Medical Science — UPSC Mains Optional PYQ (2023–2025)

Briefly describe the role of lifestyle interventions in prevention of coronary artery disease.

A 23-year-old woman with type 1 diabetes mellitus presents with nausea, vomiting and altered sensorium. On examination, she is tachypneic and hypotensive. Her random blood sugar is 460 mg/dL, and routine examination of urine is positive (++) for ketone. Outline the stepwise approach to the diagnosis and management of this patient.

(i) Elaborate the indications for initiating antiviral therapy in a patient with chronic hepatitis B. (ii) Write the first-line antivirus treatment regimen for the management of chronic hepatitis B along with the recommended monitoring strategy during therapy.

(i) How do you differentiate between acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) based on peripheral smear and bone marrow findings? (ii) Describe the current standard of care for acute lymphoblastic leukaemia (ALL) in adults and children.

(i) Enumerate the advantages as well as the limitations of laparoscopic surgery. (ii) Describe the different techniques of creating pneumoperitoneum during laparoscopic surgery.

(i) Classify hypertensive disorders in pregnancy. (ii) Enumerate the types and complications of eclampsia. (iii) Discuss the management of antepartum eclampsia in a 25-year-old primigravida with 32 weeks of pregnancy.

(i) Describe the clinical features and diagnostic workup of a suspected case of peritonitis. (ii) Enumerate the principles of management of peritonitis. (iii) Enlist the important complications of peritonitis.

Under the National Framework for Malaria Elimination in India, what are the targets set for the years 2027 and 2030 respectively? What are the key interventions recommended for States and UTs which require intensified control and fall under Category 3? Which are the parameters employed for maintaining epidemiological surveillance over malaria? (i) Describe the WHO medical eligibility criteria for contraceptive use for women with medical conditions. (ii) Discuss the complications of intrauterine contraceptive device (IUCD). (iii) How will you manage a case of misplaced copper-T (Cu-T)? Describe the embryogenesis, clinical features and principles of management of cleft palate.

(a) Discuss in short the role of a Chest X-ray in the diagnosis of pulmonary tuberculosis. (b) Describe the clinical features for diagnosing a case of Depression. (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? (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? (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?

(a) (i) Discuss in short about the different modalities used in the diagnosis of Extra-Pulmonary Tuberculosis. (ii) Describe the clinical features of malabsorption syndrome. (b) (i) Write in brief the ten steps of Baby-friendly Hospital Initiative (revised 2018). (ii) Write the advantages of breast-feeding. (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.

(a) Describe the clinical features, diagnosis and treatment of Kala-azar. (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. (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?

(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. (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? (ii) Write the complications of cyanotic congenital heart diseases. (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? (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.

(a) (i) Enlist conditions having an increased risk of malignant disease in bone and cartilage. (ii) Briefly mention classification of bone tumours. (b) A 55-year-old male patient underwent subtotal gastrectomy for carcinoma stomach. Briefly describe early and late complications of this procedure. (c) (i) A 25-year-old infertile woman presents with menorrhagia. 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.

(b) (i) A 55-year-old female presented with haematemesis. On physical examination, she was afebrile and pale. No organomegaly was noted. Serological tests for hepatitis B were positive. 1. What is the most likely diagnosis? 2. Describe the microscopic findings. 3. What is the pathogenesis? (ii) Describe the clinical features and microscopic findings in acute lymphoblastic leukaemia. (c) (i) State the role of diuretics in the management of hypertension. (ii) Discuss how excess dose of paracetamol causes acute hepatocellular toxicity and how you will manage the condition. (iii) Elaborate the advantages and disadvantages of Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors in the management of diabetes mellitus.

(a) (i) What is enteric fever? What are its causative agents? Give a detailed presentation of a case according to the time of the disease and the respective tests used for diagnosis. (ii) Draw a diagram of HIV virion depicting the various antigens and proteins. Give the serological pattern in an HIV infection according to the time of presentation. List the various diseases associated with AIDS. (b) (i) What is virtual autopsy? State its methodology. What are its merits? (ii) Define brain death. Describe its medicolegal importance. (c) (i) Discuss why infliximab is considered as an immunosuppressant. Mention its therapeutic uses. (ii) Describe briefly the pharmacological characteristics of natriuretic peptides and their clinical uses.

SECTION A (a) A 35-year-old male smoker with complaints of difficulty in swallowing and ulcer on the tip of his tongue for the last one month, visits an ENT surgeon. Based on his clinical examination and histopathological investigation of the tongue lesion, he is diagnosed as a case of carcinoma of tongue with cervical lymphadenopathy. (i) Using a flow-chart, show the principal lymph node involved and its further distribution. (ii) Explain the role of tongue in swallowing. (b) Describe the following in the context of ‘Auditory pathway’ : (i) Its course from internal ear to auditory cortex (ii) Blood supply of the auditory cortex (c) Discuss the sources and Recommended Daily Allowance (RDA) of Folic Acid and the clinical manifestations of its deficiency in the body. Add a note on ‘Folate Trap’. (d) Describe the role of cerebellum in control of voluntary movement. Add a note on cerebellar dysfunction. (e) Describe the genesis of Rapid Eye Movement (REM) sleep. Why is REM sleep called paradoxical sleep ?

(a) (i) Enlist the clinical features of dengue fever. (ii) Outline the management of a patient with dengue haemorrhagic fever. (b) Write the symptoms of schizophrenia. (c) (i) What is the full form of IMNCI and what are its objectives? (ii) What are the components of integrated care provided under IMNCI? (d) State the immunization schedule under the National Immunization Programme for infants and children. (e) A 40-year-old male presented with multiple itchy, violaceous, flat-topped papules over skin for the last one year. He also complained of burning sensation in mouth. (i) Diagnose this condition. (ii) What are the oral findings which can be associated with this condition? (iii) Outline its management.

(a) A 56-year-old male visits a surgery OPD with complaints of difficulty in passage of urine especially on straining. Based on his clinical examination and ultrasound findings, he is diagnosed with Benign hypertrophy of Prostate. (i) What is the anatomical basis of his urinary problems? (ii) Describe the relations of Prostate gland. (iii) Describe the blood supply and lymphatic drainage of Prostate gland. (b) (i) Describe the biochemical role of copper in the body. Discuss briefly about Wilson disease and the biochemical investigations that will help in its diagnosis. (ii) Define Genetic code and explain the Wobble Hypothesis. Discuss briefly the post-translational modifications of proteins. (c) Explain the physiological changes that occur in a mother during pregnancy, under the following headings : (i) Genital organs (ii) Blood and its constituents (iii) Cardiovascular system

(a) A 30-year-old female has been brought to medical emergency with a history of low-grade fever, headache, anorexia and weight loss for the last one month. She has also developed diplopia and altered sensorium for the last two days. (i) What is the most likely diagnosis? (ii) Enumerate the investigations required to confirm the diagnosis. (iii) Differentiate between the CSF findings in pyogenic, tubercular and viral meningitis. (iv) Outline the treatment plan in this patient. (b) A 2-year-old boy was brought to the emergency with the complaints of sudden onset of respiratory distress with irritability. On examination, the child is disoriented and he has both peripheral and central cyanosis. He has deep sighing respiration with SpO₂ < 65% at room air. On oxygen therapy, his SpO₂ is increased to 80%. He has no organomegaly or neurological deficit. (i) Write the complete diagnosis of this boy. (ii) How will you manage this case in emergency? (iii) Classify the congenital cyanotic heart diseases. (c) A 48-year-old male presented with yellowish, greasy scales and redness over the scalp. (i) What is the most likely diagnosis? (ii) Mention the sites of involvement in this disease. (iii) Name the organism responsible for the pathogenesis of this disease. (iv) Outline its treatment.

(a) (i) Describe the following regarding the knee joint : (I) All movements including locking and unlocking with muscles responsible for each (II) Role of cruciate ligaments in movement and stability (ii) Describe Carpal Tunnel Syndrome under the following headings : (I) Causes and structure(s) involved (II) Clinical features (b) (i) Explain the principle and steps of Polymerase Chain Reaction (PCR). Write its clinical applications. (ii) Discuss the serum biochemical markers of cholestasis. (c) (i) Describe the intrinsic regulation of cardiac output. (ii) Discuss the factors regulating erythropoiesis.

(a) Discuss in short the aetiology, clinical features, investigations and management of chronic renal failure. (b) (i) Write the causes of unconjugated hyperbilirubinemia in a newborn. (ii) What is the mechanism of action of phototherapy in the treatment of hyperbilirubinemia? (iii) What are the potential complications of the phototherapy? (c) (i) Mention the nail findings in psoriasis. (ii) Discuss the topical and systemic therapies in psoriasis.

(a) (i) Describe the role of SRY (Sex-determining region on Y gene) transcription factors in testicular development. (ii) Describe Vitelline duct abnormalities. (b) (i) Describe the role of iodine in the synthesis of thyroid hormones. Discuss briefly about Hashimoto’s Thyroiditis and the biochemical investigations that will be done for its diagnosis. (ii) Explain briefly the biochemical role of Vitamin-K in the body. What is the biochemical basis of using Warfarin as an anticoagulant drug ? (c) (i) Describe the functions of vasopressin and the regulation of vasopressin secretion. (ii) Describe the physiological effects of glucagon.

(a) A 20-year-old male has presented to the medicine OPD. He has complaints of episodes of breathlessness associated with tightness of chest and wheezing since the childhood. These episodes occurred commonly during the change of season. (i) What is the most probable diagnosis? (ii) How will you confirm the diagnosis? (iii) Discuss in short the clinical features of the disease. (iv) Outline the stepwise approach to the management of the disease. (b) (i) What are the criteria for the identification of severe acute malnutrition (SAM) in children 6 months to 59 months of age? (ii) Enumerate the criteria for admission in the facility-based care for severe acute malnutrition. (iii) Write ten steps in the management of SAM. (c) Discuss in short the role of X-ray imaging in diagnosing a case of acute abdomen.

(a) Enumerate various classes of antihypertensive drugs. Briefly discuss the role of calcium channel blockers in the treatment of hypertension.

(a) A 65-year-old lady has progressively increasing dysphagia for last 6 months. She also has significant weight loss. How will you investigate her? (b) A 42-year-old male, known case of alcoholic liver disease with portal hypertension, is brought to casualty with severe haematemesis. Describe the management of this case. (c) (i) Name any five risk factors associated with pelvic organ prolapse. (ii) Enlist the management options for a 60-year-old postmenopausal lady with procedentia with cystocoele with enterocele with rectocoele. (d) Define chronic pelvic pain. What are the various causes of chronic pelvic pain in women? (e) The Janani-Shishu Suraksha Karyakram is a unique national initiative of the Government of India. State in brief the entitlements to pregnant women and neonates under this scheme.

(a) (i) Enumerate any five risk factors for oral cancer. Describe its morphology. (ii) Enumerate five causes of membranous glomerulonephritis. Describe its morphology.

(a) (i) Enumerate the causes for postpartum haemorrhage (PPH). (ii) Discuss the management of PPH. (b) (i) Enumerate the signs of lower limb arterial ischaemia. (ii) Briefly outline the diagnostic workup in a 62-year-old male with atherosclerotic lower limb peripheral arterial disease. (iii) State the management of this case. (c) The National Rural Health Mission is committed towards improving rural healthcare delivery system in the country. State the major initiatives that have been undertaken under this Mission to strengthen the healthcare infrastructure in rural areas.

(a) Classify the various types of poisons. Enumerate the features of Plumbism. Discuss the tests which will show/establish the onset of early stages of Pb poisoning.

(a) (i) Describe the morphological characteristics of Cryptococcus neoformans on microscopic examination. Discuss the pathogenesis of Cryptococcosis. (ii) Define meningococcaemia. Discuss laboratory diagnosis of acute meningococcal meningitis. Briefly write about the available meningococcal vaccines to prevent the disease.