Medical Science 2022 Paper II 50 marks Compulsory Enumerate

Q1

(a) Enumerate the imaging modalities used in the diagnosis of cardiac diseases. List their specific indications in diagnosing cardiac illnesses. (10 marks) (b) Outline the pharmacological and non-pharmacological management of anxiety disorders. (10 marks) (c) A 3 year old girl, who weighs 12 kg, presents with a history of loose stools mixed with blood and mucus, and fever for 3 days. On examination, she is active and feeling excessively thirsty. There is some loss of skin turgor. (i) Write your complete diagnosis. (ii) Name the most common micro-organism responsible for this condition. (iii) Write two most important life-threatening complications of this condition. (iv) Outline the management of the condition in this girl. (2+2+2+4=10 marks) (d) (i) Give two examples for each of the following types of vaccines used in under-5 children: 1. Capsular polysaccharide vaccines 2. Conjugate vaccines 3. Recombinant vaccines (ii) Define the following terms: 1. Herd effect 2. Vaccine efficacy (6+4=10 marks) (e) (i) State the various modes of transmission of scabies. (ii) What is the mite burden in a classical case of scabies during 1. an initial infection 2. in reinfection 3. in Norwegian scabies (iii) Describe the distribution of cutaneous findings in scabies. (4+3+3=10 marks)

हिंदी में प्रश्न पढ़ें

(a) हृदय रोगों के निदान के लिए प्रयुक्त प्रतिबिम्बन साधनों के नाम गिनाइए । हृदय रोगों के निदान में उनके विशिष्ट चिकित्सा संकेतों की सूची बनाइए । (10 अंक) (b) चिंता विकारों के फार्माकोलॉजिकल एवं नॉन-फार्माकोलॉजिकल प्रबंधन की रूप-रेखा प्रस्तुत कीजिए । (10 अंक) (c) एक 3 वर्षीय बालिका, जिसका वजन 12 kg है, को विगत 3 दिनों से रक्त व श्लेष्मा मिश्रित पतला मल हो रहा है और बुखार है । जांच करने पर वह सक्रिय है तथा उसे अत्यधिक प्यास लग रही है । उसकी त्वचा-स्फीति सामान्य से कुछ कम है । (i) संपूर्ण निदान क्या है लिखिए । (ii) इस रुग्णता के लिए कारक सर्वाधिक आम सूक्ष्मजीवी का नाम बताइए । (iii) इस रुग्णता की 2 सर्वाधिक महत्वपूर्ण प्राण-संकटकारी जटिलताएं गिनाइए । (iv) इस बालिका की रुग्णता के प्रबंधन की रूप-रेखा प्रस्तुत कीजिए । (2+2+2+4=10 अंक) (d) (i) पांच वर्ष से कम उम्र के बच्चों में दिए जाने वाले निम्नलिखित प्रकार के टीकों के दो-दो उदाहरण दीजिए : 1. कैप्सुलर पॉलिसैकराइड टीके 2. संयुग्मित (कांजुगेट) टीके 3. रिकॉम्बिनेंट टीके (ii) निम्नलिखित पारिभाषिक शब्दों को परिभाषित कीजिए : 1. यूथ-प्रभाव (हर्ड इफेक्ट) 2. टीके की प्रभावकारिता (वैक्सीन एफिकेसी) (6+4=10 अंक) (e) (i) स्केबीज संचरण किस-किस प्रकार से हो सकता है लिखिए । (ii) स्केबीज के क्लासिकल मामलों में निम्नलिखित स्थितियों में सूक्ष्मकीट बोझ (माइट बर्डन) कितना होता है ? 1. प्राथमिक संक्रमण के समय 2. पुनः संक्रमण के समय 3. नार्वे स्केबीज में (iii) स्केबीज में मिलने वाले त्वचा संबंधी लक्षण शरीर में कहाँ-कहाँ पाए जाते हैं वर्णन कीजिए । (4+3+3=10 अंक)

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Directive word: Enumerate

This question asks you to enumerate. 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

Begin with the directive 'enumerate' for part (a), then apply 'outline' for (b) and (c)(iv), 'state/define' for (d)(ii) and (e)(i), and 'describe' for (e)(iii). Allocate approximately 20% time to each of the five main parts (a-e), with sub-part (c) requiring integrated clinical reasoning across its four components. Structure as: (a) tabulated modalities with indications; (b) two-column pharmacological vs non-pharmacological; (c) clinical case synthesis with dehydration assessment; (d) vaccine examples in list format with precise definitions; (e) transmission modes with mite burden specifics and distribution description. No conclusion needed; maximize information density within each marked section.

Key points expected

  • (a) Cardiac imaging: ECG, chest X-ray, echocardiography (TTE/TEE), stress testing, cardiac CT, cardiac MRI, nuclear imaging (MUGA, PET), cardiac catheterization with indications for each (e.g., TTE for initial valve assessment, CMR for myocarditis, coronary angiography for CAD)
  • (b) Anxiety disorders: Pharmacological (SSRIs first-line, SNRIs, benzodiazepines short-term, buspirone, beta-blockers for somatic symptoms) and non-pharmacological (CBT, exposure therapy, relaxation techniques, lifestyle modifications)
  • (c)(i-iv) Pediatric dysentery: Acute bacillary dysentery with some dehydration (WHO Plan B), Shigella flexneri/most commonly S. sonnei in developed settings, complications (hemolytic uremic syndrome, toxic megacolon/septic shock), ORS/zinc/antibiotics (azithromycin/cefixime) with monitoring
  • (d) Vaccine types: Capsular polysaccharide (Pneumococcal 23-valent, Meningococcal ACWY), Conjugate (Hib, PCV13, MenACWY-CRM), Recombinant (Hepatitis B, HPV); Herd effect (indirect protection of unvaccinated), Vaccine efficacy (protection in controlled trial vs placebo)
  • (e) Scabies: Transmission (direct skin contact, fomites, sexual transmission), mite burden (10-15 in classical initial, rapid increase in reinfection, millions in Norwegian/crusted scabies), distribution (finger webs, wrists, elbows, axillae, periumbilical, groin, buttocks, sparing of head in adults)

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Accurately names all cardiac imaging modalities with correct indications (e.g., stress echo for ischemia, CMR for ARVC); correctly identifies Shigella as causative organism for dysentery; precise mite burden numbers (10-15 initial, millions Norwegian); correct vaccine examples matching each category; accurate definitions of herd effect and vaccine efficacy with epidemiological contextLists most imaging modalities but mixes indications (e.g., CT for valve disease); identifies organism as 'bacteria' without specifying Shigella; vague mite burden descriptions; some vaccine examples misclassified (e.g., listing conjugate as polysaccharide); definitions present but impreciseMajor errors in imaging modality-indication pairing; incorrect organism (e.g., Rotavirus, E.coli); fundamental misunderstanding of vaccine types (e.g., calling live-attenuated 'recombinant'); missing or completely wrong definitions; confusion between efficacy and effectiveness
Clinical correlation20%10For (c), correctly interprets 'active but thirsty with loss of skin turgor' as some dehydration (Plan B, not severe); integrates blood-mucus stools with fever for dysentery diagnosis; recognizes clinical significance of HUS risk with Shigella dysenteriae type 1; applies anxiety management to Indian context (limited CBT availability, need for SSRI optimization)Identifies dehydration but may misclassify severity; recognizes dysentery but misses dehydration grading; lists complications without clinical correlation; anxiety management generic without contextual adaptationMisclassifies as severe dehydration requiring Plan C/IV fluids; fails to recognize dysentery vs watery diarrhea; misses life-threatening nature of complications; no clinical reasoning in anxiety management
Diagram / pathway15%7.5Includes clear diagram/table for cardiac imaging modalities with indications; flowchart for anxiety disorder management algorithm; WHO dehydration assessment chart for case (c); schematic of scabies mite life cycle or distribution pattern on body diagramSimple tables without integration; partial diagrams; lists without visual organization; mentions diagrams but doesn't execute clearlyNo diagrams or tables where clearly beneficial; disorganized presentation; diagrams with major errors (e.g., wrong anatomical distribution for scabies)
Differential / staging20%10For (c), explicitly differentiates dysentery from cholera, amoebiasis, and viral gastroenteritis; stages dehydration correctly using WHO criteria; for cardiac imaging, prioritizes modalities by clinical scenario (emergency vs elective); for anxiety, distinguishes GAD, panic disorder, phobias with specific management variationsMentions differentials without elaboration; basic dehydration classification; generic anxiety discussion without subtype differentiationNo differential for dysentery; incorrect dehydration staging; conflates all anxiety disorders; misses critical distinctions (e.g., Norwegian vs classical scabies management implications)
Management / public-health angle25%12.5Comprehensive management for (c): ORS preparation (WHO reduced osmolarity), zinc supplementation (10-20mg), antibiotic choice based on local resistance (azithromycin preferred where fluoroquinolone resistance high), monitoring for complications; for (b), stepped care model; for vaccines, mentions UIP (Universal Immunization Programme) inclusion and cold chain; for scabies, mass drug administration in outbreaks; herd effect calculation relevance for polio eradication in IndiaStandard ORS and antibiotics without specificity; generic anxiety management; vaccine schedule without public health context; individual treatment for scabies without community angleDangerous management errors (e.g., antimotility agents in dysentery, no antibiotics); misses zinc; no recognition of antibiotic resistance patterns; ignores Indian public health programs (UIP, NVBDCP for scabies); fails to mention contact treatment for scabies

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