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UPDATES 1
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Course latest uploads and scheduleLecture1.1
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UPSC CMS Notifications 30 minLecture1.2
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Sample videos and Notes 01 hour 50 minLecture1.3
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PAPER I GENERAL MEDICINE 86
This section contains videos from various sections of General Medicine as per the syllabus given by UPSC CMS board
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Cardiology Ischemic Heart disease 50 minLecture2.1
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Cardiology Examination of CVS 01 hour 50 minLecture2.2
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Cardiology ECG 40 minLecture2.3
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Cardiology Heart failure 30 minLecture2.4
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Cardiology Hypertension 01 hourLecture2.5
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Cardiology Arrhythmias 01 hour 10 minLecture2.6
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Cardiology Cardiomyopathy and Pericardial disease 45 minLecture2.7
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Cardiology miscellaneous 02 hourLecture2.8
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Pulmonology Examination of Respiratory system 30 minLecture2.9
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Pulmonology Pulmonary Function Tests 40 minLecture2.10
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Pulmonology Bronchial Asthma 01 hourLecture2.11
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Pulmonology COPD 20 minLecture2.12
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Pulmonology Respiratory Failure 13 minLecture2.13
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Pulmonology Pleural effusion 30 minLecture2.14
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Pulmonology Pneumonia 30 minLecture2.15
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Pulmonology Interstitial and Occupational Lung Diseases 01 hour 20 minLecture2.16
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Pulmonology Lung cancer 15 minLecture2.17
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Pulmonology Respiratory diseases Miscellaneous 50 minLecture2.18
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Gastrointestinal system Malabsorption syndromes 01 hourLecture2.19
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Gastrointestinal system Cirrhosis of Liver and its complications 01 hour 10 minLecture2.20
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Gastrointestinal system Hyperbilirubinemias 15 minLecture2.21
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Gastrointestinal system Peptic ulcer disease 30 minLecture2.22
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Gastrointestinal system Viral hepatitis 45 minLecture2.23
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Gastrointestinal system Pancreatitis 40 minLecture2.24
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Gastrointestinal system IBD 40 minLecture2.25
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Gastrointestinal system Misc 01 hourLecture2.26
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Genitourinary system Chronic Kidney Disease 01 hour 10 minLecture2.27
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Genitourinary system Acute Kidney Injury 20 minLecture2.28
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Genitourinary system Glomerulonephritis 40 minLecture2.29
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Genitourinary system Polycystic kidney disease 20 minLecture2.30
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Genitourinary system Contrast induced nephropathy 13 minLecture2.31
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Genitourinary system UTI 35 minLecture2.32
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Neurology Seizures and epilepsy 40 minLecture2.33
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Neurology Headache 45 minLecture2.34
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Neurology Parkinsons disease 40 minLecture2.35
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Neurology Nerve and Muscle disorders 55 minLecture2.36
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Neurology Visual disturbance and Ocular abnormalities 40 minLecture2.37
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Neurology Alcohol and Nicotine addiction 20 minLecture2.38
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Neurology Dementia and Delirium 30 minLecture2.39
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Neurology Misc 01 hourLecture2.40
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Hematology Transfusion medicine 40 minLecture2.41
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Hematology RBC 01 hour 35 minLecture2.42
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Hematology Leukemias 50 minLecture2.43
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Hematology Lymphomas 30 minLecture2.44
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Hematology Multiple Myeloma 30 minLecture2.45
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Hematology WBC misc 40 minLecture2.46
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Hematology Platelet disorders 30 minLecture2.47
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Hematology Coagulation disorders 30 minLecture2.48
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Hematology Thrombotic disorders 20 minLecture2.49
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Endocrinology Pituitary disorders 01 hour 05 minLecture2.50
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Endocrinology Thyroid function tests 20 minLecture2.51
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Endocrinology Hyperthyroidism 40 minLecture2.52
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Endocrinology Hypothyroidism 30 minLecture2.53
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Endocrinology Adrenal gland 01 hourLecture2.54
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Endocrinology Disorders of Parathyroid gland and Calcium Homeostasis 35 minLecture2.55
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Endocrinology Reproductive system 55 minLecture2.56
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Metabolic disorders Diabetes Mellitus Diagnosis and treatment 50 minLecture2.57
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Metabolic disorders Diabetes Mellitus Complications 01 hour 10 minLecture2.58
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Metabolic disorders Metabolic syndrome 40 minLecture2.59
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Fluid and Electrolyte Imbalance 01 hourLecture2.60
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Acid Base Imbalance 25 minLecture2.61
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Infectious diseases Tuberculosis 40 minLecture2.62
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Infectious diseases Typhoid 22 minLecture2.63
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Infectious diseases Clostridium 35 minLecture2.64
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Infectious diseases STI 35 minLecture2.65
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Infectious diseases Bacteria Misc 01 hour 15 minLecture2.66
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Infectious diseases HIV 01 hour 10 minLecture2.67
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Infectious diseases Virology 01 hour 40 minLecture2.68
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Infectious diseases Mycology 55 minLecture2.69
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Infectious diseases Malaria 01 hour 15 minLecture2.70
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Infectious diseases Parasitology Protozoa 01 hour 10 minLecture2.71
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Infectious diseases Parasitology Helminths 01 hour 35 minLecture2.72
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Vitamin Deficiency disorders 01 hourLecture2.73
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Disorders of Altered Energy Balance Undernutrition 40 minLecture2.74
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Dermatology 40 minLecture2.75
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Psychiatry 01 hourLecture2.76
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Musculoskeletal system Osteoporosis 25 minLecture2.77
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Musculoskeletal system Osteoarthritis 45 minLecture2.78
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Musculoskeletal system Gout 25 minLecture2.79
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Musculoskeletal system Rheumatoid arthritis 40 minLecture2.80
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Musculoskeletal system Ankylosing Spondylitis 40 minLecture2.81
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Musculoskeletal system SLE 20 minLecture2.82
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Musculoskeletal system Vasculitis syndromes 35 minLecture2.83
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Emergency Medicine & Critical Care Medicine 01 hour 10 minLecture2.84
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Toxicology Snake bite 15 minLecture2.85
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Toxicology Organophosphorus Poisoning 25 minLecture2.86
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Toxicology Misc 35 minLecture2.87
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PAPER I PAEDIATRICS 14
This section contains videos from various sections of Paediatrics as per the syllabus given by UPSC CMS board
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Common childhood emergencies 50 minLecture3.1
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Basic Newborn Care Breast feeding 01 hourLecture3.2
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Basic Newborn Care Resuscitation of Newborn 30 minLecture3.3
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Basic Newborn Care Feeding in LBW babies 30 minLecture3.4
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Basic Newborn Care MiscLecture3.5
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Developmental MilestonesLecture3.6
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Developmental AssessmentLecture3.7
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GrowthLecture3.8
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Injuries and accidents in children 40 minLecture3.9
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Poisonings in children 01 hourLecture3.10
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Birth defects and counseling including autismLecture3.11
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Recognizing children with special needs and managementLecture3.12
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ImmunizationLecture3.13
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National Programs related to Child health 01 hour 10 minLecture3.14
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PAPER II SURGERY 39
This section contains videos from various sections of Surgery (Including ENT, Ophthalmology, Traumatology and Orthopedics) as per the syllabus given by UPSC CMS board
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Wounds Infections and Wound healing 02 hour 10 minLecture4.1
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Tumours, Cysts and Sinuses 35 minLecture4.2
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Blood and Lymphatic vessels 02 hour 20 minLecture4.3
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Head and Neck Oral Cavity Malignancy 50 minLecture4.4
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Head and Neck Thyroid and Parathyroid glands 01 hour 15 minLecture4.5
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Head and Neck Salivary gland disorders 30 minLecture4.6
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Head and Neck Misc 17 minLecture4.7
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Breast 01 hour 10 minLecture4.8
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Alimentary tract Esophagus 01 hour 10 minLecture4.9
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Alimentary tract Stomach 01 hour 40 minLecture4.10
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Alimentary tract Small Intestine 01 hour 30 minLecture4.11
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Alimentary tract Large Intestine 01 hour 15 minLecture4.12
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Alimentary tract Intestinal Obstruction 01 hourLecture4.13
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Alimentary tract vermiform appendix 45 minLecture4.14
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Alimentary tract Rectum and Anal Canal 01 hour 10 minLecture4.15
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Liver 01 hour 05 minLecture4.16
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Gall bladder and bile ducts 45 minLecture4.17
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Pancreas 01 hour 45 minLecture4.18
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Spleen 40 minLecture4.19
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Hernia Basics and Ventral Hernia 01 hour 15 minLecture4.20
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Inguinal and Femoral Hernia 40 minLecture4.21
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Testis and Scrotum 45 minLecture4.22
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The peritoneum omentum mesentery and retroperitoneal space 50 minLecture4.23
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Urology 02 hour 45 minLecture4.24
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Neurosurgery 55 minLecture4.25
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Cardiothoracic surgery 01 hour 30 minLecture4.26
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Traumatology Principles of Trauma Care 01 hourLecture4.27
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Traumatology Traumatic Brain Injury 25 minLecture4.28
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Traumatology Maxillofacial Trauma and Torso Trauma 01 hourLecture4.29
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Orthopedic surgery 01 hour 15 minLecture4.30
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Anesthesiology 20 minLecture4.31
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Ophthalmology 20 minLecture4.32
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ENT 50 minLecture4.33
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Fluid and Electrolyte management in surgery and ShockLecture4.34
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Medicolegal and ethical issues in surgeryLecture4.35
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Preoperative and Postoperative care of surgical patientsLecture4.36
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Basic surgical skills 01 hour 30 minLecture4.37
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Principles of Minimal Access surgery 30 minLecture4.38
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Principles of Electrosurgery 15 minLecture4.39
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PAPER II OBSTETRICS 20
This section contains videos from various sections of obstetrics as per the syllabus given by UPSC CMS board
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Antenatal care Prenatal Genetic Counseling and Care 01 hourLecture5.1
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Physiological changes during pregnancy 40 minLecture5.2
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Foundations of Human Reproduction and Early Pregnancy 01 hour 20 minLecture5.3
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Hyperemesis gravidarum 20 minLecture5.4
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Anemia in Pregnancy 50 minLecture5.5
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PreeclampsiaLecture5.6
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Antepartum hemorrhageLecture5.7
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Abortion 45 minLecture5.8
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Rh IsoimmunizationLecture5.9
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Ectopic pregnancy 30 minLecture5.10
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Molar PregnancyLecture5.11
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Multifetal pregnancyLecture5.12
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Medical and Surgical illnesses complicating pregnancyLecture5.13
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Intranatal conditionsLecture5.14
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Postnatal conditionsLecture5.15
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Management of Normal LabourLecture5.16
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Management of Complicated LabourLecture5.17
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Normal Delivery and safe delivery practicesLecture5.18
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IUGR 20 minLecture5.19
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Maternal Pelvis and Fetal skull 01 hourLecture5.20
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PAPER II GYNAECOLOGY 18
Here you can find aThis section contains videos from various sections of Gynaecology as per the syllabus given by UPSC CMS boardnalysis of the paper in general
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Applied anatomy Uterus 40 minLecture6.1
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Applied anatomy Ureteric Injury 10 minLecture6.2
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Applied anatomy Bartholins gland 15 minLecture6.3
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Applied physiology of menstruation Tests of Ovulation 30 minLecture6.4
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Applied physiology of menstruation AUB 45 minLecture6.5
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Applied Physiology of menstruation AmenorrheaLecture6.6
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Applied physiology of FertilizationLecture6.7
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Genital tract infections 55 minLecture6.8
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Genital TuberculosisLecture6.9
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Pelvic Inflammatory Disease 20 minLecture6.10
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Genital tract malignancies Ovarian cancerLecture6.11
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Genital tract malignancies Endometrial cancerLecture6.12
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Genital tract malignancies Cervical cancer 20 minLecture6.13
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Gestational Trophoblastic DiseasesLecture6.14
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Uterine displacementLecture6.15
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Uterine Fibroid 01 hourLecture6.16
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Genital Fistula and IncontinenceLecture6.17
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Medicolegal examination of Rape victim 30 minLecture6.18
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PAPER II FAMILY PLANNING 9
This section contains videos from various sections of Family planning as per the syllabus given by UPSC CMS board
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OC PILLS 01 hourLecture7.1
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IUD 50 minLecture7.2
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Conventional contraceptivesLecture7.3
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Choice of ContraceptionLecture7.4
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Emergency ContraceptionLecture7.5
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Contraceptive failure (Pearl index)Lecture7.6
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Male sterilizationLecture7.7
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Female sterilizationLecture7.8
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Medical Termination of PregnancyLecture7.9
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PAPER II PREVENTIVE SOCIAL AND COMMUNITY MEDICINE 30
This section contains videos from various sections of Psm as per the syllabus given by UPSC CMS board
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Concept of Health 01 hour 15 minLecture8.1
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Concept of Disease 30 minLecture8.2
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Measurements of Epidemiology 02 hour 30 minLecture8.3
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Epidemiological methods Descriptive studies 40 minLecture8.4
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Epidemiological methods Analytical epidemiology 50 minLecture8.5
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Epidemiological methods Experimental epidemiology 01 hourLecture8.6
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Infectious disease epidemiology 01 hourLecture8.7
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Immunizing agents 01 hour 10 minLecture8.8
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Cold chain 50 minLecture8.9
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Screening for disease 40 minLecture8.10
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Epidemiology of Communicable diseases Respiratory infectionsLecture8.11
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Epidemiology of Communicable diseases Intestinal infectionsLecture8.12
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Epidemiology of Communicable diseases Arthropod borne infectionsLecture8.13
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Epidemiology of Communicable diseases ZoonosesLecture8.14
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Epidemiology of Communicable diseases Surface infectionsLecture8.15
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Non communicable diseasesLecture8.16
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National health programmes 01 hour 10 minLecture8.17
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Demography and Family Planning 01 hourLecture8.18
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Maternal and Child HealthLecture8.19
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Nutrition and healthLecture8.20
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Medical Sociology 50 minLecture8.21
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Environment and HealthLecture8.22
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Medical Entomology 25 minLecture8.23
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Hospital waste management 15 minLecture8.24
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Occupational healthLecture8.25
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Genetics and healthLecture8.26
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Health Information and Basic Medical StatisticsLecture8.27
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Health education administration and planningLecture8.28
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Health Care of the CommunityLecture8.29
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International health 20 minLecture8.30
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2025 UPSC CMS Solved paper 5
Brief explanation videos, detailed solutions for upsc cms 2025 paper (Q and A format)
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General Medicine 03 hour 30 minLecture9.1
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Paediatrics 01 hour 10 minLecture9.2
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General Surgery 01 hour 20 minLecture9.3
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OBG 01 hour 15 minLecture9.4
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PSM 50 minLecture9.5
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2024 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2024 paper (Q and A format)
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General MedicineLecture10.1
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PaediatricsLecture10.2
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General SurgeryLecture10.3
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OBGLecture10.4
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PSMLecture10.5
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2023 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2023 paper (Q and A format)
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General MedicineLecture11.1
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PaediatricsLecture11.2
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General SurgeryLecture11.3
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OBGLecture11.4
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PSMLecture11.5
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2022 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2022 paper (Q and A format)
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General MedicineLecture12.1
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PaediatricsLecture12.2
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General SurgeryLecture12.3
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OBGLecture12.4
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PSMLecture12.5
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2021 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2021 paper (Q and A format)
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General MedicineLecture13.1
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PaediatricsLecture13.2
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General SurgeryLecture13.3
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OBGLecture13.4
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PSMLecture13.5
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2020 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2020 paper (Q and A format)
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General MedicineLecture14.1
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PaediatricsLecture14.2
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General SurgeryLecture14.3
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OBGLecture14.4
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PSMLecture14.5
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2019 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2019 paper (Q and A format)
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General MedicineLecture15.1
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PaediatricsLecture15.2
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General SurgeryLecture15.3
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OBGLecture15.4
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PSMLecture15.5
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2018 UPSC CMS Solved paper 5
Detailed solutions for upsc cms 2018 paper (Q and A format)
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General MedicineLecture16.1
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PaediatricsLecture16.2
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General SurgeryLecture16.3
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OBGLecture16.4
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PSMLecture16.5
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MOCK TEST 1 PAPER 1 7
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Mock test 1 Paper 1 Question paper LIVE NOW 02 hourLecture17.1
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Mock test 1 Paper 1 Model answers Q 1-20Lecture17.2
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Mock test 1 Paper 1 Model answers Q 21-40Lecture17.3
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Mock test 1 Paper 1 Model answers Q 41-60Lecture17.4
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Mock test 1 Paper 1 Model answers Q 61-80Lecture17.5
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Mock test 1 Paper 1 Model answers Q 81-100Lecture17.6
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Mock test 1 Paper 1 Model answers Q 101-120Lecture17.7
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MOCK TEST 1 PAPER 2 7
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Mock test 1 Paper 2 Question paper LIVE NOW 02 hourLecture18.1
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Mock test 1 Paper 2 Model answers Q 1-20Lecture18.2
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Mock test 1 Paper 2 Model answers Q 21-40Lecture18.3
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Mock test 1 Paper 2 Model answers Q 41-60Lecture18.4
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Mock test 1 Paper 2 Model answers Q 61-80Lecture18.5
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Mock test 1 Paper 2 Model answers Q 81-100Lecture18.6
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Mock test 1 Paper 2 Model answers Q 101-120Lecture18.7
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MOCK TEST 2 PAPER 1 7
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Mock test 2 Paper 1 Question paper LIVE NOW 02 hourLecture19.1
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Mock test 2 Paper 1 Model answers Q 1-20Lecture19.2
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Mock test 2 Paper 1 Model answers Q 21-40Lecture19.3
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Mock test 2 Paper 1 Model answers Q 41-60Lecture19.4
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Mock test 2 Paper 1 Model answers Q 61-80Lecture19.5
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Mock test 2 Paper 1 Model answers Q 81-100Lecture19.6
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Mock test 2 Paper 1 Model answers Q 101-120Lecture19.7
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MOCK TEST 2 PAPER 2 7
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Mock test 2 Paper 2 Question paper LIVE NOW 02 hourLecture20.1
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Mock test 2 Paper 2 Model answers Q 1-20Lecture20.2
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Mock test 2 Paper 2 Model answers Q 21-40Lecture20.3
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Mock test 2 Paper 2 Model answers Q 41-60Lecture20.4
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Mock test 2 Paper 2 Model answers Q 61-80Lecture20.5
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Mock test 2 Paper 2 Model answers Q 81-100Lecture20.6
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Mock test 2 Paper 2 Model answers Q 101-120Lecture20.7
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MOCK TEST 3 PAPER 1 7
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Mock test 3 Paper 1 Question paper LIVE NOW 02 hourLecture21.1
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Mock test 3 Paper 1 Model answers Q 1-20Lecture21.2
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Mock test 3 Paper 1 Model answers Q 21-40Lecture21.3
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Mock test 3 Paper 1 Model answers Q 41-60Lecture21.4
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Mock test 3 Paper 1 Model answers Q 61-80Lecture21.5
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Mock test 3 Paper 1 Model answers Q 81-100Lecture21.6
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Mock test 3 Paper 1 Model answers Q 101-120Lecture21.7
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MOCK TEST 3 PAPER 2 7
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Mock test 3 Paper 2 Question paper LIVE NOWLecture22.1
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Mock test 3 Paper 2 Model answers Q 1-20Lecture22.2
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Mock test 3 Paper 2 Model answers Q 21-40Lecture22.3
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Mock test 3 Paper 2 Model answers Q 41-60Lecture22.4
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Mock test 3 Paper 2 Model answers Q 61-80Lecture22.5
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Mock test 3 Paper 2 Model answers Q 81-100Lecture22.6
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Mock test 3 Paper 2 Model answers Q 101-120Lecture22.7
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MOCK TEST 4 PAPER 1 0
Test will be live on 15th July 2026
No items in this section -
MOCK TEST 4 PAPER 2 0
Test will be live on 15th July 2026
No items in this section
Pulmonology Examination of Respiratory system
Click here to download notes pdf
PYQs with Explanations:
Question: (2024)
Which of the following statements are correct with regard to clubbing?
1. It usually affects the fingers symmetrically
2. It does not involve toes
3. It may be associated with malignant lung conditions
4. It may recede following the lung transplantation in cystic fibrosis
Select the anwer using the code given below:
Options:
1. 1, 2 and 3
2. 1, 3 and 4
3. 2, 3 and 4
4. 1, 2 and 4
Answer:
2. 1, 3 and 4
Explanation:
The selective bulbous enlargement of the distal segments of the fingers and toesQ due to proliferation of connective tissue, particularly on the dorsal surface, is termed clubbing.
Clubbing is seen in the following conditions:-
Idiopathic or primary clubbing:
pachydermoperiostosis, familial clubbing, and hypertrophic osteoarthropathy.
Secondary clubbing:
| Pulmonary disease | Lung cancerQ, bronchiectasis, asbestosis, sarcoidosis, lung abscess, cystic fibrosisQ, tuberculosis, and mesothelioma |
| Cardiac disease | Cyanotic congenital heart disease, other causes of right-to-left shunting, and bacterial endocarditis |
| Gastrointestinal disease | Ulcerative colitis, Crohn disease, primary biliary cirrhosis, cirrhosis of the liver |
| Skin disease | Pachydermoperiostosis, Fischer syndrome, palmoplantar keratoderma, and Volavsek syndrome |
| Malignancies | Thyroid cancer, thymus cancer, Hodgkin disease and disseminated chronic myeloid leukemia |
In certain circumstances, clubbing is reversible, such as following lung transplantation for cystic fibrosis.
Question: (2020)
Consider the following statements with regard to respiratory examination:
- Change in note, when patient phonates “EEE” (Egophony) is characteristic of interstitial fibrosis
- Whispered pectoriloquy is characteristic of lung consolidation
- Monophonic wheeze is characteristic of asthma
- Hyper-resonant note on percussion is characteristic of pneumothorax
Which of the above statements are correct?
Options:
1. 1 and 3
2. 2 and 4 only
3. 1, 2 and 4
4. 2, 3 and 4
Answer:
2. 2 and 4 only
Explanation:
Voice sounds
Egophony:
- The word “egophony” is derived from the Greek word “ego” which means “goat.”
- During auscultation, the patient is asked to say “Eee.”
- The “Eee” will be transformed into an “A” with the voice having a nasal or bleating quality (like the bleating of a goat).
- Egophony is seen in cases of consolidation, pleural effusion, and lung cavity.
Whispering pectoriloquy:
- The patient is asked to whisper “1-2-3” or “99.”
- Whispering pectoriloquy is present if the whisper is heard more clearly over certain areas, suggesting underlying consolidation
Wheeze
- Monophonic wheeze is generally due to obstruction or compression of a large, central airway.
- Polyphonic wheeze is most likely heard in the setting of diffuse, small airway obstruction or compression.
Hyper-resonant note on percussion is characteristic of pneumothorax
Question: (2020)
The most frequent symptom in respiratory diseases is:
Options:
1. Breathlessness
2. Chest pain
3. Hemoptysis
4. Cough
Answer:
4. Cough
Explanation:
Cough is the most frequent symptom of respiratory disease and is caused by stimulation of sensory nerves in the mucosa of the pharynx, larynx, trachea and bronchi.
Question: (2019)
Which of the following drugs causes dry cough as a side effect?
Options:
1. Fluconazole
2. Ramipril
3. Cefixime
4. Atenolol
Answer:
2. Ramipril
Explanation:
RAMIPRIL is an ACE inhibitor.
Angiotensin converting enzyme (ACE) is involved in the breakdown of bradykinin/ substance P in lungs. Inhibition of ACE by ACE inhibitors increases bradykinin/ substance P levels that can result in persistent brassy cough and angioedema in some patients.
Question: (2018)
A silent, resonant Hemithorax on examination is suggestive of:
Options:
1. Large Pleural effusion
2. Pneumothorax
3. Bronchial asthma
4. Consolidation
Answer:
2. Pneumothorax
Explanation:
Silent resonant chest is a typical finding of pneumothorax. This finding is present on the side of the pneumothorax. There is a shift of the mediastinum to the opposite side.
In pleural effusion chest is silent but on percussion, there will be stony dullness on the side of pleural effusion. There is a shift of the mediastinum to the opposite side.
Hence, the percussion note differentiates between the two.
Examination Features of Common Lung Pathologies
| Consolidation (Lobar Pneumonia) | Pleural effusion |
|
|
| Collapsed Lung (Atelectasis) | Tension Pneumothorax |
|
|
Question: (2025)
Consider the following statements regarding respiratory function in old age:
I. There is increasing ventilation perfusion mismatch.
II. There is increased ventilatory response to hypoxia and hypercapnia
III. There is a decline in maximum oxygen uptake leading to reduction in cardiorespiratory reserve
IV. There is decline in the Forced Expiratory Volume to Forced Vital Capacity ratio (FEV1/FVC) by around 0.2% per year after the forties
Which of the statements given above are correct?
Options:
1. I, II and III
2. I, II and IV
3. II, III and IV
4. I, III and IV
Answer:
4. I, III and IV
Explanation:
Respiratory function in old age
- Reserve capacity: a significant reduction in function can occur with ageing with only minimal effect on normal breathing, but the ability to combat acute disease is reduced.
- Decline in FEV1: the FEV1/FVC (forced expiratory volume/forced vital capacity) ratio falls by around 0.2% per year from 70% at the age of 40–45 years, due to a decline in elastic recoil in the small airways with age. Smoking accelerates this decline threefold on average. Symptoms usually occur only when FEV1 drops below 50% of predicted.
- Increasing ventilation perfusion mismatch: the reduction in elastic recoil causes a tendency for the small airways to collapse during expiration, particularly in dependent areas of the lungs, thus reducing ventilation.
- Reduced ventilatory responses to hypoxia and hypercapnia: older people may be less tachypnoeic for any given fall in PaO2 or rise in PaCO2
- Impaired defences against infection: due to reduced numbers of glandular epithelial cells, which lead to a reduction in protective mucus.
- Decline in maximum oxygen uptake: due to a combination of impairments in muscle, and the respiratory and cardiovascular systems. This leads to a reduction in cardiorespiratory reserve and exercise capacity.
- Loss of chest wall compliance: due to reduced intervertebral disc spaces and ossification of the costal cartilages; respiratory muscle strength and endurance also decline. These changes become important only in the presence of other respiratory disease.