Medical Science 2022 Paper II 50 marks Enumerate

Q7

7.(a) A 40 year old lady came to casualty with pain in the right upper abdomen associated with vomitings for 5 days. On examination, she was found to be having tenderness in right hypochondrium; the rest of the abdomen was normal. Ultrasound abdomen revealed a thick walled gallbladder with gall stones and pericholecystic fluid. (i) What is the clinical diagnosis and how will you manage this condition ? (6 marks) (ii) Enumerate the complications of gall stones. (6 marks) (iii) What is Mirizzi Syndrome ? How would you investigate and manage it ? (8 marks) 7.(b) (i) What is the total content of iron in the human body ? (2 marks) (ii) What are its bodily functions ? (4 marks) (iii) State the interventions being undertaken under the 'Anaemia Mukt Bharat Strategy'. (9 marks) 7.(c) (i) What is the current consensus on prescribing Hormone replacement therapy (HRT) in post menopausal women ? (10 marks) (ii) Discuss its merits and demerits. (5 marks)

हिंदी में प्रश्न पढ़ें

७.(क) एक 40-वर्षीय महिला विगत 5 दिनों से उदर के दाहिने ऊपरी भाग में दर्द और उल्टियां होने के कारण कैजुअल्टी में पहुंचती है। जांच करने पर उसका दाहिना अधःपृष्ठिक प्रदेश स्पर्शसंवेदी है। उदर का शेष भाग सामान्य है। उदर का अल्ट्रासाउंड करने पर उसके पित्ताशय की भित्ति की मोटाई बढ़ी हुई है, उसमें पित्ताश्मरी है तथा उसके परिपित्ताशय क्षेत्र में तरलता है। (i) इस रोगी का रोगलाक्षणिक निदान क्या है तथा उसकी रुग्णता का प्रबंधन करने के लिए क्या करना होगा ? (6 अंक) (ii) पित्ताश्मरी से हो सकने वाली जटिलताओं को गिनाइए। (6 अंक) (iii) मिरिज्जी संलक्षण क्या है ? उसकी जांच और प्रबंधन कैसे किया जाता है ? (8 अंक) ७.(ख) (i) मानव शरीर में लोहे की कुल मात्रा कितनी होती है ? (2 अंक) (ii) शरीर में लोहे के क्या-क्या कार्य हैं ? (4 अंक) (iii) 'एनीमिया मुक्त भारत रणनीति' के अंतर्गत क्या-क्या हस्तक्षेप लागू किए जा रहे हैं ? (9 अंक) ७.(ग) (i) रजोनिवृत्त महिलाओं में हार्मोन रिप्लेसमेंट थेरेपी (HRT) देने पर आजकल सर्वसम्मत विचार क्या है ? (10 अंक) (ii) HRT के गुणों और अवगुणों की व्याख्या कीजिए । (5 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

The directive 'enumerate' demands systematic listing with brief elaboration. Structure: (a) Acute cholecystitis diagnosis with Tokyo guidelines mention, complications in anatomical sequence, Mirizzi with Csendes classification; (b) Iron distribution with diagram, functions categorized, Anaemia Mukt Bharat 6x6x6 strategy; (c) HRT current consensus per NAMS/IMS guidelines, merits/demerits balanced. Allocate ~40% time to 7(a) [20 marks], ~35% to 7(c) [15 marks], ~25% to 7(b) [15 marks].

Key points expected

  • 7(a)(i): Diagnosis of acute calculous cholecystitis per Tokyo Guidelines 2018 (TG18) with Murphy's sign, ultrasound findings; management—IV antibiotics (ceftriaxone + metronidazole), analgesia, early laparoscopic cholecystectomy vs. delayed based on severity
  • 7(a)(ii): Complications classified as intra-luminal (mucocele, empyema), extra-luminal (perforation, peritonitis, abscess), fistulous (cholecystoenteric, gallstone ileus), and malignant (GB cancer)
  • 7(a)(iii): Mirizzi syndrome Type I (extrinsic compression) vs Type II-IV (fistula) per Csendes classification; investigation—MRCP (gold standard), ERCP; management—open surgery, subtotal cholecystectomy, Roux-en-Y hepaticojejunostomy for Type IV
  • 7(b): Total body iron 3-4g (men) / 2-2.5g (women); 65% in Hb, 30% stores (ferritin/hemosiderin), 5% myoglobin/enzymes; functions—oxygen transport, electron transport (cytochromes), DNA synthesis (ribonucleotide reductase), immune function
  • 7(b): Anaemia Mukt Bharat 6 interventions—IF supplementation, deworming, delayed cord clamping, dietary diversification, fortified foods, screening; 6 target groups—children, adolescents, women, pregnant/lactating; 6 institutional mechanisms
  • 7(c): Current HRT consensus—'window of opportunity' (age <60 or <10 years post-menopause), transdermal estradiol preferred, lowest effective dose, individualized risk assessment; contraindications—VTE, breast cancer, CVD, stroke, liver disease
  • 7(c): Merits—vasomotor symptom relief, osteoporosis prevention, urogenital atrophy improvement, possible cognitive benefit if early initiation; demerits—VTE risk (RR 2-3), breast cancer (RR 1.2 with >5 years use), stroke, gallbladder disease

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Precise terminology: Tokyo Guidelines 2018 for acute cholecystitis, Csendes classification for Mirizzi, accurate iron distribution percentages, NAMS 2022/IMS 2023 HRT position statements; no factual errors in pathophysiologyCorrect broad concepts but minor errors in classification systems, approximate iron values, or outdated HRT guidelines (e.g., WHI 2002 without nuance)Major conceptual errors: confusing acute vs chronic cholecystitis, misclassifying Mirizzi types, stating iron is 50% in Hb, or claiming HRT universally contraindicated
Clinical correlation20%10Links theory to bedside: Murphy's sign clinical utility, timing of surgery based on TG18 severity grading, MRCP vs ERCP decision-making, HRT risk stratification using actual patient profile (40-year-old vs 65-year-old)Mentions clinical features superficially without severity stratification or risk-benefit contextualization; generic statements about 'clinical judgment'Purely theoretical answer with no clinical application; fails to mention when to operate urgently vs delay, or ignores age-specific HRT recommendations
Diagram / pathway20%10Includes: Csendes classification diagram (Type I-IV), iron distribution pie-chart or metabolic pathway, HRT decision algorithm/flowchart; labeled diagrams enhance answer clarityMentions diagrams should be drawn but describes them textually only; or draws unlabeled sketches without anatomical accuracyNo diagrammatic representation despite clear visual components in question; misses opportunity to illustrate Mirizzi anatomy or iron cycle
Differential / staging20%10Systematic differentials for RUQ pain: perforated peptic ulcer, acute hepatitis, right lower lobe pneumonia, renal colic, acute pancreatitis; TG18 severity grading (Grade I-III), Csendes staging for Mirizzi, HRT risk stratification by age/time since menopauseLists differentials without prioritization or misses key differentials; mentions staging without applying to management decisionsNo differential diagnosis for acute cholecystitis; confuses Mirizzi with other biliary strictures; no risk stratification for HRT
Management / public-health angle20%10Evidence-based management: early vs delayed cholecystectomy criteria, antibiotic regimens per local resistance patterns, Anaemia Mukt Bharat 6x6x6 framework with specific Indian context (WIFS program, double fortified salt), HRT formulation/route selection with shared decision-makingGeneric management without evidence-based specifics; mentions Anaemia Mukt Bharat but misses key components; HRT advice without individualizationOutdated management (routine open cholecystectomy), misses Anaemia Mukt Bharat entirely, or gives blanket HRT contraindication without nuance; no public health perspective

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