UPSC Medical Science 2026 — Paper II

(a) 'Discuss' requires the candidate to list and describe each sputum-based diagnostic test used under India's National TB Elimination Programme (NTEP) - smear microscopy, molecular NAAT (CBNAAT/Truenat), line probe assay and culture - and for each one to state advantages AND disadvantages. A list without merits/demerits answers only half the question. (b) 'Describe the management ... as per the national guidelines of India' requires the candidate first to grade the exposure (a bleeding bite on the fingers is Category III) and then to set out the three mandatory arms of post-exposure prophylaxis under the National Rabies Control Programme - wound toilet, rabies immunoglobulin infiltration and a cell-culture vaccine schedule - plus tetanus and antibiotic cover. (c) A two-part IMNCI case. Part (i) requires systematic IMNCI assessment (danger signs plus the four main symptoms) and a COMPLETE diagnosis, i.e. every IMNCI classification the child earns, not a single label. Part (ii) requires the IMNCI management - Plan C intravenous rehydration with actual volumes for an 8 kg child, pre-referral drugs and urgent referral. (d) Two parts. (i) Classify hyperbilirubinemia (unconjugated versus conjugated) and enumerate the causes that can produce jaundice within the first 24 hours of life. (ii) Outline the management of unconjugated hyperbilirubinemia at this age - phototherapy, exchange transfusion and IVIG with their thresholds. The candidate must register that jaundice in the first 24 hours is ALWAYS pathological and that palm-and-sole involvement means a very high bilirubin. (e) Two parts. (i) Define the term papulosquamous in dermatology and enumerate the disorders in this group. (ii) Give the clinical AND the histopathological features that differentiate psoriasis from lichen planus - both sets of clues are required, and a purely clinical comparison answers only half of part (ii).

• Smear microscopy: cheap and rapid; low sensitivity, no species or resistance information
• CBNAAT (Xpert MTB/RIF): high sensitivity, rifampicin resistance in about 2 hours; costly, power needed, no isoniazid result
• Truenat and line probe assay with their merits and demerits
• Culture (LJ and MGIT) as gold standard with DST; slow, biosafety and cost limits
• Category III exposure identified
• Immediate wound washing with soap and running water for 15 minutes, antiseptic, no suturing or irritants
• RIG on day 0: human 20 IU/kg or equine 40 IU/kg or monoclonal 3.33 IU/kg, infiltrated into and around the wound
• Cell-culture vaccine: intradermal 0.1 mL two sites on days 0, 3, 7, 28 or intramuscular Essen; tetanus and antibiotics
• Assessment: danger signs, breathing rate and chest indrawing, dehydration signs, fever work-up, nutrition
• Complete classification: severe dehydration, severe pneumonia or very severe disease, very severe febrile disease
• Plan C: 100 mL/kg, that is 800 mL (240 mL in 30 minutes, 560 mL in 2½ hours) with reassessment
• Pre-referral or first-line drugs: oxygen, injectable antibiotic, paracetamol, glucose, zinc; watch for fluid overload and refer urgently
• Classification into unconjugated and conjugated; jaundice in the first 24 hours is always pathological (Kramer zone 5)
• Causes: Rh and ABO incompatibility, G6PD deficiency, sepsis or TORCH, concealed haemorrhage, polycythaemia
• Investigations and intensive phototherapy at once with 4–6 hourly bilirubin
• Exchange transfusion (double volume, indications) and IVIG 0.5–1 g/kg; treat the cause, watch for kernicterus
• Definition: raised scaly papules or plaques
• Enumeration: psoriasis, lichen planus, pityriasis rosea, secondary syphilis, seborrhoeic dermatitis, tinea, pityriasis rubra pilaris
• Clinical: silvery scale, Auspitz sign, extensor sites, nail pitting against violaceous polygonal papules, Wickham striae, flexor and mucosal sites, severe itch
• Histology: psoriasis with parakeratosis, absent granular layer, Munro abscesses, club-shaped rete ridges; lichen planus with hypergranulosis, saw-tooth acanthosis, basal liquefaction, band-like infiltrate, Civatte bodies

(a) A young adult with fever, dry cough, pleuritic chest pain, weight loss, anorexia and a unilateral pleural effusion - in the Indian setting this is tubercular pleural effusion until proved otherwise. 'Discuss the diagnostic investigations and management' requires a reasoned diagnostic work-up (imaging, pleural fluid analysis with Light's criteria, ADA, molecular tests, pleural biopsy) AND a complete management plan (the NTEP anti-tubercular regimen with doses, therapeutic drainage, monitoring and programmatic measures), with the important differential diagnoses named. (b) Four explicit sub-parts on a 2-year-old boy weighing 8 kg with a length of 72 cm: (i) assess and classify his malnutrition using the correct anthropometric indices, (ii) give the clinical features and complications of malnutrition, (iii) outline the stepwise (WHO 10-step) management of Severe Acute Malnutrition, and (iv) explain the dietary management in the rehabilitation phase. All four must be answered; omitting any one forfeits its marks. (c) Three explicit sub-parts on a 1-month-old infant with greasy yellow scaling of the vertex and frontal scalp plus erythema and scaling of the retroauricular and nasolabial folds: (i) name the diagnosis, (ii) give the aetiology/pathogenesis of the disorder, and (iii) set out the management. All three must be answered.

• Working diagnosis of tubercular pleural effusion with differentials (parapneumonic, malignancy, SLE, pulmonary embolism)
• Imaging and diagnostic thoracentesis: exudate by Light's criteria, lymphocytic, ADA above 40 U/L, low-yield smear and CBNAAT, culture
• Pleural biopsy or medical thoracoscopy for granulomas; HIV test and sputum studies
• NTEP regimen 2HRZE + 4HRE with weight-band doses, therapeutic drainage, monitoring, Nikshay notification and nutrition support
• Indices: weight-for-age, length-for-age, weight-for-length, MUAC and oedema; boy is below −3 SD for weight and length, so severely underweight and stunted; weight-for-length about −1 to −2 SD
• Features of marasmus and kwashiorkor, with complications: hypoglycaemia, hypothermia, dehydration, infection, anaemia, heart failure
• WHO 10 steps: glucose, warmth, ReSoMal, electrolytes, antibiotics, micronutrients without iron, F-75 cautious feeding
• Rehabilitation: F-100 or RUTF at 150–220 kcal/kg/day, transition of 2 days, family foods, weight gain target, stimulation and follow-up
• Diagnosis: infantile seborrhoeic dermatitis (cradle cap)
• Aetiology: sebaceous gland activity from maternal androgens, Malassezia yeast, skin barrier and immune response
• Management: reassurance, oil to soften scales, mild shampoo and soft brush
• Ketoconazole 2% shampoo or cream, short mild steroid for inflammation, follow up for other causes

(a) An 18-year-old with 4 years of episodic breathlessness, cough with sputum, chest tightness and wheeze, plus recurrent sneezing and nasal blockage - bronchial asthma with coexisting allergic rhinitis. 'Discuss the evaluation and management' requires a full diagnostic work-up (history, examination, spirometry with reversibility criteria, PEF variability, allergy and ABPA screen, assessment of control) AND a complete GINA-based management plan that also treats the rhinitis. (b) A 6-day-old neonate with cyanosis, respiratory distress, tachycardia and hepatomegaly - the classic age and picture of a duct-dependent congenital heart disease decompensating as the ductus arteriosus closes. Three sub-parts must all be answered: (i) the differential diagnosis, (ii) the diagnostic approach, and (iii) both acute AND long-term management. (c) Two parts. (i) Describe BOTH the clinical AND the histopathological features of acute, subacute and chronic eczema - all three stages, both sets of features. (ii) Define airborne contact dermatitis and discuss its aetiology and clinical features.

• Working diagnosis of bronchial asthma with allergic rhinitis, with differentials
• Evaluation: history and triggers, spirometry with reversibility (FEV1 rise above 12% and 200 mL), PEF variability, allergy tests, ABPA screen, control assessment
• GINA stepwise treatment with ICS-formoterol reliever and MART, steps up to biologics; SABA-alone not recommended
• Rhinitis treatment (intranasal steroid, antihistamine, montelukast, immunotherapy), action plan, exacerbation care and follow-up
• Duct-dependent congenital heart disease as the leading diagnosis, with differentials (TGA, TAPVC, HLHS, pulmonary atresia) and non-cardiac causes (sepsis, PPHN)
• Approach: pre- and post-ductal saturation, hyperoxia test, blood gas, chest X-ray, ECG, echocardiography
• Acute care: prostaglandin E1 0.01–0.05 µg/kg/min, oxygen with caution, diuretics and inotropes, correction of acidosis, balloon atrial septostomy
• Long-term: lesion-specific surgery (arterial switch, Norwood-Glenn-Fontan, shunt), nutrition, endocarditis prevention, follow-up
• Acute eczema: vesicles and oozing; spongiosis and exocytosis
• Subacute: scaling and crusting; mild acanthosis with parakeratosis
• Chronic: lichenification; marked acanthosis, hyperkeratosis, dermal fibrosis
• Airborne contact dermatitis: definition, Parthenium and other agents, exposed-site distribution with involvement of the folds

(a) A 45-year-old hepatitis-C positive patient with icterus, oliguria, abdominal distension and blood in stools - decompensated HCV cirrhosis with jaundice, ascites, variceal gastrointestinal bleeding and acute kidney injury/hepatorenal syndrome. 'Discuss the investigations and management' requires a full diagnostic work-up including a diagnostic ascitic tap and urgent endoscopy, severity scoring, and then a systematic management of EACH decompensation plus antiviral therapy and transplant assessment. (b) Three sub-parts on a 12-year-old girl unimmunised since the age of 1 who wants catch-up vaccination: (i) draw her catch-up plan naming the vaccines and their schedules, (ii) describe the possible adverse events following immunization, and (iii) discuss the clinical manifestations and management of post-vaccination anaphylaxis. Each sub-part carries marks and must be answered. (c) 'Briefly discuss the management of the microvascular complications of diabetes mellitus' asks for the treatment (not merely the pathogenesis) of the three microvascular complications - retinopathy, nephropathy and neuropathy, with the diabetic foot - together with the risk-factor control common to all of them, and with screening intervals.

• Diagnosis of decompensated HCV cirrhosis with variceal bleed, ascites and hepatorenal syndrome or AKI
• Investigations: blood count, INR, liver and kidney tests, HCV RNA, diagnostic ascitic tap (PMN 250 and above for SBP, SAAG), ultrasound with Doppler, endoscopy within 12 hours, Child-Pugh and MELD
• Variceal bleed: vasoactive drug, antibiotic prophylaxis, restrictive transfusion, band ligation, TIPS or balloon tamponade
• Ascites, SBP and HRS: albumin, terlipressin, stopping diuretics; lactulose for encephalopathy; DAAs after stabilisation and transplant evaluation
• Catch-up principles: check records, count doses, do not restart, minimum intervals, live vaccines same day or 4 weeks apart
• Vaccines and schedule: Tdap, MMR two doses, varicella two doses, HPV two doses 6 months apart, typhoid conjugate, hepatitis A and B, IPV, influenza
• AEFI classification: vaccine product-related, quality defect, immunisation error, anxiety-related, coincidental, with examples of minor and serious events
• Anaphylaxis: skin, respiratory, circulatory features; adrenaline 0.01 mg/kg IM thigh, oxygen, fluids, adjuncts, observation and reporting
• Common measures: glycaemic, blood pressure and lipid control, smoking cessation, screening intervals
• Retinopathy: panretinal laser, intravitreal anti-VEGF for macular oedema, vitrectomy
• Nephropathy: ACE inhibitor or ARB, SGLT2 inhibitor, finerenone, GLP-1 agonist, avoidance of nephrotoxins, nephrologist referral
• Neuropathy and foot: pregabalin, duloxetine or amitriptyline, autonomic symptom therapy, foot care, off-loading and antibiotics for ulcers

(a) Two directives. 'Enumerate' requires a listed, reasonably complete set of causes of lower gastrointestinal bleeding in an adult - a list, not a discussion. 'Discuss the management of actively bleeding haemorrhoids' then requires resuscitation, confirmation of the source, grading, and the graded ladder of conservative, office-based and operative treatment. (b) Two parts. 'Briefly discuss the life cycle of the hydatid cyst' requires the Echinococcus granulosus cycle naming the definitive host, the intermediate host and man's dead-end role, with the route of dissemination. 'How will you manage a large hydatid cyst of the liver' requires the full therapeutic ladder - peri-interventional albendazole, PAIR, surgery with its precautions - with an indication of which is chosen for a LARGE cyst. (c) Two parts. (i) A point-by-point comparison of abruptio placentae with placenta praevia. (ii) The management of a specific case - 30-year-old G3P2L2 at 36 weeks with vaginal bleeding from abruption and ABSENT foetal heart sounds, i.e. a severe (Page Grade 3) abruption with intrauterine foetal death, where the plan must centre on maternal resuscitation, coagulopathy and prompt vaginal delivery. (d) Two parts. (i) A brief differential diagnosis of primary amenorrhoea, which is best organised by the presence or absence of breast development and of the uterus. (ii) The management of a 15-year-old presenting with abdominal pain and primary amenorrhoea due to an imperforate hymen, i.e. the diagnosis of cryptomenorrhoea with haematocolpos and its surgical correction. (e) 'Comment upon' two named healthcare-waste treatment and disposal technologies: (i) the process of inertization, with its advantages AND disadvantages explicitly required, and (ii) wet and dry thermal treatment - both, described and contrasted. The answer must be technical and specific (materials, proportions, temperatures, times), not generic waste-management prose.

• Causes: haemorrhoids, fissure, diverticular disease, colorectal cancer and polyps, angiodysplasia, colitis, Meckel's diverticulum
• Assessment and resuscitation; proctoscopy and colonoscopy to exclude other lesions
• Goligher grading with conservative measures: fibre, laxatives, flavonoids
• Rubber band ligation, sclerotherapy, haemorrhoidectomy, stapled or Doppler-guided procedures, and suture ligation for active bleeding
• Life cycle: Echinococcus granulosus, dog as definitive host, sheep as intermediate host, man as accidental dead-end host, egg ingestion
• Cyst spread by portal vein to the liver (60–70%) and lungs; structure of pericyst, ectocyst and germinal layer
• Albendazole 10–15 mg/kg/day before and after any intervention
• Surgery for large cyst with scolicidal precautions, or PAIR for selected cysts, with anaphylaxis precautions
• Differences: painful concealed versus painless revealed bleeding, hard tender versus soft uterus, foetal state, risk factors, DIC
• Resuscitation with blood and coagulation factors and monitoring of urine output
• Prompt vaginal delivery with amniotomy and oxytocin; caesarean only for maternal indication
• Prevention and treatment of postpartum haemorrhage, anti-D, and counselling
• Differential organised by breasts and uterus: outflow obstruction, Turner syndrome, MRKH, androgen insensitivity, hypothalamic and pituitary causes
• Diagnosis of cryptomenorrhoea with haematocolpos: bulging bluish hymen, suprapubic mass, ultrasound
• Hymenotomy with a cruciate incision and drainage under anaesthesia
• Avoid needle aspiration; excise flaps and suture edges; follow-up and exclusion of transverse vaginal septum
• Inertization: mixing with cement, lime and water (about 65:15:15:5) to solid blocks for pharmaceutical waste and ash
• Advantages and disadvantages of inertization stated
• Wet thermal: steam autoclave at 121 °C, 15 psi, 60 minutes (or 135 °C, 31 psi, 45 minutes), microwave and hydroclave, followed by shredding
• Dry thermal: incineration at 800 and 1050 °C, plasma pyrolysis and dry-heat sterilisation, with merits and demerits

(a) Two parts. (i) Describe the CAUSES of occipito-posterior position AND the different MODES OF DELIVERY in that position - both the natural mechanisms (long anterior rotation, short posterior rotation/face-to-pubis, non-rotation) and the operative options. (ii) DEFINE deep transverse arrest precisely and ENUMERATE its maternal and foetal complications - both sets are required. (b) Three clearly signalled components for gastro-oesophageal reflux disease in a 40-year-old man: the CLINICAL FEATURES (typical, atypical and alarm), the INVESTIGATIONS (endoscopy with its grading, pH/impedance monitoring, manometry) and the TREATMENT (lifestyle, drugs, endoscopic and surgical). All three must be covered in proportion. (c) Three explicit sub-parts set in the context of the National AIDS Control Programme: (i) define post-exposure prophylaxis, (ii) establish ELIGIBILITY using the exposure code and the HIV source (status) code, which requires the actual coding system to be reproduced, and (iii) give the PEP drug regimens for healthcare personnel. Part (ii) carries the most weight because it asks for a specific algorithm.

• Causes: android or anthropoid pelvis, deflexed head, anterior placenta, pendulous abdomen, epidural
• Modes: long anterior rotation (135°, about 90%), short posterior rotation with face-to-pubis delivery, and non-rotation
• Operative options: manual rotation, Kielland's forceps, ventouse, direct forceps with episiotomy, caesarean section
• Definition of deep transverse arrest at the ischial spines with the sagittal suture transverse, with maternal (prolonged labour, sepsis, PPH, tears, fistula) and foetal (hypoxia, injury, death) complications
• Clinical features: heartburn, regurgitation, atypical symptoms, alarm features, complications
• Investigations: PPI trial, endoscopy with Los Angeles grading, 24-hour pH or impedance monitoring, manometry
• Treatment: lifestyle, PPI with doses, H2 blockers, prokinetics
• Endoscopic and surgical treatment: fundoplication with indications; Barrett's surveillance
• Definition: comprehensive management including antiretroviral drugs after potential exposure, started within 72 hours for 28 days
• Exposure codes EC 1, 2, 3 defined by site, volume and severity
• HIV source codes SC 1, SC 2 and unknown; decision by combination (PEP recommended or not warranted; HIV-negative source needs none)
• Regimens: TDF + 3TC + DTG for 28 days as the current preferred regimen, as the single three-drug regimen replacing the older basic and expanded regimens; first aid and follow-up testing

(a) Two directives. 'Describe the various complications of acute pancreatitis' requires the Revised Atlanta framework of local (fluid collections and necrosis) and systemic complications with their time course. 'Discuss the role of surgery' requires a reasoned account of WHEN and HOW to operate - the principle of delay, infected necrosis as the main indication, the step-up approach, and the management of gallstone disease and pseudocysts. (b) Two directives. 'Explain the concept of Comprehensive Primary Health Care' requires the shift from selective to comprehensive primary care, its principles and its expanded service package. 'Outline the key strategic areas essential for its effective operationalization' requires the named implementation pillars - human resources, service package, drugs and diagnostics, infrastructure, community mobilisation, referral continuum, IT, financing and quality assurance. (c) Two parts. (i) Discuss the aetiopathogenesis, the diagnosis (which means the Rotterdam criteria with their thresholds and the exclusions) and the general management of polycystic ovarian syndrome. (ii) Write briefly but specifically on the ovulation induction protocol in PCOS, i.e. the stepwise first-, second- and third-line treatments with drugs and doses.

• Local complications by Revised Atlanta: acute fluid collection, acute necrotic collection, pseudocyst, walled-off necrosis, infected necrosis, vascular and other complications
• Systemic complications: organ failure (transient versus persistent), sepsis, DIC, hypocalcaemia, compartment syndrome
• Principle of delay with conservative treatment of sterile necrosis; ERCP and cholecystectomy timing in gallstone pancreatitis
• Step-up approach for infected necrosis (drainage then minimally invasive necrosectomy); pseudocyst drainage; surgery for compartment syndrome and haemorrhage
• Concept: shift from selective to comprehensive, universal, free, continuous care near the community; Health and Wellness Centres
• Expanded package of 12 services including NCD screening, mental health, oral health, elderly and palliative care
• Strategic areas: human resources (Community Health Officer, team incentives), drugs and diagnostics, infrastructure
• Community mobilisation, referral continuum, IT (e-Sanjeevani, ABDM), financing and quality assurance (NQAS)
• Aetiopathogenesis: insulin resistance and hyperinsulinaemia, raised LH and androgens, low SHBG, anovulation
• Rotterdam criteria: two of oligo-anovulation, hyperandrogenism, polycystic ovaries (20 follicles or volume above 10 mL) after exclusion of other causes
• General management: lifestyle, combined pill, anti-androgens, metformin, endometrial protection, screening
• Ovulation induction: letrozole 2.5–7.5 mg days 3–7 (or clomiphene 50–150 mg), then gonadotropins or ovarian drilling, then IVF; monitoring and hCG trigger

(a) Two parts. (i) The main objectives (goal, targets and timeline) AND the key strategies of the National Strategic Plan for TB Elimination in India - the four strategic pillars must be named and described. (ii) Explain the SIGNIFICANCE of the Pradhan Mantri TB Mukt Bharat Abhiyaan, i.e. what it does, why nutrition and community adoption matter, and how it helps achieve elimination. (b) Two parts. (i) The indications AND the methods of second-trimester termination of pregnancy - the legal grounds and gestational limits under the MTP Act as amended in 2021, the clinical indications, and the medical and surgical techniques with drugs and doses. (ii) The medico-legal issues of mid-trimester MTP in modern practice - consent, provider and place, confidentiality, POCSO, PCPNDT, the Medical Board and the problem of live birth. (c) Two parts. (i) Describe the aetiopathogenesis of carcinoma colon - risk factors, hereditary syndromes and the molecular pathways including the adenoma-carcinoma sequence. (ii) Briefly outline the management of a carcinoma of the DESCENDING (left) colon presenting with INTESTINAL OBSTRUCTION in a 65-year-old man, which requires resuscitation, staging, and a reasoned choice between Hartmann's procedure, primary resection with anastomosis, subtotal colectomy and a self-expanding metallic stent as a bridge to surgery.

• Goal of ending TB by 2025 with targets of incidence 44, prevalence 65 and mortality 3 per lakh, and zero catastrophic costs
• Four pillars Detect, Treat, Prevent, Build, each described with specifics (private-sector notification, universal DST, daily FDC, TPT, Nikshay)
• PMTBMBA: launched 2022, Ni-kshay Mitra community adoption with nutritional, diagnostic and vocational support
• Significance: undernutrition as risk factor (RATIONS), community ownership, adherence, reduced catastrophic costs, contribution to elimination
• Legal grounds and gestational limits under MTP Act 2021: 20 weeks one RMP, 20–24 weeks two RMPs for special categories, Medical Board beyond 24 weeks for foetal abnormality
• Clinical indications: foetal anomaly, maternal disease, rape and minors
• Methods with doses: mifepristone 200 mg then misoprostol 400 µg 3-hourly, D&E with cervical priming, feticide beyond 22 weeks
• Medico-legal: woman's own consent, approved facility and trained RMP, confidentiality (section 5A), POCSO reporting, PCPNDT, live birth and illegal abortion under the BNS
• Risk factors: age, diet, obesity, polyps, ulcerative colitis, family history
• Hereditary syndromes FAP (APC) and Lynch (mismatch-repair genes)
• Molecular pathways: adenoma-carcinoma sequence (APC, KRAS, SMAD4, TP53), microsatellite instability, serrated (BRAF, CIMP)
• Management: resuscitation and CT, and choice among stent as bridge to surgery, Hartmann's, primary anastomosis and subtotal colectomy, with oncological principles and adjuvant chemotherapy