Medical Science

UPSC Medical Science 2024 — Paper II

All 8 questions from UPSC Civil Services Mains Medical Science 2024 Paper II (400 marks total). Every stem reproduced in full, with directive-word analysis, marks, word limits, and answer-approach pointers.

8Questions
400Total marks
2024Year
Paper IIPaper

Topics covered

Pulmonary tuberculosis, depression, malnutrition, scabies (1)Extra-pulmonary TB, malabsorption, breastfeeding, vitiligo (1)Kala-azar, Pneumococcal vaccines, and contact dermatitis (1)Angina pectoris, neonatal respiratory distress, and lichenoid dermatoses (1)Orthopaedics, Surgery, Obstetrics, Gynaecology, Biomedical Waste (1)Obstetrics, Surgery, HIV/AIDS Public Health (1)Thyroid malignancy, health information, pelvic inflammatory disease (1)Epidemiological studies, antenatal care, prostate carcinoma (1)

A

Q1
50M Compulsory discuss Pulmonary tuberculosis, depression, malnutrition, scabies

(a) Discuss in short the role of a Chest X-ray in the diagnosis of pulmonary tuberculosis. (10 marks) (b) Describe the clinical features for diagnosing a case of Depression. (10 marks) (c) What are the key differences between Kwashiorkor and Marasmus ? Which is the easiest method which can help in the early detection of Protein Energy Malnutrition (PEM) in children ? (10 marks) (d) During the initial phase of stabilization in a severe acute malnourished child, map out the dietary plan. State the type, amount and frequency of feed that the child requires and for how long that would be necessary. In this phase, what is the vitamin and mineral supplementation given ? (10 marks) (e) In a confirmed case of scabies in an adult : (i) What are the primary manifestations of the disease and what is the pattern of distribution of lesions on the body ? (ii) What are the complications seen in scabies ? (5+5=10 marks)

हिंदी में पढ़ें

(a) फुफ्फुस यक्ष्मा के निदान में छाती के एक्स-रे की भूमिका की संक्षेप में चर्चा कीजिए। (10 अंक) (b) उन रोगलाक्षणिक विशिष्टताओं का वर्णन कीजिए जिनसे अवसाद (डिप्रेशन) के मामले का निदान किया जा सकता है। (10 अंक) (c) क्वाशियोरकोर एवं मरास्मस के बीच मुख्य भेद क्या-क्या हैं ? वह सबसे आसान तरीका कौन-सा है जिसकी मदद से बच्चों में प्रोटीन ऊर्जा कुपोषण (PEM) का आरंभिक अवस्था में ही निदान किया जा सकता है ? (10 अंक) (d) प्रचंड तीव्र कुपोषण से पीड़ित एक बच्चे की स्थिति में स्थिरता लाने के लिए आरंभिक चरण में अपेक्षित आहार योजना का खाका तैयार कीजिए। उसे किस प्रकार का, कितनी मात्रा में और किस अंतराल पर भोजन देना आवश्यक है और यह नित्यचर्या कब तक आचरण में लानी होगी, लिखिए। इस चरण में, विटामिनों और खनिजों की पूर्ति कैसे की जाती है ? (10 अंक) (e) एक वयस्क में जिसे स्केबीज होने की पुष्टि हो चुकी है : (i) रोग की प्राथमिक अभिव्यक्तियाँ क्या-क्या होंगी और उसमें विशिष्टियों के शरीर पर वितरण का क्या पैटर्न होगा ? (ii) स्केबीज में क्या-क्या जटिलताएँ देखी जा सकती हैं ? (5+5=10 अंक)

Answer approach & key points

Framework: Clinical Sequence (Definition > Aetiology > Features > Investigation/Management). (a) discuss: intro > 3-4 dimensions > example > balanced close | (b) describe: define > structure or process in order > labelled diagram > significance | (c) compare: paired headings or point-wise contrast > key differences > significance > conclusion | (d) map: locate accurately > label > one line on why it matters | (e(i)) describe: define > structure or process in order > labelled diagram > significance | (e(ii)) describe: define > structure or process in order > labelled diagram > significance Full marks: Precise clinical terminology, correct guidelines, clear structure, no errors.

  • Screening/triage tool with high sensitivity; used for active case finding under NTEP
  • Typical findings: post-primary apical/posterior segment infiltrates, cavities; primary — Ghon focus, hilar nodes, effusion; miliary pattern
  • Limitations: low specificity, cannot confirm activity, atypical/normal in PLHIV
  • Must be followed by microbiological confirmation (NAAT — CBNAAT/Truenat, smear, culture)
  • Duration ≥ 2 weeks; change from previous functioning; impairment
  • Core: depressed mood, anhedonia, fatigue
  • Other: sleep/appetite change, psychomotor change, guilt/worthlessness, poor concentration, hopelessness, suicidal ideation
  • Severity grading and somatic presentation in Indian primary care; exclude organic/bipolar causes
  • Aetiology, oedema (present vs absent), wasting
  • Facies, mental state, skin/hair changes
  • Liver (fatty) and albumin differences
  • Early detection: growth monitoring on growth chart (earliest faltering) and MUAC (easiest field screening; <11.5 cm SAM)
  • Feed: F-75 (75 kcal, 0.9 g protein/100 mL), low osmolarity, low sodium
  • Amount: 130 mL/kg/day (100 mL/kg/day if severe oedema) ≈ 100 kcal/kg/day
  • Frequency: 2-hourly (12 feeds) → 3-hourly → 4-hourly; duration ~2–7 days till appetite returns and oedema subsides
  • Micronutrients: vitamin A, folic acid, K, Mg, zinc, copper, multivitamin; no iron in stabilisation
  • Nocturnal pruritus (hypersensitivity to mite products)
  • Burrows — pathognomonic; papules, vesicles, nodules
  • Distribution: finger webs, wrists, elbows, anterior axillary folds, periumbilical/waist, buttocks, genitals, areolae
  • Adults: face, scalp, palms, soles spared (involved in infants/immunocompromised)
  • Secondary bacterial infection (impetigo, ecthyma, cellulitis, abscess) by GAS/S. aureus
  • Post-streptococcal glomerulonephritis
  • Crusted (Norwegian) scabies in immunocompromised
  • Nodular scabies, eczematisation, psychological morbidity
Q2
50M describe Extra-pulmonary TB, malabsorption, breastfeeding, vitiligo

(a) (i) Discuss in short about the different modalities used in the diagnosis of Extra-Pulmonary Tuberculosis. (10 marks) (ii) Describe the clinical features of malabsorption syndrome. (10 marks) (b) (i) Write in brief the ten steps of Baby-friendly Hospital Initiative (revised 2018). (10 marks) (ii) Write the advantages of breast-feeding. (5 marks) (c) A young adult female develops asymptomatic depigmented chalky white macules and patches with no sign of inflammation over face and around body orifices. (i) What is the diagnosis ? (ii) What are the associated findings seen in this disorder ? (iii) How is this disorder classified ? (iv) Describe the clinical course of the disease. (3+4+4+4=15 marks)

हिंदी में पढ़ें

(a) (i) क्षयरोगेतर यक्ष्मा के निदान में प्रयुक्त होने वाली विभिन्न प्रणालियों की संक्षेप में चर्चा कीजिए। (10 अंक) (ii) अपावशोषण संलक्षण की रोगलाक्षणिक विशिष्टताओं का वर्णन कीजिए। (10 अंक) (b) (i) सन् 2018 में संशोधित शिशु-अनुकूल अस्पताल की पहल के दस चरणों का संक्षेप में वर्णन कीजिए। (10 अंक) (ii) स्तनपान के क्या-क्या लाभ हैं, लिखिए। (5 अंक) (c) एक युवा वयस्क स्त्री को चेहरे के ऊपर और शरीर के विभिन्न द्वारों के इर्द-गिर्द अलक्षणी विवर्णक चौक जैसे श्वेत चकत्ते और धब्बे पनप आए हैं, जिनमें शोथ के कोई संकेत नहीं हैं। (i) निदान क्या है ? (ii) इस विकार में दूसरी क्या-क्या सहचारी विशेषताएँ देखी जा सकती हैं ? (iii) इस विकार को कैसे वर्गीकृत किया जाता है ? (iv) रोग के रोगलाक्षणिक व्यवहार का वर्णन कीजिए। (3+4+4+4=15 अंक)

Answer approach & key points

Framework: null. (a(i)) discuss: intro > 3-4 dimensions > example > balanced close | (a(ii)) describe: define > structure or process in order > labelled diagram > significance | (b(i)) explain: definition/context > points in order > small example > short close | (b(ii)) explain: definition/context > points in order > small example > short close | (c) describe: define > structure or process in order > labelled diagram > significance Full marks: Comprehensive, accurate, and well-structured answers with specific clinical details.

  • Specimen types (fluids, FNAC/biopsy, urine, pus)
  • Molecular: CBNAAT/Xpert Ultra/Truenat (rifampicin resistance); LPA
  • Smear, liquid culture (MGIT) with DST; histopathology/cytology (caseating granulomas)
  • ADA in fluids; imaging by site (USG, CT, MRI for spine/CNS); IGRA/TST limited
  • Chronic diarrhoea, steatorrhoea, bloating, weight loss/failure to thrive
  • Anaemia (iron, folate, B12), glossitis, oedema (hypoproteinaemia)
  • Fat-soluble vitamin deficiencies: night blindness, osteomalacia/tetany, bleeding
  • Clues to cause: coeliac (DH, anti-tTG), tropical sprue, Whipple's
  • Step 1: Code compliance, written infant-feeding policy, monitoring/data systems
  • Step 2: staff competence
  • Steps 3–6: antenatal discussion, immediate skin-to-skin and early initiation, support to maintain breastfeeding, no supplements unless indicated
  • Steps 7–10: rooming-in, responsive feeding, counselling on bottles/teats/pacifiers, coordinated discharge with ongoing support
  • Infant: ideal nutrition, anti-infective factors (sIgA, lactoferrin), less diarrhoea/pneumonia/NEC
  • Long-term: lower obesity/diabetes risk, better cognition
  • Mother: involution, LAM, lower breast/ovarian cancer risk
  • Family/society: economical, hygienic, bonding
  • Diagnosis: vitiligo (non-segmental, acrofacial/generalised)
  • Associated: Koebner, leukotrichia, Wood's lamp; autoimmune thyroid disease, T1DM, pernicious anaemia, alopecia areata, halo naevi
  • Classification (VGICC 2012): non-segmental (acrofacial, mucosal, generalised, universal, mixed), segmental, undetermined
  • Course: NSV unpredictable with activity signs; SV rapid then stable; repigmentation perifollicular; prognostic factors
Q3
50M describe Kala-azar, Pneumococcal vaccines, and contact dermatitis

(a) Describe the clinical features, diagnosis and treatment of Kala-azar. 20 marks (b) What are the types of vaccines currently in use against Pneumococcus organisms ? State the National Immunization Schedule for administering Pneumococcal Vaccine in infants. Enumerate the diseases that the Pneumococcal Vaccine can safeguard against. 15 marks (c) A young female patient develops acute inflammatory papules and vesicles all over her scalp and tips of ears following repeated use of hair dye. (i) What is the diagnosis ? (ii) How can the diagnosis be confirmed ? (iii) How will this condition be treated ? 5+5+5=15 marks

हिंदी में पढ़ें

(a) कालाजार की रोगलाक्षणिक विशिष्टताओं, निदान तथा उपचार का वर्णन कीजिए। 20 अंक (b) वर्तमान में न्यूमोकोकस जीवाणुओं के विरुद्ध प्रयोग में लाए जा रहे वैक्सीन कौन-कौन से प्रकार के हैं ? राष्ट्रीय प्रतिरक्षीकरण सूची के अनुसार शिशुओं को न्यूमोकोकल वैक्सीन कब दी जाती है, उल्लेख कीजिए। उन रोगों के नाम बताइए जिनके विरुद्ध न्यूमोकोकल वैक्सीन सुरक्षा प्रदान करती है। 15 अंक (c) बार-बार केश रंगने की डाई प्रयोग करने के पश्चात् एक युवा महिला रोगी के सम्पूर्ण शिरोवल्क और कानों के सिरों पर तीव्र शोथज पिटिकाएँ तथा जलस्फोट उत्पन्न हो गए हैं। (i) निदान क्या है ? (ii) इस निदान की पुष्टि कैसे की जा सकती है ? (iii) इस रुग्णता का उपचार कैसे किया जाएगा ? 5+5+5=15 अंक

Answer approach & key points

Framework: Clinical Sequence (Definition > Aetiology > Features > Investigation > Management). (a) describe: define > structure or process in order > labelled diagram > significance | (b) enumerate: list the items in order > one line each > no commentary | (c(i)) define: precise definition > the distinguishing feature > one example | (c(ii)) explain: definition/context > points in order > small example > short close | (c(iii)) suggest: the problem in one line > implementable measures > who acts > conclusion Full marks: Accurate clinical reasoning, correct NKEP/UIP data, and precise management protocols.

  • Agent (L. donovani), vector (Phlebotomus argentipes), endemic states; India's 2023 elimination milestone
  • Features: prolonged fever (double quotidian), massive splenomegaly, hepatomegaly, pancytopenia, hyperpigmentation, weight loss; PKDL
  • Diagnosis: rK39 RDT with clinical features (programme), LD bodies in splenic/marrow aspirate, culture, PCR
  • Treatment: single-dose L-AmB 10 mg/kg (NVBDCP), alternatives (miltefosine + paromomycin), avoid antimonials; vector control
  • Conjugate (PCV10, PCV13, newer PCV15/20) vs polysaccharide (PPSV23) with immunological basis
  • UIP: 6 weeks, 14 weeks, booster at 9 months (2+1), since 2017 phased rollout
  • Indigenous PCV10 (Pneumosil) and PCV13 in use
  • Diseases: pneumonia, meningitis, bacteraemia/sepsis, otitis media, sinusitis
  • Acute allergic contact dermatitis
  • Allergen: para-phenylenediamine (PPD)
  • Type IV delayed hypersensitivity; sensitisation then elicitation
  • Typical distribution: scalp margin, ears, forehead, neck
  • Patch test (Indian Standard Series; PPD 1% pet)
  • Applied on back; read at 48 and 72/96 hours
  • Grading of reactions; relevance to exposure
  • Avoid testing during acute flare/steroids
  • Stop dye; avoid PPD and cross-reactors
  • Wet compresses for vesicles; potent topical steroids
  • Oral antihistamines; short oral steroid course if severe/widespread
  • Education: PPD-free alternatives, labelling, protection for hairdressers
Q4
50M discuss Angina pectoris, neonatal respiratory distress, and lichenoid dermatoses

(a) A sixty-year-old male develops central chest pain while walking uphill. The pain is squeezing in character, radiating to left arm, that relieves on taking rest. Discuss in short about the evaluation and treatment of this case. 20 marks (b) (i) Enumerate the causes of respiratory distress in a newborn. How would you differentiate between respiratory distress of respiratory origin and that of cardiac origin ? 8 marks (ii) Write the complications of cyanotic congenital heart diseases. 4 marks (iii) How will you manage a one-year five-month old child presenting with severe respiratory distress with a history of cough and fever for 5 days ? 8 marks (c) (i) What is the meaning of the term 'lichenoid' ? (ii) Name the disease that is a prototype of lichenoid reaction. (iii) Describe the clinical features of the disease. 3+3+4=10 marks

हिंदी में पढ़ें

(a) चढ़ाई पर चलते हुए एक 60-वर्षीय पुरुष को सीने के मध्य भाग में दर्द उठता है। यह दर्द इस प्रकार का है कि लगता है जैसे छाती भींच रही है, यह दर्द उसकी बाईं बाँह में भी जा रहा है, विश्राम करने पर उसे दर्द में आराम मिलता है। इस मामले में रोगी का आकलन तथा उपचार कैसे किया जाएगा, संक्षेप में विवेचना कीजिए। 20 अंक (b) (i) नवजात में श्वसन कष्ट के कारण गिनाइए । आप श्वसन प्रणाली-जन्य श्वसन कष्ट तथा हृदय-जनित श्वसन कष्ट के बीच कैसे भेद कर सकते हैं ? 8 अंक (ii) श्याव जन्मजात हृदय रोगों की जटिलताएँ लिखिए। 4 अंक (iii) एक 1 वर्ष 5 माह की आयु वाला बच्चा, जिसे विगत 5 दिनों से खाँसी और बुखार है, प्रचंड श्वसन कष्ट के साथ लाया जाता है । इस बच्चे की देखभाल करने के लिए आपको क्या करना होगा ? 8 अंक (c) (i) पारिभाषिक शब्द 'लाइकेनॉयड' का क्या अर्थ है ? (ii) उस रोग का नाम बताइए जो लाइकेनॉयड प्रतिक्रिया का प्राकृत है । (iii) उस रोग की रोगलाक्षणिक विशिष्टताओं का वर्णन कीजिए । 3+3+4=10 अंक

Answer approach & key points

Framework: Clinical Sequence (Definition > Aetiology/Pathophysiology > Features > Investigation/Management). (a) discuss: intro > 3-4 dimensions > example > balanced close | (b(i)) enumerate: list the items in order > one line each > no commentary | (b(ii)) explain: definition/context > points in order > small example > short close | (b(iii)) explain: definition/context > points in order > small example > short close | (c(i)) define: precise definition > the distinguishing feature > one example | (c(ii)) enumerate: list the items in order > one line each > no commentary | (c(iii)) describe: define > structure or process in order > labelled diagram > significance Full marks: Comprehensive clinical reasoning, correct management hierarchy, and precise terminology.

  • Diagnosis: stable angina (chronic coronary syndrome); CCS class; risk factors
  • Evaluation: ECG, troponin to exclude ACS, lipids/HbA1c/renal function, echo; stress testing (TMT, stress echo/SPECT) or CT coronary angiography; invasive angiography if high risk
  • Treatment: lifestyle and risk-factor control; sublingual nitrate; beta-blocker/CCB first line; second-line nitrates, nicorandil, ranolazine, trimetazidine
  • Prevention: aspirin, high-intensity statin, ACE inhibitor when indicated; revascularisation (PCI/CABG) for refractory symptoms or high-risk anatomy
  • Pulmonary causes: RDS, TTN, MAS, pneumonia, air leak, CDH
  • Non-pulmonary: cyanotic CHD, PPHN, sepsis, metabolic, CNS
  • Hyperoxia test (PaO₂ > 150 in lung disease; < 100–150 in cyanotic CHD); pre/post-ductal SpO₂
  • Clinical (murmur, hepatomegaly, tachypnoea without distress), CXR, echocardiography
  • Polycythaemia, hyperviscosity, relative iron deficiency
  • Hypercyanotic (Tet) spells; growth failure; clubbing
  • Cerebrovascular: stroke, paradoxical embolism, brain abscess
  • Infective endocarditis, heart failure, bleeding tendency, hyperuricaemia/gout, arrhythmias
  • Assess danger signs (ABCD), SpO₂; classify as severe pneumonia (IMNCI/WHO)
  • Oxygen to SpO₂ ≥ 92–94%; hospitalise; investigations (CXR, CBC, blood culture, ABG)
  • IV antibiotics: ampicillin + gentamicin or ceftriaxone; switch/add per response (staphylococcal cover if needed)
  • Supportive: fluids (restricted), antipyretics, feeding; monitor; PICU/ventilation criteria; consider bronchiolitis, empyema, foreign body
  • Literally resembling lichen — flat-topped shiny papules clinically
  • Histological lichenoid (interface) tissue reaction
  • Basal vacuolar degeneration, Civatte bodies
  • Band-like lymphocytic infiltrate at the DEJ
  • Lichen planus
  • T-cell mediated attack on basal keratinocytes
  • Association with hepatitis C
  • Lichenoid drug eruptions as mimics
  • 6 Ps: pruritic, purple, polygonal, planar papules/plaques; Wickham striae; Koebner
  • Sites: flexor wrists, forearms, shins, lower back; post-inflammatory hyperpigmentation
  • Mucosal (reticular/erosive oral LP), genital; nails (ridging, pterygium); scalp (lichen planopilaris)
  • Variants (hypertrophic, annular, actinic, bullous) and course/risk of SCC in erosive oral LP

B

Q5
50M Compulsory describe Orthopaedics, Surgery, Obstetrics, Gynaecology, Biomedical Waste

(a) (i) Enlist conditions having an increased risk of malignant disease in bone and cartilage. (ii) Briefly mention classification of bone tumours. 5+5=10 (b) A 55-year-old male patient underwent subtotal gastrectomy for carcinoma stomach. Briefly describe early and late complications of this procedure. 10 (c) (i) A 25-year-old infertile woman presents with menorrhagia. USG (Ultrasound) pelvis revealed multi-fibroid uterus, largest measuring 3 × 3 cm. Describe the evaluation and management of Fibroid Uterus in the above patient. (ii) Describe recent classification of Abnormal Uterine Bleeding (AUB). Briefly discuss the endometrial pattern in various types of Abnormal Uterine Bleeding. 5+5=10 (d) (i) A young newly married couple wants advice on contraception. Describe the various methods of contraception which are suitable for them. (ii) Enlist the various methods of female sterilization and complications of tubectomy. 5+5=10 (e) (i) Describe the 'yellow' category of biomedical waste in terms of — types of waste, types of bags or containers to be used, and treatment and disposal options. (ii) Comment upon 'incineration' as a method of biomedical waste management. 5+5=10

हिंदी में पढ़ें

(a) (i) अस्थियों और उपास्थियों में दुर्दम रोग का जोखिम बढ़ने वाली अवस्थाओं की सूची दीजिए। (ii) अस्थियों में होने वाले अर्बुद (बोन ट्यूमर) के वर्गीकरण का संक्षेप में उल्लेख कीजिए। 5+5=10 (b) आमाशयी कार्सिनोमा के एक 55-वर्षीय पुरुष रोगी का उप-पूर्ण जठरोच्छेदन किया गया है। इस प्रक्रिया की आरंभिक और विलंबित जटिलताओं का संक्षेप में वर्णन कीजिए। 10 (c) (i) एक 25-वर्षीय बंध्य स्त्री अत्यातव के साथ आती है। श्रोणि का अल्ट्रासाउंड (USG) करने पर उसके गर्भाशय में अनेक फाइब्रॉइड दिखाई देते हैं, जिनमें सबसे बड़ा फाइब्रॉइड 3 × 3 cm माप का है। इस रोगी में गर्भाशय फाइब्रॉइड का आकलन और प्रबंधन कैसे किया जाना चाहिए, इसका वर्णन कीजिए। (ii) अपसामान्य गर्भाशय रक्तस्राव (AUB) के हाल में किए गए वर्गीकरण का वर्णन कीजिए। भिन्न-भिन्न प्रकार के अपसामान्य गर्भाशय रक्तस्राव में अंतर्गर्भाशयकला पैटर्न की संक्षेप में विवेचना कीजिए। 5+5=10 (d) (i) एक युवा नव-विवाहित दम्पति गर्भनिरोधक परामर्श के इच्छुक हैं। उनके लिए जो भिन्न-भिन्न गर्भनिरोधक साधन उपयुक्त हैं, उनका वर्णन कीजिए। (ii) महिला बंध्यीकरण की विभिन्न विधियों की सूची प्रस्तुत कीजिए तथा डिंबवाहिनी अवरोधन की जटिलताएँ गिनाइए। 5+5=10 (e) (i) 'पीट' श्रेणी के जीव-चिकित्सीय उच्छिष्ट का निम्नलिखित मदों के अंतर्गत वर्णन कीजिए — उच्छिष्ट के प्रकार, किस प्रकार के बैग या कंटेनर प्रयोग में लाने होंगे, एवं उसके उपचारण तथा निपटान के विकल्प। (ii) जीव-चिकित्सीय उच्छिष्ट प्रबंधन की विधि के रूप में 'भस्मीकरण' पर टिप्पणी लिखिए। 5+5=10

Answer approach & key points

Framework: Clinical Sequence (Definition > Aetiology > Features > Investigation > Management). (a(i)) enumerate: list the items in order > one line each > no commentary | (a(ii)) describe: define > structure or process in order > labelled diagram > significance | (b) describe: define > structure or process in order > labelled diagram > significance | (c(i)) describe: define > structure or process in order > labelled diagram > significance | (c(ii)) describe: define > structure or process in order > labelled diagram > significance | (d(i)) describe: define > structure or process in order > labelled diagram > significance | (d(ii)) enumerate: list the items in order > one line each > no commentary | (e(i)) describe: define > structure or process in order > labelled diagram > significance | (e(ii)) comment: context > arguments both sides > judgment > close Full marks: Comprehensive, clinically accurate, follows sequence, uses specific terminology, addresses all sub-parts.

  • Paget's disease (secondary osteosarcoma)
  • Multiple hereditary exostoses; Ollier disease and Maffucci syndrome (chondrosarcoma)
  • Hereditary syndromes: retinoblastoma (RB1), Li–Fraumeni (TP53), Rothmund–Thomson/Werner
  • Prior radiation; fibrous dysplasia; bone infarcts; chronic osteomyelitis sinus (Marjolin)
  • WHO 2020 by line of differentiation, each benign/intermediate/malignant
  • Chondrogenic, osteogenic, fibrogenic, vascular groups with examples
  • Osteoclastic giant cell-rich (GCT, ABC), notochordal (chordoma), other mesenchymal, haematopoietic (myeloma, lymphoma)
  • Ewing and small round cell sarcomas; primary vs secondary (metastases commonest)
  • Early: haemorrhage, anastomotic leak, duodenal stump blow-out
  • Early: pancreatic fistula/pancreatitis, abscess, delayed gastric emptying, afferent/efferent loop obstruction, pulmonary and thromboembolic events
  • Late: dumping (early and late), afferent loop syndrome, bile reflux gastritis, marginal ulcer, stricture
  • Late: iron/B12/folate deficiency, malabsorption, bone disease; recurrence and remnant carcinoma
  • Evaluation: Hb/ferritin, TSH; TVS/SIS/hysteroscopy with FIGO 0–8 mapping; MRI if needed
  • Complete couple work-up: ovulation, AMH/AFC, tubal patency, semen analysis
  • Hysteroscopic myomectomy for submucous; small intramural non-distorting fibroids generally left; myomectomy for cavity distortion/large fibroids
  • Tranexamic acid/NSAIDs; hormonal agents only as bridge; avoid UAE/hysterectomy
  • FIGO System 1 terminology (HMB) and System 2 PALM-COEIN (2011, revised 2018)
  • PALM structural and COEIN non-structural components
  • Anovulatory: proliferative/disordered proliferative with breakdown, hyperplasia
  • Secretory in AUB-E, irregular ripening/shedding, polyp, atypical hyperplasia/carcinoma, pill endometrium, atrophic
  • Goal: reversible spacing with rapid return of fertility; WHO MEC counselling
  • Condoms (STI protection, dual protection); COCs
  • Centchroman, POP; Cu-IUD/LNG-IUS usable in nulliparous women
  • DMPA with delayed fertility return; fertility-awareness methods; emergency contraception
  • Timing: interval, postpartum, post-abortal, at caesarean
  • Approaches: minilaparotomy, laparoscopy (ring, clip, electrocoagulation), vaginal, hysteroscopic
  • Techniques: Pomeroy, Parkland, Irving, Uchida, fimbriectomy, salpingectomy
  • Complications: anaesthetic, haemorrhage, visceral injury, infection; failure with ectopic, regret, menstrual disturbance
  • Types: human and animal anatomical, soiled, expired/cytotoxic medicines, chemical solid and liquid
  • Also contaminated linen/mattresses and microbiology/lab waste
  • Yellow non-chlorinated bags (≥ 50 µ), labelled, bar-coded; separate collection for liquid chemical waste
  • Incineration/plasma pyrolysis/deep burial (rural only); cytotoxics > 1200 °C or returned; ETP for liquids; lab waste pre-treated on site
  • Double-chamber norms: 800 ± 50 °C and 1050 ± 50 °C, ≥ 2 s residence, ≥ 30 m stack
  • Emission limits incl. dioxins/furans 0.1 ng TEQ/Nm³; ash to TSDF
  • Advantages: pathogen destruction, volume reduction, suitable for anatomical/cytotoxic waste
  • Limitations: dioxins from chlorinated plastics, mercury, cost; unsuitable waste; judgement favouring CBWTFs plus non-burn technologies
Q6
50M discuss Obstetrics, Surgery, HIV/AIDS Public Health

(a) (i) A 22-year-old Unbooked Primigravida at 38 weeks of gestation presents to Emergency with labour pains. How would you evaluate the patient for obstetric triaging and further management of labour ? (ii) Discuss the clinical features, diagnosis and management of Rupture Uterus following obstructed labour. 10+10=20 (b) (i) Write the clinical features and diagnostic work-up in a case of carcinoma rectum. (ii) Briefly mention Dukes' staging for this condition. (iii) Enumerate surgical options for this disease. 5+5+5=15 (c) In the context of HIV/AIDS control and the National AIDS Control Programme in India, comment upon the following : (i) 95-95-95 targets (ii) Categorization of districts (iii) TB-HIV coordination to reduce mortality 3+4+8=15

हिंदी में पढ़ें

(a) (i) एक 22-वर्षीय प्रथमग्राभी, जिसने पहले अस्पताल में नहीं दिखाया है, 38 सप्ताह की गर्भावस्था पर आपात सेवा में प्रसव वेदना के साथ आती है। आप इस स्त्री की प्रसूति चिकित्सा देखभाल की प्राथमिकता निर्धारित करने तथा तत्पश्चात् प्रसव-प्रबंधन करने के लिए कैसे आकलन करेंगे ? (ii) अवरुद्ध प्रसव से हुए गर्भाशय विदार की रोगलाक्षणिक विशिष्टताओं, निदान तथा प्रबंधन की विवेचना कीजिए। 10+10=20 (b) (i) मलाशय कार्सिनोमा के मामले में रोगलाक्षणिक विशिष्टताएं तथा उसकी नैदानिक जाँच-पड़ताल पर लिखिए। (ii) इस रोग में प्रयुक्त ड्यूक्स स्टेजिंग का संक्षेप में उल्लेख कीजिए। (iii) इस रोग में कौन-कौन से शल्योपचार विकल्प हैं, उन्हें लिखिए। 5+5+5=15 (c) एच.आई.वी./AIDS नियंत्रण तथा भारत के राष्ट्रीय AIDS नियंत्रण कार्यक्रम के संदर्भ में निम्नलिखित पर टिप्पणी कीजिए : (i) 95-95-95 लक्ष्य (ii) जिलों का वर्गीकरण करना (iii) मृत्यु-संख्या घटाने के लिए टी.बी.-एच.आई.वी. समन्वय 3+4+8=15

Answer approach & key points

Framework: Clinical Sequence & Management Hierarchy. (a(i)) explain: definition/context > points in order > small example > short close | (a(ii)) discuss: intro > 3-4 dimensions > example > balanced close | (b(i)) explain: definition/context > points in order > small example > short close | (b(ii)) explain: definition/context > points in order > small example > short close | (b(iii)) enumerate: list the items in order > one line each > no commentary | (c(i)) comment: context > arguments both sides > judgment > close | (c(ii)) comment: context > arguments both sides > judgment > close | (c(iii)) comment: context > arguments both sides > judgment > close Full marks: Comprehensive, clinically accurate, follows management hierarchy, references national programs.

  • Colour-coded triage (red/yellow/green) with danger signs; MEOWS
  • History, general (BP, pallor, height), abdominal and aseptic vaginal examination incl. pelvimetry
  • Unbooked-specific screening: Hb, group/cross-match, HIV/syphilis/HBsAg, urine protein/sugar, blood sugar, USG
  • Labour plan: WHO LCG/partograph, intermittent FHR, CS/referral for CPD or complications, AMTSL, newborn care, PPH watch
  • Pathogenesis: Bandl's ring, thinned lower segment
  • Impending vs actual rupture signs (cessation of contractions, shock, easily felt fetal parts, absent FHR, haematuria)
  • Diagnosis mainly clinical; USG/FAST; laparotomy confirms
  • Resuscitation + immediate laparotomy; repair vs hysterectomy; bladder repair; prevention
  • Bleeding PR, mucus, altered habit/spurious diarrhoea, tenesmus
  • Late features: pain, obstruction, weight loss, anaemia, metastatic signs; DRE findings
  • Proctoscopy/sigmoidoscopy biopsy; full colonoscopy for synchronous lesions
  • Pelvic MRI (CRM), ERUS, CECT/PET, CEA; TNM staging and MDT
  • Dukes A: confined to wall
  • Dukes B: through wall, nodes negative
  • Dukes C: nodes positive (C1/C2)
  • Dukes D: distant metastasis (Turnbull)
  • TME principle; neoadjuvant CRT for locally advanced
  • Local excision (TEMS/TAMIS) for early T1
  • Anterior/low anterior/ultra-low resection, intersphincteric resection with coloanal anastomosis
  • APR/ELAPE; Hartmann's; pelvic exenteration; palliative stoma/stent
  • Define three 95s (know status, on ART, viral suppression)
  • ≈86% of all PLHIV suppressed
  • NACP-V goals (80% reduction in new infections and deaths vs 2010, EVTHS)
  • India's progress and gaps (testing is the weakest link) with strategies
  • Category A: > 1% ANC
  • Category B: < 1% ANC but > 5% HRG
  • Category C and D criteria
  • Purpose (DAPCU, prioritisation), later refinement and limitations
  • TB leading cause of death in PLHIV; NACO–NTEP joint framework
  • Intensified case finding, bidirectional testing, CBNAAT/Truenat, LF-LAM
  • TPT (6H/3HP), airborne infection control, CPT
  • Early ART within 2 weeks of ATT (deferred in TB meningitis); Ni-kshay/SOCH tracking, nutrition support
Q7
50M enumerate Thyroid malignancy, health information, pelvic inflammatory disease

(a) A 50-year-old male presented with a 3 cm nodule in the left lobe of thyroid gland with a hard left cervical lymph node. Fine Needle Aspiration Cytology (FNAC) from the thyroid nodule revealed orphan Annie-eyed nuclei. (i) What is the diagnosis in this case? How can this condition be managed surgically? (ii) Enumerate different prognostic scoring systems for this condition. (iii) What are the post-operative complications of total thyroidectomy? 8+5+7=20 (b) (i) List the various sources of health information. (ii) Describe the limitations of hospital records as a source of health information. (iii) Write in brief the use of pictograms for presenting health information data. 5+5+5=15 (c) (i) What are the signs and symptoms of Pelvic Inflammatory Disease (PID)? (ii) What are the complications of PID? (iii) How do you manage a 28-year-old woman, P1L1 with unilateral Tubo-ovarian abscess? 5+5+5=15

हिंदी में पढ़ें

(a) एक 50-वर्षीय पुरुष, अवटु ग्रंथि की बायीं पालि में 3 cm की परिवृका तथा बायीं कठोर ग्रीवा लसिका पर्व के साथ आता है। अवटु परिवृका का 'सूक्ष्म सूचिका चूषण कोशिका परीक्षण' (एफ.एन.ए.सी.) करने पर उसमें अनाथ एनी-नेत्र केंद्रक दिखाई दिए हैं। (i) इसका निदान क्या है? इस रुग्णता का शल्योपचार से प्रबंधन कैसे किया जाना चाहिए? (ii) इस रुग्णता में प्रयोग में लाई जाने वाली विभिन्न प्राज्ञान गणन प्रणालियों को लिखिए। (iii) पूर्ण अवटु-उच्छेदन करने पर क्या-क्या शस्त्रकर्मोत्तर जटिलताएँ उत्पन्न होती हैं? 8+5+7=20 (b) (i) स्वास्थ्य संबंधी जानकारी देने वाले विभिन्न स्रोतों की सूची प्रस्तुत कीजिए। (ii) स्वास्थ्य संबंधी जानकारी देने में अस्पताल के रिकॉर्डों की क्या-क्या सीमाएँ होती हैं, वर्णन कीजिए। (iii) स्वास्थ्य जानकारी का डाटा प्रस्तुत करने के लिए चित्रलेखों के प्रयोग पर संक्षेप में लिखिए। 5+5+5=15 (c) (i) श्रोण-शोथज रोग (PID) के क्या-क्या संकेत और लक्षण होते हैं? (ii) श्रोण-शोथज रोग (PID) की क्या-क्या जटिलताएँ हो सकती हैं? (iii) एक 28-वर्षीय महिला जो P1L1 है और जिसे एक-तरफा डिंबवाहिनी-डिंब ग्रंथि विद्रधि है, उसका प्रबंधन कैसे किया जाना चाहिए? 5+5+5=15

Answer approach & key points

Framework: Clinical Sequence (Definition > Aetiology > Features > Investigation > Management). (a(i)) explain: definition/context > points in order > small example > short close | (a(ii)) enumerate: list the items in order > one line each > no commentary | (a(iii)) highlight: name the salient points > one line of substance each > close | (b(i)) enumerate: list the items in order > one line each > no commentary | (b(ii)) describe: define > structure or process in order > labelled diagram > significance | (b(iii)) write short notes: define > 3-4 key features > one example > one-line significance | (c(i)) explain: definition/context > points in order > small example > short close | (c(ii)) enumerate: list the items in order > one line each > no commentary | (c(iii)) justify: claim > 3-4 reasons > evidence > conclusion Full marks: Accurate diagnosis, complete management plan, and specific clinical details.

  • Papillary thyroid carcinoma with lateral cervical nodal metastasis (N1b); Orphan Annie nuclei, grooves, pseudo-inclusions
  • Work-up: neck USG mapping, node FNAC with Tg washout, laryngoscopy, calcium/PTH
  • Total thyroidectomy + central (level VI) + therapeutic lateral modified radical neck dissection (II–V); no berry picking
  • Preserve RLN/EBSLN/parathyroids; post-op RAI, TSH suppression, Tg surveillance
  • AGES and MACIS (Mayo)
  • AMES (Lahey)
  • EORTC, GAMES, DeGroot/Ohio State, NTCTCS
  • AJCC TNM 8th (age 55 cut-off) and ATA 2015 recurrence risk / dynamic stratification
  • Haemorrhage/haematoma with airway compromise
  • RLN injury (unilateral hoarseness, bilateral stridor) and EBSLN injury
  • Hypoparathyroidism/hypocalcaemia (transient vs permanent)
  • Hypothyroidism, infection, seroma, scar; neck-dissection complications (chyle leak, accessory nerve)
  • Census and vital registration (CRS, MCCD)
  • SRS, notification/surveillance (IDSP/IHIP)
  • Hospital records/HMIS, disease registers, record linkage
  • Population surveys (NFHS, LASI, NSS), health manpower and environmental statistics
  • Tip of iceberg – incomplete coverage
  • Selection (Berkson's) bias – not representative
  • No denominator – rates cannot be computed
  • Quality/standardisation problems, duplication, lack of linkage, delay
  • Definition: symbols resembling the item, each representing a fixed number
  • Construction rules: equal-size symbols, number not size varies, key/title/source
  • Uses: lay and less-literate audiences, IEC/BCC, comparisons
  • Limitations: approximate, few categories, misleading if sizes vary
  • Lower abdominal pain, abnormal discharge, fever, dyspareunia, abnormal bleeding
  • CDC minimum criteria: cervical motion, uterine or adnexal tenderness
  • Supportive: fever > 38.3 °C, mucopurulent discharge, WBCs, raised ESR/CRP, positive NAAT
  • Adnexal mass (TOA); Fitz-Hugh–Curtis RUQ pain; silent PID
  • TOA/pelvic abscess, rupture with peritonitis and sepsis
  • Tubal infertility (rising with episodes)
  • Ectopic pregnancy
  • Chronic pelvic pain, adhesions, hydrosalpinx, recurrence, Fitz-Hugh–Curtis
  • Admit; sepsis assessment; hCG; STI tests; USG/CT
  • IV antibiotics with anaerobic cover (ceftriaxone + doxycycline + metronidazole, or alternatives), total 14 days
  • Image-guided drainage if no response in 48–72 h or > 7–8 cm; surgery (laparoscopy) for rupture/failure, conserve fertility
  • Partner treatment, follow-up, tubal assessment, fertility counselling
Q8
50M describe Epidemiological studies, antenatal care, prostate carcinoma

(a) (i) What are the different types of epidemiological studies? (ii) What are the possible sources of control in case-control studies? (iii) List the advantages of case-control studies as compared to cohort studies. 6+6+8=20 (b) Define Antenatal Care. What are its objectives? What is the schedule of antenatal clinic visits that a mother is expected to follow during the course of her pregnancy? What are the advantages and disadvantages of 'domiciliary midwifery service'? 15 (c) (i) Enumerate the causes of hematuria in a 60-year-old male. (ii) Briefly describe the management of carcinoma prostate in a 60-year-old male. 5+10=15

हिंदी में पढ़ें

(a) (i) विभिन्न प्रकार के जनपदिक रोगविज्ञानीय अध्ययन कौन-कौन से हैं? (ii) केस-कंट्रोल अध्ययनों में, कंट्रोल लेने के संभावित स्रोत कौन-कौन से हैं? (iii) कोहर्ट अध्ययनों की तुलना में केस-कंट्रोल अध्ययनों के क्या-क्या लाभ हैं, सूची बनाइए। 6+6+8=20 (b) जन्मपूर्व देखरेख (एंटीनेटल केयर) को परिभाषित कीजिए। उसके क्या-क्या उद्देश्य हैं? गर्भावस्था के दौरान सगर्भा माता को कब-कब एंटीनेटल क्लिनिक जाना आवश्यक है? 'गृह प्रसूति सहायक सेवा' के क्या-क्या लाभ और क्या-क्या हानियाँ हैं? 15 (c) (i) एक 60-वर्षीय पुरुष में रक्तमेह के कारण गिनाइए। (ii) एक 60-वर्षीय पुरुष में पुरःस्थ कार्सिनोमा के प्रबंधन का संक्षेप में वर्णन कीजिए। 5+10=15

Answer approach & key points

Framework: Clinical Sequence (Definition > Aetiology > Features > Investigation > Management). (a(i)) enumerate: list the items in order > one line each > no commentary | (a(ii)) enumerate: list the items in order > one line each > no commentary | (a(iii)) compare: paired headings or point-wise contrast > key differences > significance > conclusion | (b) describe: define > structure or process in order > labelled diagram > significance | (c(i)) enumerate: list the items in order > one line each > no commentary | (c(ii)) describe: define > structure or process in order > labelled diagram > significance Full marks: Comprehensive, clinically accurate, follows sequence, specific to age/gender.

  • Observational vs experimental division
  • Descriptive: case report/series, cross-sectional, ecological
  • Analytical: case-control (OR) and cohort (prospective/retrospective; RR, AR)
  • Experimental: RCT, field trial, community trial; non-randomised trials
  • Hospital controls (varied unrelated diagnoses; Berkson's bias)
  • General population controls
  • Neighbourhood controls
  • Relatives/friends/associates; multiple control groups and matching
  • Suitable for rare diseases and long latency
  • Quick, cheap, fewer subjects
  • Multiple exposures for one outcome
  • No attrition, no risk to subjects, few ethical problems
  • Definition (WHO 2016) and objectives: detect high risk, prevent complications, birth preparedness, reduce maternal/perinatal mortality, health education
  • India: minimum 4 visits (≤12 wk, 14–26, 28–34, 36–term), PMSMA; WHO 8 contacts; traditional monthly/fortnightly/weekly
  • Components: BP, Hb, urine, HIV/syphilis, OGTT, Td, IFA, calcium, deworming
  • Domiciliary midwifery: advantages (familiar setting, less infection, cheaper) and disadvantages (emergencies, asepsis, rest, supervision); institutional delivery policy
  • Painless haematuria = malignancy until proven otherwise
  • Kidney/ureter: RCC, urothelial ca, stones, infection, TB, GN
  • Bladder: urothelial carcinoma, cystitis, stone, radiation; prostate: BPH, CaP, prostatitis; urethra
  • Systemic: anticoagulants, coagulopathy; pseudo-haematuria
  • Diagnosis: PSA, DRE, mpMRI, biopsy (Gleason/ISUP), PSMA-PET/bone scan; risk groups
  • Localised: active surveillance (low risk); radical prostatectomy or RT ± ADT
  • Metastatic HSPC: ADT (orchiectomy/GnRH) + ARPI ± docetaxel
  • mCRPC: docetaxel/cabazitaxel, PARP inhibitors, Lu-177 PSMA, radium-223; bone health, PSA follow-up

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