Paper II — Q8
(a) (i) Summarise the spectrum of Iodine Deficiency Disorders. (10 marks) (ii) State the goal, objectives and salient features of…
Summarise the spectrum of Iodine Deficiency Disorders. 10 marks
State the goal, objectives and salient features of Iodine Deficiency Disorder Control Programme. 10 marks
What are the major changes that have been introduced under the MTP (Amendment) Act, 2021? 6 marks
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 marks
What measures can help increase the use of contraceptives in India? 4 marks
A 47-year-old female presents to the surgery OPD with a solitary nodule in the right lobe of thyroid gland.
How will you investigate this case? 5 marks
What is the ideal treatment if investigations are suggestive of follicular neoplasm? 5 marks
How will you follow-up a patient who has undergone total thyroidectomy for papillary carcinoma thyroid 5 days back? 5 marks
हिंदी में प्रश्न पढ़ें
आयोडीन अल्पता से होने वाले विकारों के स्पेक्ट्रम का सारांश प्रस्तुत कीजिए । (10 अंक)
आयोडीन अल्पता विकार नियंत्रण कार्यक्रम (आयोडीन डेफिशिएंसी डिसऑर्डर कंट्रोल प्रोग्राम) के ध्येय (गोल), लक्ष्य (ऑब्जेक्टिव्स) तथा मुख्य विशेषताओं की संक्षेप में चर्चा कीजिए । (10 अंक)
एम.टी.पी. (संशोधन) अधिनियम, 2021 के अंतर्गत क्या-क्या प्रमुख परिवर्तन लाए गए हैं ? (6 अंक)
भारत में लोग कौन-कौन से गर्भनिरोधक उपाय व्यवहार में लाते हैं ? उनके उपयोग के आधार पर उन्हें क्रम से गिनाइए और उनके प्रचलन के आँकड़े बताइए । (5 अंक)
कौन-कौन से उपाय भारत में गर्भनिरोधकों के प्रचलन को बढ़ावा देने में उपयोगी सिद्ध हो सकते हैं ? (4 अंक)
अवटु ग्रंथि के दक्षिण खंड में एकल पर्विका होने के कारण एक 47-वर्षीय महिला शल्योपचार (सर्जरी) ओ.पी.डी. में अपने उपचार के लिए आती है ।
इस रोगी की जाँच आप कैसे करेंगे ? (5 अंक)
यदि जाँच करने पर पुटकीय अर्बुद होने के संकेत मिलें, तो सर्वथा उपयुक्त उपचार क्या होगा ? (5 अंक)
एक रोगी जिसका 5 दिन पूर्व अवटु ग्रंथि के पैपिलरी कार्सिनोमा के लिए संपूर्ण अवटु-उच्छेदन किया गया था, उसका फोलो-अप आप कैसे करेंगे ? (5 अंक)
Model answer
Drafted with AI by UPSC Answer Check against this question's marking rubric, to the expected length. UPSC does not publish answers for Mains — this is one way to score well, not an official key. How we build rubrics and answers.
(a)(i) Spectrum of iodine deficiency disorders
- Fetus: abortion, stillbirth, congenital anomalies, perinatal and infant mortality, neurological cretinism (mental deficiency, deaf-mutism, squint, spastic diplegia) and myxoedematous cretinism.
- Neonate: goitre, hypothyroidism.
- Child and adolescent: goitre, juvenile hypothyroidism, impaired mental function, retarded physical development, lower school performance.
- Adult: goitre with its complications (compression, nodules, toxic change), hypothyroidism, impaired mental function, reduced work productivity, and spontaneous or iodine-induced hyperthyroidism (Jod-Basedow phenomenon).
- Community: endemic goitre, loss of productivity and increased infant mortality.
(a)(ii) NIDDCP: goal, objectives and salient features
The National Goitre Control Programme (1962) was renamed the National Iodine Deficiency Disorders Control Programme in 1992.
Goal: to reduce the prevalence of iodine deficiency disorders below 5% and ensure universal consumption of adequately iodised salt.
Objectives:
- Survey districts to assess the magnitude of the problem.
- Replace common salt with iodised salt.
- Resurvey every 5 years to measure progress.
- Laboratory monitoring of iodised salt and urinary iodine excretion.
- Health education and publicity.
Salient features: technical guidance to states; production and supply of iodised salt with quality control (iodine at least 15 ppm at the consumer end, 30 ppm at manufacture); the sale of non-iodised salt for direct human consumption is prohibited; salt testing kits for field checks; training of health workers; inter-sectoral coordination with the salt industry and transport; monitoring through urinary iodine and goitre surveys; and observance of Global IDD Prevention Day on 21 October.
(b)(i) Changes under the MTP (Amendment) Act, 2021
- Upper limit raised from 20 to 24 weeks for special categories of women (survivors of rape or incest, minors, women whose marital status changes during pregnancy, women with disabilities and others notified in the rules).
- One registered medical practitioner's opinion up to 20 weeks; two for 20–24 weeks.
- No upper limit when a Medical Board diagnoses substantial fetal abnormalities.
- Contraceptive-failure ground now applies to any woman or her partner, not only a married woman and her husband.
- Confidentiality: the woman's name and particulars cannot be revealed except as authorised by law.
(b)(ii) Contraceptive use in India (NFHS-5, 2019–21)
Among currently married women aged 15–49, about two-thirds use any method, and 56.5% use a modern method. In order: female sterilisation 37.9%; traditional methods 10.2%; condoms 9.5%; oral pills 5.1%; intrauterine devices 2.1%; injectables 0.6%; male sterilisation 0.3%. Reliance on female sterilisation is very high and spacing methods are low.
(b)(iii) Increasing contraceptive use
Counselling by ASHAs and a wider method mix, including injectables (such as DMPA) and postpartum IUCD; male involvement and promotion of condoms and vasectomy; postpartum and post-abortion family planning; assured supplies and trained providers at all levels; removing method targets in favour of client choice; social marketing; and education, early marriage reduction and spacing awareness.
(c)(i) Investigating a solitary thyroid nodule
- History and examination: rapid growth, hoarseness, family history, radiation exposure, hard fixed nodule, cervical nodes.
- Serum TSH (and free T4); if TSH is low, radionuclide scan to find a hot nodule.
- Neck ultrasound with TI-RADS features (solid, hypoechoic, irregular margins, microcalcification, taller than wide) and node survey.
- Fine-needle aspiration cytology reported by the Bethesda system.
- Calcitonin if medullary carcinoma is suspected; laryngoscopy before surgery; CT or MRI for retrosternal or fixed lesions.
(c)(ii) Treatment for follicular neoplasm
Diagnostic hemithyroidectomy (lobectomy with isthmusectomy), because cytology cannot tell follicular adenoma from carcinoma; diagnosis requires histology showing capsular or vascular invasion. If carcinoma is confirmed, completion thyroidectomy is advised for larger or higher-risk tumours (lobectomy may suffice for small, low-risk tumours), followed by radioiodine and TSH suppression according to risk.
(c)(iii) Follow-up five days after total thyroidectomy for papillary carcinoma
- Early: examine wound for haematoma; check voice and, if hoarse, laryngoscopy for recurrent laryngeal nerve palsy; monitor calcium and PTH for hypoparathyroidism, with calcium and calcitriol supplements if needed.
- Review histology and stage, and decide on radioiodine ablation (about 4–6 weeks, with TSH stimulation).
- Start levothyroxine and adjust to the TSH target by risk (suppression for higher risk).
- Long term: TSH, thyroglobulin and anti-thyroglobulin antibodies with neck ultrasound at 6–12 months, then yearly, with lifelong follow-up.
How this answer will be evaluated
Framework: Clinical Sequence & National Health Programme
What earns full marks: Comprehensive clinical reasoning, accurate statutory references, and clear management protocols.
Evaluation rubric
Each sub-part is marked on its own, against the marks and word limit printed on the paper.
- (a)(i) Summarise the spectrum of iodine deficiency disorders 10 marks
describe— define → structure or process in order → labelled diagram → significance
Must cover
- Fetal effects: abortion, stillbirth, cretinism
- Child and adult effects: goitre, hypothyroidism and impaired mental function
- Neurological and myxoedematous cretinism
Loses marks
- Listing only goitre
- Describing iodine excess as the cause
Earns more
- Neonatal goitre and hypothyroidism
- Reduced productivity at community level
- Hyperthyroidism, including iodine-induced Jod-Basedow phenomenon
Extra mark
- Presents the spectrum by life stage
- (a)(ii) State the goal, objectives and salient features of the Iodine Deficiency Disorders Control Programme 10 marks
highlight— name the salient points → one line of substance each → close
Must cover
- Goal: IDD prevalence below 5% with universal adequately iodised salt
- Objectives: surveys, iodised salt supply, resurvey every 5 years, monitoring, health education
- Programme history: NGCP 1962 renamed NIDDCP in 1992
Loses marks
- Naming a wrong programme start year or goal
- Omitting salt iodisation
Earns more
- Salt iodine standard of 15 ppm at consumer level
- Prohibition of sale of non-iodised salt for direct consumption
- Laboratory monitoring of salt and urinary iodine, and training
Extra mark
- Mentions Global IDD Prevention Day on 21 October
- (b)(i) State the major changes introduced under the MTP (Amendment) Act, 2021 6 marks
highlight— name the salient points → one line of substance each → close
Must cover
- Upper limit raised to 24 weeks for special categories
- Opinion of one provider up to 20 weeks and two for 20–24 weeks
- Medical Board for substantial fetal abnormalities with no upper limit
Loses marks
- Stating 24 weeks for all women
- Listing the 1971 Act provisions as the amendments
Earns more
- Contraceptive failure applies to any woman or her partner
- Confidentiality of the woman's identity
- Examples of special categories such as rape survivors and minors
Extra mark
- Mentions rules notified in 2021
- (b)(ii) List contraceptive methods used in India in order of use with statistics 5 marks
enumerate— list the items in order → one line each → no commentary
Must cover
- Female sterilisation as the most common method at 37.9%
- Traditional methods, condoms, pills, IUDs, injectables and male sterilisation in correct order
- Modern method use of 56.5% (NFHS-5)
Loses marks
- Giving figures from an older survey without naming it
- Putting male sterilisation above condoms
Earns more
- Condom 9.5%, pills 5.1% and IUD 2.1%
- Injectables 0.6% and male sterilisation 0.3%
Extra mark
- Notes the dominance of female sterilisation
- (b)(iii) State measures that can help increase the use of contraceptives in India 4 marks
suggest— the problem in one line → implementable measures → who acts → conclusion
Must cover
- Counselling and a wider method choice including injectables
- Male involvement and promotion of condoms and vasectomy
- Postpartum and post-abortion family planning
Loses marks
- Advising coercive targets
- Ignoring male participation
Earns more
- Assured supplies and trained providers
- Removal of method-specific targets
Extra mark
- Mentions social marketing
- (c)(i) State how a 47-year-old woman with a solitary right thyroid nodule will be investigated 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- TSH and thyroid function
- Neck ultrasound with TI-RADS
- FNAC reported by the Bethesda system
Loses marks
- Starting with a radionuclide scan in all patients
- Omitting FNAC
Earns more
- Radionuclide scan if TSH is low
- Calcitonin if medullary carcinoma is suspected
- Cervical node assessment
Extra mark
- Mentions laryngoscopy before surgery
- (c)(ii) State the ideal treatment if investigations suggest follicular neoplasm 5 marks
justify— claim → 3-4 reasons → evidence → conclusion
Must cover
- Diagnostic hemithyroidectomy (lobectomy)
- Histology for capsular or vascular invasion
- Completion thyroidectomy if carcinoma with higher risk
Loses marks
- Advising upfront total thyroidectomy for all
- Relying on frozen section as definitive
Earns more
- Cytology cannot distinguish adenoma from carcinoma
- Radioiodine and TSH suppression according to risk
Extra mark
- Notes lobectomy may suffice for small low-risk tumours
- (c)(iii) Describe follow-up of a patient five days after total thyroidectomy for papillary carcinoma 5 marks
explain— definition/context → points in order → small example → short close
Must cover
- Early checks of wound, voice and calcium or PTH
- Levothyroxine with TSH target by risk
- Radioiodine ablation decision and thyroglobulin follow-up
Loses marks
- Omitting calcium monitoring
- Stopping follow-up after one year
Earns more
- Calcium and calcitriol for hypoparathyroidism
- Neck ultrasound with TSH and thyroglobulin at 6–12 months
Extra mark
- Notes anti-thyroglobulin antibody measurement
What "Describe" is asking you to do
Give a full, ordered account of the thing named — its parts, stages or mechanism — in the sequence in which it actually exists or occurs. Most describe questions come from the science optionals, where the marks sit in correct technical detail and, where the stem says so, a labelled diagram.
Structure that answers it
One-line identification of the subject → the parts or stages in their real order, each with its defining detail → labelled diagram where the subject is structural → closing line on function or significance
Where marks are lost
Loose general prose where the examiner is ticking named parts, correct terminology and their sequence; and in the General Studies papers, turning to evaluation before the description is finished.
Practice this exact question
Write your answer and it is marked point by point against the model answer above — what you covered, what you missed, what you got wrong.
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