UPSC Medical Sciences Optional 2026 Question Paper and Analysis

2026 Paper

PAPER 1

SECTION A (Anatomy, Physiology and Biochemistry)

1.a. Describe the hip joint under the following headings :
(i) Factors responsible for its stability (5)
(i) Arterial supply of upper end of femur along with mechanism of avascular necrosis of femoral head (5)

1.b. A 55-year-old male is operated for a lung tumour. During the postoperative stay, he develops shortness of breath. His examination shows paradoxical movement of right hemidiaphragm during inspiration and same was also recorded on MR imaging.
In the above case-
(i) explain the anatomical basis of his clinical findings;
(i) enumerate the major openings of diaphragm and their vertebral levels, along with all the structures passing through each of them. (10)

1.c. A 55-year-old male presented in surgery OPD with yellow-coloured sclera and greasy stools. On detailed examination, he was diagnosed with carcinoma of head of pancreas. Based on these clinical findings, discuss the following :
(i) Serum markers of cholestasis
(i) Biochemical findings in serum, urine and stool sample in this patient
(iii) Cause of greasy stools (10)

1.d. Describe the phases of action potential in a neuron. State the difference in ‘conduction’ between myelinated and unmyelinated neuron. (10)

1.e. With the help of a suitable well-labelled diagram, explain the principal connections of basal ganglia (10)

2.a. A 32-year-old male is brought to the emergency department following a road traffic accident. His clinical examination shows that his arm is adducted and medially rotated, elbow is extended and forearm is pronated. Sensory loss is also noted on lateral aspect of his forearm. His MR scan shows involvement of upper part of brachial plexus.
Based on this clinical scenario, answer the following :
(i) Identify the site of involvement of brachial plexus, using a diagram. (5)
(i) Explain the anatomical basis of motor and sensory loss. (5)

2.b.i. Describe the role of various proteins regulating the iron absorption, transport and storage in the body. (10)

2.b.ii. Explain the biochemical role of vitamir B6. Explain Why the deficiency of vitamin B6 causes pellagra-like symptoms. (10)

2.c.i. Describe the functions of growth hormone. Write a note on the regulation of secretion of growth hormone. (10)

2.c.ii. Discuss the mechanism of action of insulin at receptor level. (5)

3.a.i
1. Name the ligaments of ovary and their role in ovarian torsion and its complications.
2. Explain the surgical importance of anatomical relations of structures in (ovarian fossa). (10)

3.a.ii. Describe the major anatomical sites of portosystemic anastomosis, listing the veins involved. (10)

3.b.i.  Define genetic code. What are the salient features of genetic code? (5)

3.b.ii. What are posttranslational modifications? Discuss in brief the post- translational modifications involving various amino acids. (10)

3.c.i. Describe any two methods to measure cardiac output. Explain the role of Frank-Starling law in cardiac contraction. (5+5)

3.c.ii. Discuss the structure and function of Golgi tendon organ. (5)

4.a.i. Describe the cerebrospinal fluid (CSF) flow from site of production to its absorption. Write a note on the mechanism of its absorption. (5)

4.a.ii. A 62-year-old hypertensive male is brought to medical OPD with the complaints of sudden onset of visual loss in both his eyes. His ophthalmologic examination reveals right homonymous hemianopia with macular sparing, and his MR scan shows cerebral hemorrhage involving left occipital lobe. Based on the above findings, explain the anatomical basis of visual loss in this patient using a diagram depicting the entire visual pathway. (10)

4.b.i. Define glomerular filtration rate (GFR) Discuss the different clearance tests used to measure glomerular filtration rate. (10)

4.b.ii. Discuss briefly the different steps of polymerase chain reaction (PCR) technique. Write three applications of PCR technique in clinical medicine (10)

4.c.i. Discuss in brief the functional divisions of/cerebellum and state the role of each division (5)

4.c.ii. Discuss in brief the medial and lateral descending pathways and their functions. (5)

4.c.iii. Discuss in brief the role of oxytocin in parturition and lactation. (5)

SECTION B (Pathology, Pharmacology, Microbiology and FMT)

5.a.i. State the therapeutic indications, drug interactions and side effects of Methotrexate (5)

5.a.ii. State the therapeutic indications, drug interactions and side effects of Furosemide. (5)

5.b.i. Enumerate any four ‘antigen-presenting cell (APCs): Describe in brief two major antigen processing pathways (5)

5.b.ii. Enumerate any two types of effector T cells. What are Treg cells? (5)

5.c. A 16-year-old boy presented with fever, chills and malaise. On history, he revealed intense throbbing pain around the right knee. X-ray of the knee revealed a lytic focus of bone destruction surrounded by a zone of sclerosis.
(i) What is the most probable diagnosis?
(i) Describe the pathogenesis of this condition.
(il) Enumerate four complications. (10)

5.d. Describe the laboratory diagnosis and immunophenotypic classification of acute lymphoblastic leukaemia. (10)

5.e. Classify thermal injuries? How is the total body surface area involved in burns calculated in adults? Give the various causes of death in burns. (3+4+3)

6.a.i. Define inflammation. Describe the cardinal features of acute inflammation. (10)

6.a.ii. Describe the pathogenesis of secondary tuberculosis. Enumerate five microscopic features of tuberculosis in AIDS (5+5)

6.b.i. Elaborate the mechanism of action of antimicrobial resistance. (5)

6.b.ii. Name the Third-generation Cephalosporins. State their therapeutic indications and side effects. (5)

6.c.i.
1.Name five clinically important species of Candida
2. Write the laboratory diagnosis of Candida infection.
3. Mention a seromarker for invasive candidiasis. (5+3+2)

6.c.ii. Describe in brief any five clinical manifestations of Aspergillus infection. Mention one specific antigen test used for its diagnosis. (10)

7.a.i. Classify neurotoxic poisons. Discuss in brief the clinical features treatment and postmortem findings in acute poisoning by opiates (5+5)

7.a.ii. Write a brief note on ‘atypical drowning’ (5)

7.b.i. A 60-year-old male presented with an irregular plaque-like lesion at the base of tongue. Biopsy showed a proliferation of atypical cells displaying keratin pearls.
1. What is the most probable diagnosis?
2. Describe the pathogenesis of this condition. (10)

7.b.ii. Enumerate five differences between benign and malignant tumours. Describe the mechanisms by which the tumour cells evade the immune system. (10)

7.c.i. Briefly describe the advantages of Liposomal Amphotericin-B over conventional Amphotericin-B. (5)

7.c.ii. Briefly describe the therapeutic indications and adverse effects of Thiazides. (5)

7.c.iii. Elaborate the therapeutic indications, mechanism of action and side effects of Metformin (5)

8.a.i.
1. Enumerate five agents of malaria in humans. (5)
2. Describe in brief rapid diagnostic test (RDT) used for malaria and its advantages. (3)
3. Mention the vaccine available for malaria. (2)

8.a.ii. Discuss the role of ‘antibody-dependent enhancement’ in pathogenesis, of severe dengue. Write in brief the laboratory diagnosis of dengue. (10)

8.b.i. Define injury as per Bharatiya Nyaya Sanhita. Enumerate the various mechanical injuries. Write a brief note on ‘concealed punctured wound”. (3+3+4)

8.b.ii. What is identification? Describe in brief the primary and secondary characteristics of identification. Which is the surest test for identification of an individual? Why? (3+4+3)

8.c.i. Discuss the management of complicated Plasmodium falciparum malaria. (5)

8.c.ii. Describe the therapeutic indications and side effects of Primaquine. (5)

PAPER 2

SECTION A (General Medicine, Dermatology and Paediatrics)

1.a. Discuss the various sputum-based tests for the diagnosis of tuberculosis under the National Programme in India, along with their advantages and disadvantages. (10)

1.b. Describe the management of a case of dog bite on the fingers associated with bleeding às per the national guidelines of India. (10)

1.c. A 15-month-old child, weighing 8 kg, is brought to the District hospital with fever for 5 days, loose motions and vomiting for 2 days, and respiratory distress for 1 day and has not passed urine.
(i) Assess and classify the child as per IMNCI guidelines and document the complete diagnosis.
(ii) How will you manage this case as per the IMNCI guidelines? (5+5)

1.d. A 24-hour-old newborn has presented with jaundice extending to the palms and soles.
(i) Classify and enumerate the possible causes of hyperbilirubinemia in this newborn.
(ii) Outline the management for unconjugated hyperbilirubinemia at this age. (5+5=10)

1.e.i. What do you understand by a papulosquamous lesion in dermatology? Enumerate these disorders. (3)
1.e.ii. Describe the clinical and histopathological clues for differentiation between psoriasis and lichen planus. (7)

2.a. A 20-year-old medical student presents with fever, dry cough, and right-sided chest pain. She also has loss of weight and loss of appetite. The chest X-ray shows right-sided pleural effusion. Discuss the diagnostic investigations and management of this patient. (20)

2.b. A 2-year-old boy, weighing 8 kg, with a length of 72 cm, has presented at the hospital.
(i) How does one assess and classify malnutrition in this boy?
(ii) What are the clinical features of malnutrition and what are its complications?
(iii) Outline the stepwise management of ‘Severe Acute Malnutrition’.
(iv) Explain the dietary management during the rehabilitation phase. (5+5+5+5=20)

2.c. A 1-month-old infant has yellowish greasy scaling on the vertex and frontal area of the scalp. His retroauricular and nasolabial folds show erythema and scaling.
(i) What is the diagnosis ?
(ii) What is the aetiology of this disorder?
(iii) How do you manage this disorder ? (3+3+4=10)

3.a. An 18-year-old girl presents with episodic breathlessness, cough with sputum, chest tightness and wheezing for the last 4 years. She also complains of recurrent sneezing and nasal blockage. Discuss the evaluation and management of this patient. (25)

3.b. A 6-day-old newborn presents with cyanosis, respiratory distress, tachycardia and hepatomegaly.
(i) Discuss the differential diagnosis of this newborn.
(ii) Outline the diagnostic approach.
(iii) Discuss the acute and long-term management of this newborn. (5+5+5=15)

3.c.i. Describe the clinical and histopathological features of acute, subacute and chronic eczema. (5)
3.c.ii. What is Airborne Contact Dermatitis? Discuss its aetiology and clinical features. (5)

4.a. A 45-year-old hepatitis-C positive patient presents with icterus, oliguria, abdominal distention and blood in stools. Discuss the investigations and management of this patient. (25)

4.b. A 12-year old girl, unvaccinated since the age of 1 year, reports to you for a ‘catch-up vaccination’.
(i) How would you draw her vaccination plan? Which vaccines should be administered to the girl and what should be their schedule?
(ii) Describe the possible adverse events that may occur following vaccination (immunization).
(iii) Discuss the clinical manifestations of acute anaphylaxis following vaccination and its management. (5+5+5=15)

4.c. Briefly discuss the management of the microvascular complications of diabetes mellitus. (10)

SECTION B (General Surgery, OBG and PSM)

5.a. Enumerate the causes of lower gastrointestinal bleeding in an adult. Discuss the management of actively bleeding haemorrhoids. (3+7=10)

5.b. Briefly discuss the life cycle of the hydatid cyst. How will you manage a large hydatid cyst of the liver ? (4+6=10)

5.c.i. Discuss the differences between ‘abruptio placentae’ and ‘placenta praevia’. (4)

5.c.ii. Outline the management of a 30-year-old G3P2L2 woman at 36 weeks of gestation with bleeding per vaginum due to abruptio placentae along with absent foetal heart sounds. (6)

5.d.i. Briefly discuss the differential diagnosis of “primary amenorrhea”. (3)

5.d.ii. How do you manage a 15-year-old girl presenting with abdominal pain and primary amenorrhea due to an imperforate hymen? (7)

5.e. In the context of treatment and disposal technologies for healthcare waste, comment upon the following :
(1) The Process of Inertization with its advantages and disadvantages
(ii) Wet and dry thermal treatment

6.a.i. Describe the causes of occipito-posterior position and different modes of delivery in the occipito-posterior position. (10)
6.a.ii. Define ‘Deep Transverse Arrest’ and enumerate the maternal and foetal complications associated with it. (10)

6.b. Describe the clinical features, investigations and treatment of gastro-oesophageal reflux disease in a 40-year-old male. (5+5+5=15)

6.c. In the context of HIV/AIDS Control and the National AIDS Control Programme in India, answer the following questions :
(i) Define Post-Exposure Prophylaxis (PEP).
(ii) How will you establish eligibility for Post-Exposure Prophylaxis (PEP) based on exposure and HIV source codes?
(iii) What are the Post-Exposure Prophylaxis (PEP) drug regimens for healthcare personnel ? (2+6+7=15)

7.a. Describe the various complications of acute pancreatitis. Discuss the role of surgery in acute pancreatitis (10+10=20)

7.b. Under the National Rural Health Mission, explain the concept of Comprehensive Primary Health Care and outline the key strategic areas essential for its effective operationalization. (15)

7.c.i. Discuss the atiopathogenesis, diagnosis and management of Polycystic Ovarian Syndrome (PCOS). (10)
7.c.ii. Write briefly on the ovulation induction protocol in a Polycystic Ovarian Syndrome (PCOS) patient. (5)

8.a.i. What are the main objectives and key strategies of the National Strategic Plan (NSP) for Tuberculosis Elimination in India? (10)

8.a.ii. Explain the significance of the “Pradhan Mantri TB Mukt Bharat Abhiyaan” (PMTBMBA) in eliminating tuberculosis. (10)

8.b.i. Discuss the indications and methods of second-trimester termination of pregnancy. (8)

8.b.ii. Describe the medico-legal issues of mid-trimester medical termination of pregnancy in modern practice. (7)

8.c.i. Describe the atiopathogenesis of carcinoma colon. (7)

8.c.ii. Briefly mention the management of carcinoma of descending colon in a 65-year-old male who has presented with intestinal obstruction. (8)