Medical Science 2022 Paper II 50 marks Discuss

Q2

(a) Discuss in brief the etiology, clinical features, diagnosis and treatment of nephrotic syndrome in a 40 year old adult. (20 marks) (b) A 2 year old unimmunized boy weighing 6 kg presented with fever, cough, and difficult breathing for 5 days. There was a history of fever with maculopapular rash lasting for 3 days around 7 days prior to this episode. The child is febrile, has a pulse rate 116/min, respiratory rate : 72/min, SpO₂ 88%. There is severe chest indrawing and nasal flaring. Auscultation revealed bronchial breath sounds on left side and bilateral crepitations. (i) State the complete diagnosis. (ii) Enumerate 3 most important complications associated with this condition. (iii) How would you assess the severity of illness in this child ? (iv) Discuss in brief the management of this child. (3+3+3+6=15 marks) (c) (i) What are the four 'P's used to describe clinical manifestation of lichen planus ? (ii) What are the common sites of cutaneous involvement in lichen planus ? (iii) Describe Koebner phenomena. List the disorders where this phenomena can be observed. (5+5+5=15 marks)

हिंदी में प्रश्न पढ़ें

(a) एक 40-वर्षीय पुरुष में अपवृक्कीय संलक्षण की हेतुकी, रोगलाक्षणिक विशिष्टताएं, निदान तथा उपचार की संक्षेप में व्याख्या कीजिए । (20 अंक) (b) एक 2-वर्षीय बालक को, जिसका वजन 6 kg है, विगत 5 दिनों से बुखार, खांसी और कष्ट-श्वसन है । इस घटना से लगभग 7 दिन पहले उसे 3 दिन तक बुखार और चित्ती-पिट्टीकीय विस्फोट होने की बूति है । बालक को बुखार है, नाड़ी दर 116/मिनट है, श्वसन दर 72/मिनट है तथा SpO₂ 88% है । उसकी छाती तीव्र रूप से भीतर खिंची है और उसकी नासिका फैली हुई है । छाती का परीक्षण करने पर बायीं ओर श्वसन ध्वनियां ब्रांकियल हैं और दोनों ओर क्रेपिटेशन हैं । (i) संपूर्ण निदान क्या है लिखिए । (ii) इस रुग्णता से संबंधित तीन सर्वाधिक महत्वपूर्ण जटिलताएं गिनाइए । (iii) इस बालक की रुग्णता की गंभीरता का आकलन कैसे किया जा सकता है ? (iv) इस बालक के प्रबंधन की संक्षेप में व्याख्या कीजिए । (3+3+3+6=15 अंक) (c) (i) समतल शैवाक की रोगलक्षण विशिष्टताओं का वर्णन करते समय प्रयोग में लाए जाने वाले अंग्रेजी वर्णमाला के चार 'P' क्या-क्या हैं ? (ii) समतल शैवाक में त्वक् रोगलक्षण शरीर में बहुधा किस-किस स्थान पर पाए जाते हैं ? (iii) 'कॉबनर घटना' का वर्णन कीजिए। उन विकारों की सूची प्रस्तुत कीजिए जिनमें कॉबनर घटना देखी जा सकती है। (5+5+5=15 अंक)

Evaluate your answer to this question → See all 2022 Medical Science questions

Directive word: Discuss

This question asks you to discuss. 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

This multi-part question requires a structured response across three distinct clinical scenarios. Allocate approximately 40% of time/words to part (a) on adult nephrotic syndrome (20 marks), 30% to part (b) on pediatric pneumonia with its four sub-parts (15 marks), and 30% to part (c) on lichen planus with its three sub-parts (15 marks). Begin each part with clear headings, use bullet points for sub-parts (b)(i)-(iv) and (c)(i)-(iii), and ensure clinical reasoning is explicit throughout.

Key points expected

  • Part (a): Etiology of adult nephrotic syndrome distinguishing primary (minimal change disease, FSGS, membranous nephropathy, MPGN) vs secondary causes (diabetes, amyloidosis, SLE, infections, drugs); clinical features emphasizing edema, proteinuria >3.5g/day, hypoalbuminemia, hyperlipidemia; diagnosis including urine analysis, 24-hour urine protein, serum albumin, lipid profile, renal biopsy indications; treatment with ACE inhibitors, steroids, immunosuppressants, and complications management
  • Part (b)(i): Complete diagnosis as Measles complicated by severe pneumonia (likely bacterial superinfection) with respiratory distress, recognizing the 7-day interval between measles rash and current presentation as characteristic of measles-associated immune suppression
  • Part (b)(ii): Three most important complications: respiratory failure/ARDS, bacterial superinfection (Staphylococcus aureus, Streptococcus pneumoniae, H. influenzae), and measles croup/subglottic obstruction; or alternatively sepsis, empyema, or heart failure
  • Part (b)(iii): Severity assessment using WHO IMCI criteria or PAEDIATRIC RISK OF MORTALITY (PRISM) score, specifically noting danger signs: SpO₂ <90%, chest indrawing, nasal flaring, RR >70/min in <2 months (or >60 in 2-12 months), inability to feed, altered consciousness
  • Part (b)(iv): Management including oxygen therapy (target SpO₂ >92%), IV antibiotics (ampicillin/ceftriaxone ± gentamicin or vancomycin if MRSA suspected), bronchodilators, hydration, nutrition support, measles vitamin A supplementation, and possible ICU referral for respiratory failure
  • Part (c)(i): Four 'P's of lichen planus - Pruritic, Purple, Polygonal, Papules/Plaques (sometimes including fifth P: Planar surfaces)
  • Part (c)(ii): Common sites: flexor wrists, forearms, ankles, lumbar region, oral mucosa (buccal, tongue, gingiva), scalp (lichen planopilaris), nails, and genitalia
  • Part (c)(iii): Koebner phenomenon definition (isomorphic response - appearance of lesions at sites of trauma); associated disorders: psoriasis, lichen planus, vitiligo, molluscum contagiosum, flat warts, Darier disease

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness22%11Demonstrates precise knowledge across all parts: for (a) correctly classifies adult vs pediatric nephrotic syndrome etiologies and cites specific diagnostic thresholds; for (b) accurately identifies measles immune suppression timeline and bacterial superinfection pathophysiology; for (c) correctly defines all four 'P's and Koebner phenomenon with accurate disease associationsCovers most concepts correctly but with minor errors: confuses some etiologies of nephrotic syndrome, misidentifies the 7-day interval significance in measles, or lists only 2-3 correct 'P's with vague Koebner definitionMajor conceptual errors: treats pediatric and adult nephrotic syndrome identically, fails to recognize measles history significance, provides incorrect 'P's, or fundamentally misunderstands Koebner phenomenon
Clinical correlation20%10Integrates clinical data expertly: for (a) links age 40 to specific disease predilections (membranous nephropathy, FSGS); for (b) synthesizes unimmunized status, weight-for-age assessment (6kg at 2 years = severe undernutrition), vital signs interpretation, and auscultation findings into coherent diagnostic reasoning; for (c) describes characteristic lesion morphology and distribution patterns accuratelyMakes some clinical connections but misses key integrations: notes unimmunized status without linking to measles, describes findings without severity interpretation, or provides generic rather than specific morphological descriptionsFails to correlate clinical data: ignores unimmunized status, misinterprets vital signs (does not recognize severe respiratory distress), or provides purely textbook descriptions without applying to the specific case scenarios
Diagram / pathway16%8Includes well-labeled diagrams where appropriate: nephrotic syndrome pathophysiology flowchart (proteinuria → edema formation), chest X-ray findings in lobar pneumonia, or lichen planus lesion morphology diagram; or describes clear algorithmic approaches (diagnostic algorithm for nephrotic syndrome, severity assessment flowchart, management protocol)Mentions diagrams or pathways but lacks clarity: vague references to 'pathophysiology' without structured presentation, or describes investigations without logical sequencingNo diagrams, flowcharts, or structured algorithms; purely narrative description without visual or logical organization of complex information
Differential / staging18%9Provides robust differential diagnoses: for (a) distinguishes nephrotic from nephritic syndrome, lists secondary causes by category; for (b) considers alternative diagnoses (foreign body aspiration, congenital heart disease, tuberculosis) and stages severity using IMCI/WHO criteria; for (c) differentiates lichen planus from lichenoid drug eruption, psoriasis, and secondary syphilisLimited differential consideration: brief mention of alternatives without elaboration, or generic severity assessment without specific criteria applicationNo differential diagnosis provided, fails to assess severity systematically, or confuses lichen planus with entirely unrelated conditions
Management / public-health angle24%12Comprehensive management with public health integration: for (a) evidence-based treatment protocols (KDIGO guidelines), steroid-sparing strategies, and vaccination status; for (b) IMCI-based management, oxygen therapy protocols, antibiotic selection rationale, vitamin A supplementation per Indian guidelines, and measles outbreak control measures; for (c) treatment options (topical steroids, tacrolimus) and patient counseling on chronicityStandard management without prioritization: lists treatments without severity-based stratification, omits vitamin A or outbreak considerations, or provides generic dermatological managementIncomplete or dangerous management: omits oxygen for hypoxemic child, fails to address severe malnutrition, misses antibiotic coverage, or provides inappropriate treatment recommendations

Practice this exact question

Write your answer, then get a detailed evaluation from our AI trained on UPSC's answer-writing standards. Free first evaluation — no signup needed to start.

Evaluate my answer →

More from Medical Science 2022 Paper II