Medical Science 2022 Paper II 50 marks Outline

Q4

(a) A 25 year old female has presented to the medicine OPD with complaints of excessive tiredness, cold intolerance and menstrual irregularities. (i) Write the name of thyroid disorder that can lead to above manifestations. (ii) Tabulate the differentiating cardiovascular clinical manifestations in hypothyroidism and hyperthyroidism. (iii) Outline the pharmacological management of hypothyroidism and hyperthyroidism. What are the blood investigations conducted to monitor the treatment of hypothyroidism and hyperthyroidism ? 2+8+10=20 (b) A 6 week old sick looking young infant is brought to a primary health centre with suspicion of "Possible Bacterial Infection" as per Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy. (i) How will you assess this child, and classify as having "Possible Serious Bacterial Infection" or "Local Bacterial Infection" ? (ii) State the treatments for "Possible Serious Bacterial Infection" and "Local Bacterial Infection", as per IMNCI strategy. 10+10=20 (c) A young epileptic patient was put on antiseizure drug Lamotrigine. Three weeks later he develops an eruption consisting of purpuric macules and bullae all over skin with involvement of lips, oral mucous membrane and eyes. Skin was tender to touch. (i) What is the differential diagnosis in this case ? (ii) How will you manage this condition ? 5+5=10

हिंदी में प्रश्न पढ़ें

(क) एक 25-वर्षीय महिला काय-चिकित्सा बाह्य रोग विभाग में प्रस्तुत हुई है । उसे अत्यधिक थकान, शीत असहनता तथा आर्तव अनियमितता होने की समस्याएं हैं । (i) ये रोगलक्षण जिस अवटु विकार में पाए जा सकते हैं उसका नाम लिखिए । (ii) अवटु अल्पक्रियता तथा अवटु अतिक्रियता में पाए जाने वाली हृद्वाहिकीय रोगलक्षण अभिव्यक्तियों में क्या-क्या भेद होता है, उन्हें तालिकाबद्ध प्रस्तुत कीजिए । (iii) अवटु अल्पक्रियता तथा अवटु अतिक्रियता के फार्माकोलॉजिकल प्रबंधन की रूप-रेखा प्रस्तुत कीजिए । ऐसी कौन-सी रक्त जांच है जिनके द्वारा अवटु अल्पक्रियता तथा अवटु अतिक्रियता के उपचार को मॉनिटर किया जा सकता है ? 2+8+10=20 (ख) एक 6-सप्ताह का बीमार दिख रहा शिशु प्राथमिक चिकित्सा केंद्र में लाया जाता है । नवजात एवं बाल्यपन रोगों की एकीकृत प्रबंधन (IMNCI) रणनीति के अंतर्गत संदेह है कि शिशु को 'संभावित जीवाणु संक्रमण' (पॉसिबल बैक्टीरियल इंफेक्शन) है । (i) इस शिशु का आकलन कैसे किया जाना चाहिए ? यह वर्गीकरण कैसे होगा कि शिशु को 'संभावित जीवाणु संक्रमण' है अथवा 'स्थानिक जीवाणु संक्रमण' ? (ii) IMNCI रणनीति के अनुसार 'संभावित जीवाणु संक्रमण' तथा 'स्थानिक जीवाणु संक्रमण' का उपचार क्या होगा लिखिए । 10+10=20 (ग) मिर्गी के एक युवा रोगी को आक्षेपरोधी औषधि लेमोट्रिगिन पर डाला गया । उपचार शुरू करने के 3 सप्ताह उपरांत उसकी त्वचा पर नीललोहित चित्ती तथा जलस्फोटों का विस्फोट हो गया जिसका प्रभाव उसके ओंठों, मुखीय श्लेष्मल कला तथा नेत्रों पर था । उसकी त्वचा स्पर्शसंवेदनशील थी । (i) इस मामले का विभेदक निदान क्या होगा ? (ii) इस वृणता का प्रबंधन कैसे किया जाना चाहिए ? 5+5=10

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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 directive 'outline' demands structured, systematic presentation of facts across all sub-parts. Allocate approximately 40% time/words to part (a) [20 marks], 40% to part (b) [20 marks], and 20% to part (c) [10 marks]. Structure: Begin with direct identification of hypothyroidism in (a)(i), followed by tabulated cardiovascular comparison, then pharmacological management with monitoring protocols; for (b), present IMNCI assessment criteria in algorithmic format with clear classification and treatment protocols; for (c), provide differential diagnosis with Stevens-Johnson syndrome as primary, followed by immediate management steps. Use tables for comparisons and bulleted lists for protocols to enhance clarity.

Key points expected

  • Part (a)(i): Correct identification of primary hypothyroidism (Hashimoto's thyroiditis most likely in 25-year-old female) with brief justification based on clinical triad
  • Part (a)(ii): Comprehensive tabular comparison of cardiovascular manifestations: hypothyroidism (bradycardia, diastolic hypertension, decreased cardiac output, pericardial effusion, hypercholesterolemia) versus hyperthyroidism (tachycardia, systolic hypertension, increased cardiac output, high-output failure, atrial fibrillation)
  • Part (a)(iii): Pharmacological management—levothyroxine for hypothyroidism (dosing, titration); carbimazole/methimazole, propylthiouracil, radioiodine, surgery for hyperthyroidism; monitoring via TSH (primary), FT4, FT3 with target ranges
  • Part (b): IMNCI assessment using main symptoms (convulsions, fast breathing, severe chest indrawing, nasal flaring, grunting, bulging fontanelle, pus discharge from ear, umbilical redness, skin pustules, lethargy, reduced feeding, fever/low body temperature); classification criteria for PSBI versus local infection; treatment protocols including referral, antibiotics (ampicillin + gentamicin), supportive care
  • Part (c): Differential diagnosis prioritizing Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum (lamotrigine-induced), DRESS syndrome, bullous pemphigoid; management emphasizing immediate drug withdrawal, supportive care, IV fluids, infection prevention, ophthalmology referral, role of corticosteroids

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness25%12.5Accurately identifies hypothyroidism (Hashimoto's) in (a); correctly lists all IMNCI danger signs and classification criteria in (b); precisely identifies SJS/TEN as lamotrigine adverse effect with correct pathophysiology; no factual errors in drug names, doses, or physiological mechanismsCorrectly identifies hypothyroidism but misses Hashimoto's; lists most IMNCI criteria but omits 1-2 key signs; identifies SJS but confuses with other bullous disorders; minor errors in drug nomenclature or monitoring parametersMisidentifies thyroid disorder (e.g., hyperthyroidism); fundamental errors in IMNCI classification; fails to recognize SJS/TEN; significant errors in pharmacological facts or physiological concepts
Clinical correlation20%10Demonstrates strong clinical reasoning: links menstrual irregularities to elevated TRH/ prolactin in hypothyroidism; explains why young infants are high-risk for PSBI; connects 3-week lamotrigine exposure to delayed hypersensitivity; uses age-appropriate clinical examples throughoutShows basic clinical correlation without mechanistic explanation; mentions high-risk groups without elaborating why; notes temporal relationship of drug exposure without immunological basisPurely theoretical answer with no patient context; fails to relate clinical presentations to underlying pathophysiology; no appreciation of pediatric or dermatological emergency severity
Diagram / pathway15%7.5Includes well-labeled table for cardiovascular comparison in (a)(ii); presents IMNCI algorithm/flowchart for assessment and classification in (b); uses structured format for SJS management protocol; diagrams enhance clarity and completenessBasic table present but incomplete; textual description of IMNCI algorithm without visual structure; management presented as paragraph rather than protocol formatNo tables or diagrams where clearly indicated; disorganized presentation that hinders understanding; missing visual representation of comparison or algorithm
Differential / staging20%10Comprehensive differential in (c): SJS vs TEN (by body surface area), DRESS syndrome, bullous drug eruption, staphylococcal scalded skin syndrome; includes diagnostic criteria (RegiSCORING for DRESS, SCORTEN for TEN); clear staging of thyroid disorders by severityMentions 2-3 differentials without clear distinguishing features; basic mention of SJS-TEN spectrum without classification criteria; limited staging of thyroid disease severitySingle diagnosis without differential; confuses SJS with other conditions; no appreciation of disease severity classification or prognostic indicators
Management / public-health angle20%10Evidence-based management: levothyroxine dosing with weight-based calculation, follow-up protocols; IMNCI pre-referral antibiotics and referral criteria; SJS immediate care with burn unit criteria, ophthalmology emergency; mentions RNTCP/NRHM relevance for hypothyroidism screening, ASHA worker role in IMNCIStandard management protocols without dosing specifics; basic IMNCI treatment without pre-referral care details; SJS management without multidisciplinary approach; limited public health integrationIncomplete or dangerous management suggestions; misses critical steps (e.g., no mention of drug withdrawal in SJS); no appreciation of primary health care context or referral pathways

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