 So, we will start with the paper 2 discussion. So, first we will be discussing the general strategy how to write answer in paper 2 for all medicines, surgery, gynae, peds, all the 4 section all they have a similar answer writing strategy. So, we will full discuss it. So, there are 3-4 things in it. So, there are 3-4 types of question. First is question come is enumerate the differential diagnosis. Then you just have to enumerate the differential diagnosis. If the question come discuss, so then you have to write all the differential diagnosis and write 2-3 points about each differential diagnosis that why it can be a diagnosis and why it can not be a. Means you have to write 2-3 points about each differential diagnosis. And third is what is the diagnosis of this? So, if such question what is the diagnosis, do not directly write the diagnosis. Just form a case type of thing of 3-4 lines that based on these, these, these findings, these, these clinical findings, this is radiological findings, I arrive on the diagnosis that the diagnosis is this, of this system. Not like that only case they ask that does you write it like pulmonary embolism, no. This is a case of acute case of breathlessness or something like that. So, these 3 types of there enumerate, discuss and what is the diagnosis. Enumerate you have just have to mention, discuss you have to write 2-3 points about each diagnosis and for what is the diagnosis, write about the findings which is there and then finally arrive on the diagnosis rather than directly writing the diagnosis. Then the question is about how to write. The question comes about the management part. So, in management you have to write the history in 2-3 lines, then the investigations, investigations will be like this, blood investigations, radiological investigations, surgical investigations which can be invasive, non-invasive and if there is a urine or other investigations. Then the treatment part, treatment will be medical, medical can be pharmacological, non-pharmacological, surgical and the follow up part. In surgical also there will be 3 things, pre-op, pre-operative, operative and post-operative care. All the 3 cares you have to write about. And then the follow up advice you have to give to the patient. So, the management will be pharmacological, medical that will be pharmacological and non-pharmacological. Then for example, exercise, diet habit, your lifestyle modifications, surgical, then pre-operative, operative, post-operative and then the follow up part. So, this will be the approach of writing answer that you will first write about the history for the management only. History in 2-3 lines, then the clinical findings, then the investigations and then the treatment. This approach will go for all the answers, whether it is medicine, whether it is surgeony, whether it is gynae, whether it speeds or any other subject of any clinical related aspect. But what is there is that there are slight modification in each subject, like for medicine or maybe gynae there might be slight modifications, for pleats there might be some modifications. We will discuss that modification when it comes in the question wise questions. But we will start with the question, but the approach or the format will remain same. So, we will start with question number 1A. So, first is enumerate the causes of acute hepatitis. So, the question directly says enumerate, just enumerate the causes. Then what are the natural history and clinical manifestation? Write about the clinical manifestation and natural history, you can draw the flow chart, that what can be the complication and what will be finally leading to cirrhosis, leading to cancer or it can lead to death and coma also. Then the question is what are the direct acting antiviral agents for hepatitis C infections? This is the direct question. Similarly, next question is 10, 1B. Ten months old with tetralogy of blood is brought to the pediatric emergency, what with history of excessive crying and then become dyspepsic, drowsy and bruised. So, what is the likely diagnosis in this event? Or in the direct likely diagnosis, you just don't write that this is a case of this, this, this mention about it. What is it exactly? So, what exactly is this? So, you don't have to be a base there that is a case of crying and then becoming patient is having dyspnea also, crying is also there. So, you mention about that based on these parameters, I arrive to this diagnosis and then write the management of the condition. This is a basically synotic spell capacitor. So, you have to mention about the likely diagnosis, it is a synotic spell based on these these parameters, I arrive on this diagnosis that the patient is crying, dyspnea also there is a history of tetralogy of pellet. So, it is a case of synotic spell. Then similarly, patient the format is there and so directly they have asked describe the etiopathogenesis causes without clinical features without and the management. Management may will go for investigation, investigations mention about all the investigation and treatment, medical, non-medical, this is a question of psychiatry. So, the surgical you might not have it, but you can have a ECT portion. If there is a ECT required or not, then you can mention about the ECT in the psychiatric portion. So, this is how it will be done for this thing. And similarly, in the management of tetralogy of pellet, then you write about the history clinical examination, what are the investigations required and the treatment medical part, non-medical part and follow-up and advice given to the father, that will be in the follow-up portion. Then similarly, the D-version is question number 1, D is a 16 month old attending pediatrics with past history of diarrhea and respiratory infection. This is a direct question. They have asked which physical examination you will describe the two phases of treatment, what are the two phases and you can write about those. So, direct question or based on the malnutrition portion. Similarly, one E is also a direct question. How does classical scabies differ from custard scabies infection? You do not have to mention a referent about it, just draw a table and mention about the differences. And how do you treat treatment again in the same portion? What is the investigation you will do and followed by the management portion? Medical, non-medical, if there is any advice given to the patient or if there is any follow-up given, like advice is given, how to wash it, then you have to give treatment to the other members of the family also, what are the drugs required and what are the precautions you need to take. Then is question number 2A. So, what a middle age, a hypothyroid woman on irregular medication become drowsy. So, they are asking what are the causes of drowsiness? And then how will you diagnose? Diagnosed, we will be doing by history, clinical examination and investigation. This is how we will diagnose. So, what are the history required, clinical examination required and what are the investigations you are going to do. And then management is the treatment portion, you will write about it. The third portion is about the complication, you have to directly write about the complications, if there is nothing more required about it. Then 2B, a 10-month old infant having watery natural discharge for the last two days, developed rapid breathing, chest distraction and decrease feeding over the last one day. What is the likely diagnosis? Likely diagnosis, you mention about it on the basis of parameter or what parameters you are arising. So, it is, you lead to be a case of viral pneumonia, it seems like because the discharge is watery and there is a chest distraction and rapid breathing. So, respiratory system is involved. So, cases of, it might be a likely case of viral pneumonia. Enumerate the microbiological agents. For pneumonia, the microbiological agents is given age wise. That for infants, for infants what is there, 2 to 5 years, what is there, 5 to this year. So, write this way. And what are the agents can give you. Then again question is discuss the investigation and management. Mention the investigations, blood radiological, culture, whatever investigations are required and then the management is then again, medical, non-medical advice given to the father or advice given to the mother in the follow up portion. So, this is how it will be there. So, what you can see is that almost all the questions have to be approached in the same manner. And this pattern has to be followed everywhere and in the same manner either they will ask or you will have to write. And that is what they have been doing. Similarly, question number 2c, discuss the various theories which have been proposed to explain the pathogenesis of Vitelligo. So, you write about all the theories, what are their neurological theory, autoimmune theory, immune theory, then the toxin theory, whatever the theories are there, how do you assess the severity of Vitelligo. Then discuss the various lines of treatments of various grade of the disease. Treatment in the same way, medical, non-medical, what are the surgical treatment available, what are the advice given to the patient. And in this, for the phototherapy portion, you can draw the diagram of phototherapy. There is a given how, what is the exposure required to the son, how much amount of exposure is required. So, in that way, you can also draw the diagram of phototherapy also. Then comes question number 3a, a young male patient come to medical emergency with fever, headache and necromancy. He was also having some skin lesion on both lower limbs, abdomen. On clinical examination, patient was drowsy and having neck rigidity. So, it seems like a cases of neck rigidity is there. So meningitis, now the question is what is his differential diagnosis. So, now you have to write about the differential diagnosis portion. Then the manifestation, they have asked clinical manifestation, I told you, the diagnosis, investigation and the management of acute meningitis. Then what are the causes of acute meningitis? This is a direct question. You do not have to worry about it. Similarly, the gynecology portion, the pills portion, 32-week pre-term may not by Celerine section found to have a respiratory rate of this grunting and sinosus within a half a bar of birth. This is the case of respiratory distress syndrome. So, they have asked what is the likely diagnosis, mention about them. So, this is a pre-term baby of 32 weeks and having a respiratory distress. The most common cause is respiratory distress syndrome. Then discuss the management of this condition, write about the management and also the complications. It is a very direct question. A young woman presented to the emergency department with a history of pesticide intake, she has massive frothing from the mouth and nose. What is the pesticide which is likely to have consumed? This is a question out of Thorasas, out of labor situation. Question number 3C. So, a young woman presented to the emergency department with a history of pesticide intake, she has massive frothing from mouth and nose. So, what is the pesticide she is likely to have consumed? You mentioned about the pesticide. This is a slight out of Sleba's question. So, you could have eliminated this question in when you do not have to attempt because you have to attempt 5 questions only. You can ignore the question and not attempt it, but if you have to do it, write whatever you know about it. So, slight out of bit question, that 10 percent question you have to avoid it is a lug-based approach. Now, we come to question number 4A. A 13-month-old baby was brought by his mother with 6 episodes of loose stool and persistent vomiting to the emergency ward. He was found to be lethargic as his pulse rate was 160 per minute. Sometimes, they have a direct question, that what are the danger signs you look for dehydration? What if you find severe dehydration? There is a direct question given for what is the management of severe dehydration and if child is fit, what is the doubt they have directly asked? What advice will you give to mother? What I have been saying is if not even if they are not asking, then also you have to write what are the advice you are going to give to the mother or father. Here, they have directly asked the advice. Then question number 4B is a direct question. What are the current guidelines regarding the classification of hypertension? Draw that table of hypertension, prehypertension, hypertension stage 1, stage 2. Enumerate the causes of secondary hypen. The question is enumerate. So, just enumerate. Don't write it in detail about it. And third is enumerate the various antihypertensive drugs based on their mechanism of action. So, third question is also enumerate. Then just only enumerate the antihypertensive drugs. Don't write about it. Then 4C, this 470-year-old male bedridden for last two weeks following a fracture of the femoral lack presented to the Medical Emergency Department with Southern Breastlessness and Hypotension. What is the likelihood diagnosis? Now, this type of question, what you have to do? You don't have to likely diagnosis. You can mention what is the fracture femoral lack and there is a breastlessness. It might be a case of pulmonary embolism. But how would you diagnose this patient? I have been mentioning it about it, that you don't approach the question based on what is there in the syllabus. Approach the question in the way that what is the symptom given. And for this, you have to talk to your seniors, talk to your colleagues who are there in the department. How will you approach a patient of breathlessness? In this diagnosis, there is a flowchart given in the Harrison. You just draw that flowchart of pulmonary embolism diagnosis. But the patient is of breathlessness. So, now you have to rule out other causes of breathlessness also. So, for that, in investigation, you have to mention that I will do chest x-ray to rule out the pulmonary causes. I will do ECG to rule out the cardiac causes. I will do the chest x-ray also rule out the rib cage causes or any other causes of breathlessness is there. You have to rule out those causes also because you cannot say it is a patient of pulmonary embolism directly. You have to rule out other causes also. So, for that, when the diagnose, how do you diagnose the patient? You have to approach in this manner only. And the management goes in the same manner only. So, what I am saying is that for any symptom like abdominal pain, chest pain, breathlessness, headache or maybe other causes, there are seven, eight main, main, main major symptoms. You do not directly write the diagnosis what is there in the slavers. You do it in an approach manner. Approach manner that what are the other causes of chest pain which I have to rule out? Or what are the other causes of abdominal pain which I have to rule out? What are the other causes of breathlessness which I have to rule out? What are the other causes of headache which I have to rule out? So, you have to write those in the investigation part of yours. That for with this, like for the chest pain, you have to rule out the respiratory causes. You have to do the x-ray for that. For the breathlessness, you have to rule out the cardiac causes and respiratory causes both. So, x-ray easily both needs to be done or eco needs to be done. So, in that manner, you have to rule out the other causes also, not only this. So, that way it goes, not directly that the pulmonary embolism in the slavers and I will do the pulmonary embolism. We will do question number 5A. A 40-year-old lady presents an OPD with complaint of rise breast lump for last one year which is progressively increasing size. This is a direct question on the breast carcinoma. They ask how will you evaluate this patient? Evaluation will be in the history part, clinical part and investigation like triple assessment approach. And then outline the treatment. Treatment is a flow chart given, you can directly draw that flow chart and that is more than enough. But you have to focus on the counseling to the patient also. Then 5B is there, 25-year-old young patient is presented with emergency. This is the question where they are asking, discuss the differential diagnosis. Now, they have to discuss. So, you have to discuss all the differential diagnosis. So, it is a patient pain, pain in abdomen. So, differential diagnosis of all pain in the abdomen. Now, in investigation, you have to rule out other differential diagnosis also. So, you have to mention about those that it can be a perforated ulcer, it can be a burst abdomen, it can be a appendicitis, it can be other causes of also that. So, you have to rule out those. And then the management of peptic ulcer perforation in the same manner. Then 5C, it is a direct question, how do they have asked on the combined oral contraceptive? How long can women stay and direct question they have asked? You just have to write the direct question, direct answer given in the book. There is nothing specific approach required. Similarly, for 5D, what are the possible reasons for unexplained infertility? This is a slight offbeat question, but you can write about if you have done about the causes of infertility. Then about the rare causes of infertility, you can write about those which says these are the unexplained causes of infertility. For part 2, specifically every question has one question of PSM or community medicine. So, community medicine is a very important topic because every one part is of their community medicine and specifically the recent development or the current development which are happening in the country which is by the Ministry of Health. You have got the government of India which is doing on this portion, you have to remember them. You have to read about them from the current affairs portion, read about this. Similarly, this 5V is question is a direct question which is given on the National Vector Bond Disease Control Program. It is a program directly given, they have directly asked the question from that only. Then come question number 6A, the notes on issue you would raise in counseling a woman about to be delivered at 28 week gestation after placental abruption. So, in this, this is a question where you have to study about the approach. I told you that you have to discuss with your seniors, colleagues who are there in the different departments. So, for such questions while reading about the placenta previa or placenta abruption, you have to discuss with your colleagues that how do you approach such patient. So, they are asking about that approach where you will read about that approach, you will know about the issues also. So, discuss with your colleagues regarding this topic of medicine, surgery and gynae and pleads and then you will know how about the approaches and what are the issues they will raise. So, this is what they are asking about. Then in 6V at 40 year old male patient is presented with hematuria often or not for last 4 months, enumerate. Now that they are asking directly that enumerate the causes of hematuria. So, you just have to enumerate, just write down the causes. How will you investigate the patient? Investigation I have told you, you have to think all aspects of hematuria, what are the causes and you have to rule out all the causes. Maybe it is the coagulopathy, maybe it is a bladder, maybe it is a kidney, maybe it is urethra or urethra, whatever possibilities you can think about, you have to investigate all the possible causes and then only you can reach the diagnosis of hematuria. And then they have asked direct question, discuss the treatment of renal soon. Treatment will be in the same manner, medical, non-medical, surgical or post-op follow-up advice. The 6V question is a direct question on the Government of India initiative of NFHS survey, what is national iron plus initiative, specific interventions required, mechanism of service delivery. It is a direct question, you have to just copy and paste from the specific scheme of the Government of India, which have they asked. Now, question number 7, describe the etiopathogenesis of clinical feature investigation and management of varicose vein of lower limb. This is a direct question they have asked, etiopathogenesis, clinical feature investigation and management. You write in the same order, but at the same time draw the diagram of surgery of varicose vein. The surgery of varicose is strapping, there is a diagram given in Robbins as well as in Belize, it is a diagram given of stripping of surgery. You can directly draw that diagram because this diagram will add marks, it is a 20 mark question. So, you have to draw diagram of surgery also, you should draw the diagram. Then 7B, there is a direct question on mission in the Dharush. There is a objective goal strategy, what are the interventions required of mission in Dharush. They have directly asked the question of mission in Dharush. You do not need to have to have a different approach for this, just a copy paste question. 7C is a good question. It is a faulty year old multiparas woman present with two-year history of irregular periods and increasing tiredness on clinical examination. She appears pale. The uterus is enlarged to 12 weeks in size. The cervix and adnexa are unremarkable, describe giving reason, how would you manage the case? See, again they have now asked a question based on the approach that how will you approach such questions and that is they are, how will you manage? So, management will include your clinical part, then your history part, then your clinical examination, history method, you have to write about the obs history also and the menstrual history also, then the examination port, then your investigations, then your treatment. Treatment is also will go same, that medical, non-medical, surgical, post-op advice and in gynecology you have to also mention about the contraceptive advice. What kind of contraceptive advice you will give to such patients? You have to mention about this also. So, it is an approach based question. You have to discuss with your batchmate also or your colleagues about the gynecology approach. How will you approach such questions and also then in this manner only, history, clinical examination, investigation, treatment and all this. Then question number 8, A is a direct question. 8, A, 1, 2, 3, part, all the three are a direct question. They have asked what is MMR, what are the government initiative of MMR and what are the different states in the country and what are the benefits given by the government of India. It is a direct question, you do not need to have to think about it. Similarly, A is B is also a direct question. They have asked about the SCG pattern between normal and abnormal pregnancy. How does SCG varies in normal pregnancy and how does it varies in ectopic pregnancy or other issues? How accurate, about the false positive and false negative is the PSM question. What is false positive, false negative you need to know about the screening and the scoping part. Then 8c question is also a direct question. They have asked describe the indication and complication of colonoscopy, outline the principle of primary survey and trauma and enumerate the advantages or disadvantages of laparoscopic surgery. Well for surgery and medicine I would like to tell that you have to specifically read the radiology portion in medicine, the surgical aspect laparoscopic surgery, then endoscopic surgery, then what are the bariatric surgery or robotic surgery. These are the new developments which are happening. You have to prepare about this, what are the advantages, what are the disadvantages, what are the indication, what are the contraindications of these and how they are helpful and beneficial for the patient. These are the new aspects which have to be and similarly they have been not a single question orthopedics. So you should prepare orthopedics because this year the question might come on orthopedics also. So you should prepare on that part also. PSM is important, you should focus on PSM because one part in every question is from PSM. You should focus on that, draw flow charts and diagram from Harrison and Bailey's. I have been repeating this. So this was about the paper 1 and paper 2 discussion for medical sciences. How do you write answers and the paper discussion? Thank you. Don't forget to subscribe with us and press the bell icon to never miss the video on Chanakya IES Academy.