Medical Science 2023 Paper II 50 marks Compulsory Describe

Q5

(a) A 65-year-old lady has progressively increasing dysphagia for last 6 months. She also has significant weight loss. How will you investigate her? (10 marks) (b) A 42-year-old male, known case of alcoholic liver disease with portal hypertension, is brought to casualty with severe haematemesis. Describe the management of this case. (10 marks) (c) (i) Name any five risk factors associated with pelvic organ prolapse. (ii) Enlist the management options for a 60-year-old postmenopausal lady with procidentia with cystocoele with enterocoele with rectocoele. (5+5=10 marks) (d) Define chronic pelvic pain. What are the various causes of chronic pelvic pain in women? (10 marks) (e) The Janani-Shishu Suraksha Karyakram is a unique national initiative of the Government of India. State in brief the entitlements to pregnant women and neonates under this scheme. (10 marks)

हिंदी में प्रश्न पढ़ें

(a) एक 65-वर्षीय महिला को विगत 6 माह से निगरण-कष्ट है, जो उत्तरोत्तर बढ़ता जा रहा है। उसके वजन में भी गिरावट हुई है, जो दिखाई देती है। इस महिला की जाँच कैसे की जानी चाहिए? (10 अंक) (b) मद्य युक्त रोग के साथ-साथ प्रतिहारी अतिरक्तदाब से पीड़ित एक 42-वर्षीय पुरुष को प्रचंड रक्तवमन होने पर कैजुअल्टी में लाया गया है। इस रोगी का प्रबंधन कैसे करना होगा, वर्णन कीजिए। (10 अंक) (c) (i) श्रोणि अंग भ्रंश (पेल्विक ऑर्गन प्रोलैप्स) से संबंध किन्हीं पांच जोखिमकारी तत्वों के नाम गिनाइए। (ii) एक 60-वर्षीय रजोनिवृत्तुतर महिला, जिसे गर्भाशयपूर्णभ्रंश है, मूत्राशय हर्निया है, आत्र हर्निया है तथा साथ ही मलाशय हर्निया है, उसके प्रबंधन विकल्पों की सूची प्रस्तुत कीजिए। (5+5=10 अंक) (d) चिरकारी श्रोणि वेदना (क्रोनिक पेल्विक पेन) को परिभाषित कीजिए। महिलाओं में चिरकारी श्रोणि वेदना के विभिन्न कारण क्या-क्या हैं? (10 अंक) (e) जननी-शिशु सुरक्षा कार्यक्रम भारत सरकार की राष्ट्रीय स्तर पर चलाई जा रही एक अद्वितीय पहल है। इस योजना के अंतर्गत गर्भवती महिलाओं एवं नवजात शिशुओं की पात्रताओं को संक्षेप में उल्लिखित कीजिए। (10 अंक)

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Directive word: Describe

This question asks you to describe. 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 'describe' demands systematic, detailed exposition of clinical features, investigations, and management across all sub-parts. Allocate approximately 20% (10 marks) to each sub-part equally. Structure: begin with (a) dysphagia workup emphasizing malignancy exclusion; (b) emergency variceal bleed protocol with pharmacological and endoscopic steps; (c) prolapse risk factors then comprehensive surgical management for complex procidentia; (d) definition followed by anatomically-organized causes of chronic pelvic pain; (e) JSSK entitlements with specific free services and transport provisions. Use standard headings, prioritize recent Indian guidelines (MOHFW, ICMR), and conclude each part with patient-centered outcomes.

Key points expected

  • (a) Progressive dysphagia with weight loss: prioritize esophageal malignancy; outline stepwise investigation—barium swallow, upper GI endoscopy with biopsy, CT chest-abdomen for staging, PET-CT if available; mention differential (achalasia, peptic stricture, external compression)
  • (b) Severe hematemesis in portal hypertension: immediate resuscitation (IV access, fluids, blood products), pharmacotherapy (terlipressin/octreotide, antibiotics), endoscopic band ligation/sclerotherapy as definitive, balloon tamponade as bridge, TIPS for refractory cases; mention Child-Pugh stratification
  • (c)(i) Pelvic organ prolapse risk factors: parity/vaginal delivery, advancing age, menopause/estrogen deficiency, chronic raised intra-abdominal pressure (cough, constipation, heavy lifting), connective tissue disorders
  • (c)(ii) Complex procidentia management: conservative (pessary, pelvic floor exercises) vs surgical—vaginal hysterectomy with pelvic floor repair (anterior/posterior colporrhaphy), McCall culdoplasty, sacrospinous fixation, or abdominal/laparoscopic sacrocolpopexy based on fitness
  • (d) Chronic pelvic pain: define as non-cyclic pain ≥6 months; causes—gynecological (endometriosis, adenomyosis, chronic PID, ovarian remnant), urological (interstitial cystitis), gastrointestinal (IBS, IBD), musculoskeletal (pelvic floor tension myalgia), psychological
  • (e) JSSK entitlements: free ANC, delivery (including C-section), postnatal care; free diagnostics, drugs, consumables; free transport from home to facility and back; free treatment of sick neonates up to 30 days including transport between facilities

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Demonstrates precise, error-free core knowledge: for (a) correctly identifies alarm features warranting urgent malignancy workup; for (b) accurately describes portal hypertensive bleed pathophysiology and evidence-based stepwise management per Baveno VII guidelines; for (c) correctly classifies POP-Q staging implications for surgical approach; for (d) provides WHO-consistent definition of chronic pelvic pain; for (e) accurately lists all five JSSK entitlement pillars without omission or fabricationShows generally correct concepts with minor errors: for (a) mentions endoscopy but omits biopsy necessity; for (b) lists treatments but confuses pharmacotherapy sequence; for (c) identifies some risk factors but mixes surgical approaches inappropriately; for (d) definition incomplete or causes poorly categorized; for (e) mentions 3-4 entitlements with some inaccuraciesContains significant conceptual errors: for (a) suggests empirical treatment without investigation; for (b) omits resuscitation or suggests inappropriate surgery as first-line; for (c) fails to distinguish cystocoele from rectocoele management; for (d) confuses chronic pelvic pain with dysmenorrhea; for (e) invents non-existent entitlements or omits JSSK entirely
Clinical correlation20%10Integrates patient-specific factors throughout: for (a) correlates 65-year age and weight loss with high malignancy pre-test probability; for (b) tailors management to alcoholic cirrhosis severity using Child-Pugh/MELD; for (c) considers postmenopausal status and surgical fitness for procidentia repair selection; for (d) emphasizes biopsychosocial model and impact on quality of life; for (e) connects JSSK to India's maternal mortality reduction goals and NRHM integrationShows some clinical context but limited integration: mentions age in (a) and (c) without using it to guide investigation or treatment selection; describes standard protocols in (b) without severity stratification; lists causes in (d) without addressing patient impact; states JSSK provisions in (e) without public health linkageLacks clinical correlation entirely: treats all patients identically regardless of age, comorbidity, or context; presents generic textbook answers without applying to the specific vignettes; for (e) describes scheme in isolation from maternal health outcomes
Diagram / pathway20%10Includes clear, labeled diagrams or flowcharts where appropriate: for (a) algorithm for dysphagia investigation with decision nodes for benign vs malignant; for (b) stepwise management flowchart from resuscitation through definitive therapy; for (c) diagram of pelvic floor anatomy showing cystocoele/rectocoele/enterocoele relationships; for (d) mind map categorizing chronic pelvic pain by organ system; for (e) flowchart of JSSK service delivery from home to facilityMentions diagrams or includes basic sketches without labels; describes algorithms in text without visual representation; anatomy descriptions in (c) are purely textual; organizational charts in (e) are described but not drawnNo diagrams, flowcharts, or structured algorithms; purely narrative description without visual organization; anatomical relationships in (c) and (d) unclear; service delivery in (e) described as unstructured list
Differential / staging20%10Comprehensive differentials with staging where relevant: for (a) structured differential (malignant: SCC vs adenocarcinoma; benign: achalasia, scleroderma, peptic stricture, external compression) with TNM staging mention; for (b) stratifies bleed severity and liver disease staging (Child-Pugh/MELD); for (c) references POP-Q staging system for objective prolapse quantification; for (d) systematic differential across gynecological, urological, GI, musculoskeletal, psychological domains; for (e) implicitly addresses staging through continuum of careLists some differentials but incomplete: for (a) mentions cancer and achalasia only; for (b) notes severity without formal staging; for (c) describes prolapse without POP-Q; for (d) omits 1-2 major cause categories; for (e) no staging concept applicableMinimal or no differential: for (a) assumes malignancy without considering alternatives; for (b) no severity assessment; for (c) no staging system mentioned; for (d) fewer than 3 cause categories; for (e) not applicable but no care continuum description
Management / public-health angle20%10Evidence-based, prioritized management with public health integration: for (a) stepwise investigation leading to MDT management (surgery/oncology/nutrition); for (b) comprehensive protocol including secondary prophylaxis (beta-blockers, band ligation) and transplant evaluation; for (c) individualized surgical algorithm based on compartment defects and patient factors; for (d) multidisciplinary pain management approach; for (e) complete JSSK entitlements with implementation context (JSY integration, ASHA role, impact on out-of-pocket expenditure reduction)Describes standard management without prioritization or individualization; mentions some secondary prevention in (b); surgical options in (c) listed without selection criteria; pain management in (d) limited to medical; JSSK in (e) described without implementation mechanics or outcome metricsManagement incomplete or inappropriate: for (a) omits oncology referral; for (b) no mention of secondary prophylaxis or transplant; for (c) single approach without alternatives; for (d) no multidisciplinary element; for (e) major omissions in entitlements or no public health significance explained

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