UPSC Medical Sciences Optional 2021 Question Paper

PAPER I SECTION A

1 (a) Describe the formation, course, tributaries, and termination of coronary sinus? (10)

1 (b) Describe the role of the cerebellum in maintenance of posture and equilibrium? (10)

1 (c) A 14-year-old girl presented with low-grade fever, loss of appetite, and yellow discontinuation of the conjunctiva.

The attending physician suggested evaluation of liver functions of the patient.

(i) Define and classify jaundice?
(ii) Describe the laboratory tests for jaundice and their clinical interpretation? (10)

1 (d) Describe the typical intercostal space? (10)

1 (e) Compare and contrast the features of REM and non-REM sleep? (10)

2(a) Describe the prostate under the following headings: (15)

(i) Gross features
(ii) Lobes
(iii) Capsule and ligaments
(iv) Blood supply
(v) Lymphatic drainage
(vi) Age changes

2 (b) Describe the key events occurring in the ovarian cycle with reference to their hormonal basis. Enumerate the diagnostic tests for ovulation? (15)

2 (c) (i) Discuss the principle and steps involved in PCR? Mention any five of its applications in clinical medicine? (10)

2 (c) (ii) Write a note on different vitamers of vitamin B6 and write their biochemical role in cellular metabolism? (10)

3 (a) Elaborate on hormonal regulation of blood glucose level. Explain in brief the signs and symptoms of hypoglycemia? (20)

3 (b) Describe the sources, RDA and biochemical significance of vitamin C. Write a note on clinical manifestations of vitamin C deficiency? (15)

3 (c) (i) Discuss the formation, course, and branches of the ulnar nerve (5)

3 (c) (ii) Describe the formation and tributaries of the portal vein. List the sites of portocaval anastomosis. (10)

4 (a) Explain in detail the absorption and hormonal regulation of blood calcium in body. Discuss in brief the clinical manifestations of hypocalcemia? (20)

4 (b) Describe the key mechanisms for the regulation of cardiac output. Comment on the changes observed in moderate isotonic exercise? (15)

4 (c) (i) Write in brief about hepatic segments (5)

4 (c) (ii) Enumerate all cranial nerve nuclei with their functional components (10)

PAPER I SECTION B

5 (a) Define metastasis. Enumerate the steps involved in metastasis. Write briefly about the role of stromal elements in metastasis? (10)

5 (b) (i) Explain the functions of each class of immunoglobulins. Describe the subsets of T-lymphocytes. (5)

5 (b) (ii) List the intestinal and extraintestinal manifestations of amoebiasis? (5)

5 (c) Discuss about the longer-acting insulin analogues. How are they different from insulin preparations? Mention the therapeutic uses and adverse effects of insulin? (10)

5 (d) Define chronic inflammation? Enumerate the causes of chronic inflammation? What is the role of macrophages in chronic inflammation? (10)

5 (e) Enumerate the data of identification. Write a note on fingerprinting? (10)

6 (a) Define ischemic heart disease. Enumerate four ischemic syndromes? Discuss the pathogenesis of myocardial infarction? Briefly describe infarct modification by reperfusion? (20)

6 (b) State the therapeutic indications, drug interactions and side effects of the following drugs : (i) Methotrexate (ii) Furosemide (10)

6 (c) (i) Discuss the importance of CD4 cell count and viral load in HIV infection (10)

6 (c) (ii) Describe the antigenic structure of Salmonella typhi with its implication in the diagnosis of enteric fever cases and carriers (10)

7 (a) Define poison and classify it. Describe the treatment of venomous snakebite. Write a note on designer drug? (15)

7 (b) (i) Enumerate predisposing conditions for oral cancer. Describe the pathogenesis, molecular basis and morphology of oral cancer? (10)

7 (b) (ii) Describe the pathologic responses of the glomerulus to injury and pathogenesis of glomerulonephritis? (10)

7 (c) (i) Elaborate on mechanisms of antimicrobial resistance? (10)

7 (c) (ii) Name the third and fourth-generation cephalosporins. Mention their therapeutic indications? (5)

8 (a) (i) Describe the uniqueness of pulse polio programme in INDIA? (10)

8 (a) (ii) A 28-year-old man with a history of HIV antibody positive brought to the emergency headache and fever for three days. He also has had a history of forgetfulness, irritability, and confusion for the last two weeks. His CSF examination shows numerous WBCs predominantly lymphocytes and budding yeasts with a wide capsule in Indian Ink preparation.

1) Write the most probable diagnosis in this case?
2) Describe the laboratory diagnosis of this condition?
3) Mention the predisposing conditions?
4) What is the treatment to be given to the patient? (10)

8 (b) (i) Define injury and hurt? Enumerate the ingredients of grievous hurt. Briefly differentiate hurt from grievous hurt? (10)

8 (b) (ii) Describe signs of asphyxia. Enumerate the types of violent asphyxial deaths. Briefly discuss about sexual asphyxia?  Enumerate the tests for confirmation of semen. State the modus operandi of collection of samples for detection of semen in alleged case of rape victim? (10)

8 (c) (i) Discuss the artemisinin-based combination therapies for the treatment of malaria? (5)

8 (c) (ii) Briefly discuss the advantages of liposomal amphotericin B over conventional amphotericin B? (5)

PAPER-II SECTION A

1 (a) Discuss in brief the role of ultrasound in the investigation of pain in right hypochondrium? (10)

1 (b) Outline the pharmacological and non-pharmacological treatment of depressive disorders (10)

1 (c) A neonate born at 30 weeks of gestation is found to have tachypnea, chest retractions, and grunt within 30 minutes of birth.

(i) What is the most likely diagnosis? Mention the basis of your diagnosis and state briefly the pathophysiology of the condition. (5)
(ii) Describe the management of this condition? (5)

1 (d) A 6-month-old infant attending pediatrics OPD is found to have central cyanosis, clubbing, and no hepatomegaly?

(i) What is the most likely cardiovascular condition? State its cardiovascular examination findings and accompanying hemodynamic changes? (5)
(ii) Write about the clinical course and complications related to this condition? (5)

1(e) An adolescent girl fond of wearing artificial jewelry presented with itchy, papulovesicular skin lesions on ears, wrists, and neck.

(i) What is the likely diagnosis? (2)
(ii) Name the gold standard test which you would use for the confirmation of diagnosis? (2)
(iii) How would you interpret the test results? (3)
(iv) State the complications of this test? (3)

2 (a) A sixty-year old diabetic presented to the emergency department with acute onset, central squeezing type of chest pain, which is severe in intensity and not relieving even after taking rest.

(i) What is the most probable diagnosis? (2)
(ii) How will you investigate the case to reach the diagnosis? (4)
(iii) Outline the steps in the management of the case? (14)

2 (b) A 12-month old infant with a history of delayed initiation of complementary feeding and a few diarrheal episodes was found to have a length of 72 cm, a weight of 5 kg, MUAC of 10cm, and loss of subcutaneous fat.

(i) State the diagnosis. Under what severity of condition would you place this infant? (4)
(ii) Enumerate the complications associated with the condition? (5)
(iii) Describe the steps and phases of treatment? (6)

2 (c) (i) Write the atypical presentations of scabies? (5)

2 (c) (ii) Describe the management of scabies in a neonate, in a child less than 2 years of age, an adult and a pregnant female? (5)

2 (c) (iii) State the causes which can lead to persistent itching following the administration of scabicide therapy? (5)

3 (a) A 40-year-old male who was bedridden for the last two months following a fracture in the lower limb developed sudden breathlessness.

(i) What is the most probable diagnosis? (2)
(ii) How will you investigate the case? (8)
(iii) How will you manage the case? (10)

3 (b) A term neonate born to O negative blood group mother was found to have deep jaundice involving palms and soles, excessive crying and convulsions at 20 hours of life.

(i) How would you assess the clinical severity of Jaundice in this neonate? (3)
(ii) List the key investigations to arrive at the diagnosis? (4)
(iii) Describe the management of this neonate? (8)

3 (c) (i) Give the clinical findings of lichen planus at the following sites: Nails/Scalp/Mucosa/Palms and soles (5)

3 (c) (ii) State the histopathological findings of oral lichen planus (5)

3 (c) (iii) Discuss the management of oral lichen planus? (5)

4 (a) Discuss in short the etiology, diagnosis, treatment, and complications of Cirrhosis of the Liver (5+5+5+5)

4 (b) A 15-month old child brought by the mother with a history of 6 episodes of vomiting and 4 episodes of watery diarrhea was found to have lethargy and is unable to drink. The child weighed 10 kg before this event of illness.

(i) How would you assess the severity of the illness in this child? (4)
(ii) Write the fluid management in the first 3 hours? (4)
(iii) Write the treatment guidelines after 3 hours if the child still exhibits signs of dehydration? (4)
(iv) Write the composition and preparation of the WHO Oral Rehydration Salts (ORS) (8)

4 (c) (i) What is the differential diagnosis of psoriatic arthritis? How would you distinguish psoriatic arthritis from other conditions? (5)

4 (c) (ii) Discuss the management of psoriatic arthritis? (5)

PAPER-II SECTION B

5 (a) Briefly describe the clinical features, diagnostic workup and management of a patient of choledochal cyst? (3+4+3)

5 (b) A 60-year-old lady presents to the casualty after a fall on her right outstretched hand. X-ray image is suggestive of Colles fracture

(i) Briefly write the clinical features of this condition (5)
(ii) Enumerate five complications of this fracture (5)

5 (c) (i) Define Foetal Growth Restriction (FGR) (2)

5 (c) (ii) List the common causes of FGR (4)

5 (c) (iii) Outline the strategy for managing a severely growth-restricted pregnancy diagnosed at 26 weeks of gestation. This female has no living issues and has a past history of undergoing cesarean section at 32 weeks of pregnancy? (4)

5 (d) (i) Define menopause (2)

5 (d) (ii) List the medical indications for prescribing HRT? (4)

5 (d) (iii) State briefly the controversies that have demerited the concept of Universal HRT? (4)

5 (e) Dengue has become a major health problem for the country. The number of cases and disease severity have worsened over the years. Keeping this in context, answer the following questions:

(i) What are the reasons which have led to a major shift in the geographic extent of dengue in the country? (5)
(ii) How is climatic change impacting the disease? (5)

6 (a) (i) Write in brief the reasons for rising cesarean section rates globally and in India. (5)

6 (a) (ii) Discuss briefly the advantages and disadvantages of vaginal birth and cesarean section (5)

6 (a) (iii) What measures can be adopted to reduce cesarean section rates? (5)

6 (a) (iv) How will you counsel a patient who had previous cesarean section for vaginal delivery? (5)

6 (b) A 55-year-old male, tobacco chewer, presents to OPD with difficulty in opening his mouth for one month. On examination, he is found to be having poor oral hygiene and a white patch on right buccal mucosa.

(i) Briefly describe leukoplakia and its significance. (5)
(ii) What are the premalignant conditions for oral cavity cancer? (5)
(iii) What are the different cervical lymph nodes which can get involved in a patient with oral cavity cancer? (5)

6 (c) (i) When is a protein said to be biologically complete? (5)

6 (c) (ii) How do vegetable proteins compare and compete with animal proteins? (5)

6 (c) (iii) What are the proteins needed in the body? (5)

7 (a) A 60-year-old male presents with progressively increasing jaundice for 2 months. He is having clay coloured stools and pruritus. On examination, he is having a palpable and distended gall bladder.

(i) How will you investigate this patient? (5)
(ii) Briefly mention Courvoisiers law and its exceptions? (7)
(iii) What are the treatment options for this patient? (8)

7 (b) The Mother and Child Tracking System (MCTS) is a significant initiative of the government.

(i) Briefly explain what is MCTS (5)
(ii) What are its objectives? (5)
(iii) How is it being put into operation? (5)

7 (c) (i) How will you investigate a couple; wife 35 years and husband 37 years, married for 3 years, but trying for conception since 6 months? (5)

7 (c) (ii) What are the major factors affecting fertility? (5)

7 (c) (iii) Outline the treatment options available for unexplained infertility? (5)

8 (a) (i) Summarise spectrum of Iodine deficiency disorders. (10)

8 (a) (ii) State the goal, objectives, and salient features of the Iodine Deficiency Disorder Control Programme. (10)

8 (b) (i) What are the major changes that have been introduced under the MTP (Amendment) Act, 2021? (6)

8 (b) (ii) What are the different contraceptive methods employed by people in India? List them in the order of their usage stating the statistics of how commonly they are used.(5)

8 (b) (iii) What measures can help increase the use of contraceptives in India? (4)

8 (c) A 47-year-old female presents to the surgery OPD with a solitary nodule in the right lobe of thyroid gland.

(i) How will you investigate this case? (5)
(ii) What is the ideal treatment if investigations are suggestive of follicular neoplasms? (5)
(iii) How will you follow up a patient who has undergone total thyroidectomy for papillary carcinoma thyroid 5 days back? (5)