage	Misinterprets retention as neurological; fails to recognize hemorrhagic shock; no patient-specific management tailoring; contraindications listed without clinical context; generic goals without national program linkage
Diagram / pathway	15%	7.5	Draws labeled Trendelenburg test setup with tourniquet placement; illustrates BPH management algorithm with flowchart for retention → catheter → TURP pathway; sketches algorithm for PPH management with decision tree for medical vs surgical intervention	Mentions tests without diagrammatic representation; describes management in prose without algorithm; attempts flowchart but misses critical decision nodes	No diagrams or algorithms; purely descriptive without visual organization; incorrect representation of anatomical relationships
Differential / staging	20%	10	For (b): differentiates BPH from urethral stricture, neurogenic bladder, prostate cancer; for (c): distinguishes atonic PPH from traumatic, coagulopathic, and retained placenta with CEW classification; for (a)(iii): stages venous ulcer (CEAP classification); for (d): stratifies OCP eligibility using WHO MEC categories 1-4	Lists differentials without distinguishing features; mentions PPH causes without prioritization; aware of CEAP but applies incompletely; knows contraindications exist without MEC framework	No differentials provided; confuses arterial and venous ulcers; fails to distinguish medical from surgical emergencies; no risk stratification
Management / public-health angle	25%	12.5	For (a)(iii): comprehensive venous ulcer protocol with compression classes, wound care, and surgical options; for (b): stepwise acute retention protocol with catheterization technique, followed by definitive TURP with complications; for (c): ATOMICAL approach (Antibiotics, Tamponade, Oxytocics, Massage, Intrauterine balloon, Compression sutures, Arterial ligation, Hysterectomy); for (e): explicit linkage to India's POSHAN Abhiyaan, Anemia Mukt Bharat, and SDG targets for malnutrition reduction	Describes standard management without prioritization; mentions hysterectomy but not stepwise escalation; aware of national programs without specific goal quantification; compression therapy mentioned without pressure specifications	Management steps incomplete or dangerous (e.g., forceful placental extraction in scarred uterus); no recognition of referral protocols; generic health advice without program linkage; outdated or harmful practices suggested

Q5

Directive word: Outline

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