Medical Science 2021 Paper II 50 marks Outline

Q2

(a) A sixty-year-old diabetic male 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? (ii) How will you investigate the case to reach the diagnosis? (iii) Outline the steps in the management of the case. (2+4+14=20 marks) (b) A 12-month-old infant with history of delayed initiation of complementary feeding and few diarrhoeal episodes was found to have length of 72 cm, weight of 5 kg, mid arm circumference of 10 cm and loss of subcutaneous fat. (i) State the diagnosis. Under what severity of condition would you place this infant? (ii) Enumerate the complications associated with the condition. (iii) Describe the steps and phases of treatment. (4+5+6=15 marks) (c) (i) Write the atypical presentations of scabies. (ii) Describe the management of scabies in a neonate, in a child less than 2 years of age, an adult and a pregnant female. (iii) State the causes which can lead to persistent itching following the administration of scabicide therapy. (5+5+5=15 marks)

हिंदी में प्रश्न पढ़ें

(a) एक 60-वर्षीय पुरुष जिसे मधुमेह है आपातकालीन विभाग में पहुँचता है। उसे वक्ष के मध्य भाग में अचानक ऐसा तेज दर्द उठा है कि मानो उसकी छाती भींच रही है और यह दर्द विश्राम लेने पर भी कम नहीं हो रहा। (i) सर्वाधिक संभावित निदान क्या है? (ii) रोगनिदान तक पहुँचने के लिए आप इस रोगी की क्या-क्या जाँच करेंगे? (iii) इस रोगी के प्रबंधन हेतु विभिन्न उपायों की रूपरेखा प्रस्तुत कीजिए। (2+4+14=20 अंक) (b) एक 12-माह का शिशु जिसे पूरक आहार शुरू करने में वि�िलम्ब हो गया था और जिसे प्रवाहिका होने के कुछ प्रसंग भी हुए हैं, उसकी लम्बाई 72 cm है, वजन 5 kg है, मध्य-भुजा घेरा 10 cm है और उसकी अधस्त्वक् वसा का लोप हो चुका है। (i) निदान क्या है? रोग की गम्भीरता के आधार पर इस शिशु की क्षण अवस्था को आप किस श्रेणी में रखेंगे? (ii) इस क्षण अवस्था से क्या-क्या जटिलताएँ सम्बन्धित हैं, उन्हें गिनाइए। (iii) उपचार हेतु विभिन्न उपायों का चरणबद्ध वर्णन कीजिए। (4+5+6=15 अंक) (c) (i) स्केबीज की असामान्य प्रस्तुतियों के बारे में लिखिए। (ii) एक नवजात में, एक 2 वर्ष से छोटे बालक में, एक वयस्क में तथा एक गर्भवती स्त्री में स्केबीज के प्रबन्धन का वर्णन कीजिए। (iii) स्केबीनाशी चिकित्सा दिए जाने के पश्चात् कण्डू के निरन्तर बने रहने के क्या-क्या कारण हो सकते हैं, लिखिए। (5+5+5=15 अंक)

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Directive word: Outline

This question asks you to outline. The directive word signals the depth of analysis expected, the structure of your answer, and the weight of evidence you must bring.

See our UPSC directive words guide for a full breakdown of how to respond to each command word.

How this answer will be evaluated

Approach

The question demands outlining across all six sub-parts: for (a) spend ~40% of time (20 marks) covering STEMI diagnosis, ECG-cardiac biomarker correlation, and stepwise management including thrombolysis; for (b) allocate ~30% (15 marks) on SAM classification using WHO criteria, complications like hypoglycemia and refeeding syndrome, and phased nutritional rehabilitation; for (c) use remaining ~30% (15 marks) on crusted scabies variants, age-stratified permethrin/ivermectin protocols, and post-scabetic pruritus causes. Structure each part with immediate diagnosis → investigation → management flow.

Key points expected

  • (a)(i) Diagnosis: Acute STEMI in diabetic patient with atypical presentation masking typical chest pain
  • (a)(ii) Investigations: ECG within 10 min, troponin I/T, CK-MB, echocardiography for wall motion abnormality, coronary angiography
  • (a)(iii) Management: MONA protocol, primary PCI vs thrombolysis (tenecteplase), dual antiplatelet, beta-blockers, ACE inhibitors, statins
  • (b)(i) Diagnosis: Severe acute malnutrition (SAM) by WHZ <-3SD or MUAC <11.5 cm with bilateral pitting edema check; severity: complicated SAM if edema/infection present
  • (b)(ii) Complications: Hypothermia, hypoglycemia, hypokalemia, refeeding syndrome, septic shock, heart failure
  • (b)(iii) Treatment phases: Initial stabilization (F-75, 100 kcal/kg/day), transition, rehabilitation (F-100/RUTF, 150-220 kcal/kg/day), follow-up
  • (c)(i) Atypical scabies: Crusted/Norwegian scabies, scabies incognito, nodular scabies, bullous scabies in infants, scalp involvement in elderly/immunocompromised
  • (c)(ii) Age-specific management: Permethrin 5% cream (neonate 1-2 months: 2.5% or sulfur 5-6%; child: full 5%; adult: 5% overnight; pregnant: permethrin first-line, avoid ivermectin)
  • (c)(iii) Persistent pruritus causes: Treatment failure (resistance, incorrect application), reinfection from untreated contacts, post-scabetic nodules, secondary eczema, delusion of parasitosis

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Accurately identifies STEMI over NSTEMI/unstable angina in (a); correctly applies WHO SAM criteria (WHZ, MUAC, edema) in (b); distinguishes Sarcoptes scabiei var. hominis lifecycle and resistance patterns in (c); no factual errors in drug dosages or contraindicationsCorrect broad diagnoses but minor errors in classification thresholds (e.g., MUAC cutoff confusion) or drug dosing; some outdated management protocols mentionedMajor diagnostic errors (e.g., diagnosing GERD for chest pain, kwashiorkor for marasmus, confusing scabies with atopic dermatitis); dangerous pharmacological errors
Clinical correlation20%10Links diabetic autonomic neuropathy to atypical MI presentation in (a); correlates delayed complementary feeding with micronutrient deficiencies and infection susceptibility in (b); identifies immunocompromised/HIV status for crusted scabies in (c); cites Indian epidemiology (RUTF programs, NCD burden)Mentions risk factors superficially without mechanistic explanation; limited connection to Indian public health contextNo clinical reasoning provided; lists facts without patient-context linkage; ignores age-specific physiological considerations
Diagram / pathway15%7.5Draws ECG showing ST elevation in leads II, III, aVF for inferior MI; illustrates WHO SAM classification algorithm; sketches scabies mite lifecycle or treatment decision tree; labels clearly with anatomical/physiological correlationsMentions need for diagrams but provides poorly labeled or incomplete sketches; no integration with textNo diagrams despite clear indication (ECG, classification systems); or irrelevant illustrations that don't enhance answer
Differential / staging20%10For (a): differentiates STEMI vs NSTEMI vs aortic dissection vs PE using clinical scores (HEART, TIMI); for (b): stages SAM severity (complicated vs uncomplicated) with precise anthropometric cutoffs; for (c): distinguishes scabies variants from psoriasis, eczema, Darier diseaseLists differentials without discriminatory features; staging mentioned without criteria applicationNo differentials provided; confuses disease entities (e.g., marasmus vs kwashiorkor pathophysiology); misses critical red flags
Management / public-health angle25%12.5For (a): door-to-balloon <90 min, door-to-needle <30 min protocols; for (b): community-based management of SAM (CMAM), ICDS integration, RUTF (Nutrikhichdi, Plumpy'Nut); for (c): mass drug administration strategies, contact tracing, ivermectin in scabies-endemic communities (WHO 2023 guidelines); mentions NLEP and RBSK programsStandard hospital-based management only; no community or national program integration; generic drug names without protocolsIncomplete or dangerous management (e.g., oral ivermectin in neonates, rapid refeeding in SAM); no public health perspective; ignores standard treatment guidelines

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