Medical Science 2023 Paper II 50 marks Discuss

Q6

(a) (i) Enumerate the causes for postpartum haemorrhage (PPH). (ii) Discuss the management of PPH. (10+10=20 marks) (b) (i) Enumerate the signs of lower limb arterial ischaemia. (ii) Briefly outline the diagnostic workup in a 62-year-old male with atherosclerotic lower limb peripheral arterial disease. (iii) State the management of this case. (5+5+5=15 marks) (c) The National Rural Health Mission is committed towards improving rural healthcare delivery system in the country. State the major initiatives that have been undertaken under this Mission to strengthen the healthcare infrastructure in rural areas. (15 marks)

हिंदी में प्रश्न पढ़ें

(a) (i) प्रसवोत्तर रक्तस्राव (पी. पी. एच.) के कारणों को गिनाइए। (ii) प्रसवोत्तर रक्तस्राव के प्रबंधन की व्याख्या कीजिए। (10+10=20 अंक) (b) (i) अधःशाखा धमनी अरक्तता के लक्षण गिनाइए। (ii) एक 62-वर्षीय पुरुष, जिसकी अधःशाखा में एथेरोस्क्लेरोटिक परिसरिय धमनी रोग है, के नैदानिक (डायग्नोस्टिक) वर्क-अप की संक्षिप्त रूपरेखा प्रस्तुत कीजिए। (iii) इस रोगी का प्रबंधन कैसे होगा, वर्णन कीजिए। (5+5+5=15 अंक) (c) राष्ट्रीय ग्रामीण स्वास्थ्य मिशन देश में ग्रामीण स्वास्थ्य देखभाल वितरण प्रणाली में सुधार के लिए प्रतिबद्ध है। ग्रामीण क्षेत्रों में स्वास्थ्य सेवा के बुनियादी ढांचे को मजबूत करने के लिए इस मिशन के अंतर्गत कौन-कौन सी प्रमुख पहल की गई हैं? (15 अंक)

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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

The primary directive is 'discuss' for PPH management (10 marks), with secondary directives 'enumerate' for causes and signs, 'outline' for diagnostic workup, and 'state' for management and NRHM initiatives. Allocate approximately 40% of time/words to part (a) PPH (20 marks), 30% to part (b) peripheral arterial disease (15 marks), and 30% to part (c) NRHM (15 marks). Structure with brief introductions for each part, systematic enumeration followed by explanatory discussion where demanded, and conclude with integrated takeaways on emergency preparedness and rural healthcare strengthening.

Key points expected

  • Part (a)(i): Enumerate 4Ts of PPH causes (Tone-uterine atony, Trauma, Tissue-retained placenta, Thrombin-coagulopathy) plus additional causes like uterine inversion, lacerations
  • Part (a)(ii): Discuss medical management (uterotonics: oxytocin, misoprostol, ergometrine, carboprost), mechanical methods (uterine massage, bimanual compression), surgical interventions (B-Lynch suture, uterine artery ligation, hysterectomy), and WHO/FIGO guidelines
  • Part (b)(i): Enumerate 6Ps of acute ischaemia (Pain, Pallor, Pulselessness, Paralysis, Paraesthesia, Poikilothermia) plus Rutherford classification stages, chronic limb threatening ischaemia signs
  • Part (b)(ii-iii): Outline ABI measurement, duplex ultrasound, CTA/MRA angiography; state management including risk factor modification, antiplatelets (aspirin, clopidogrel), statins, cilostazol, endovascular interventions (angioplasty, stenting), and bypass surgery
  • Part (c): State ASHA workers, Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, Mobile Medical Units, Rogi Kalyan Samitis, Indian Public Health Standards (IPHS), and Accredited Social Health Activist (ASHA) roles in rural healthcare infrastructure

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Accurately defines PPH (≥500ml vaginal/≥1000ml cesarean), correctly classifies 4Ts with pathophysiology, precisely states Rutherford stages I-VI for PAD, and accurately describes NRHM launch year (2005) with correct flagship componentsBasic definitions correct but minor errors in PPH thresholds, incomplete 4Ts classification, vague PAD staging, or generic NRHM description without specific scheme namesFundamental errors like wrong PPH volume definition, confused atony with coagulopathy, missing Rutherford classification entirely, or factually wrong NRHM information
Clinical correlation20%10For (a): Links atony to multiparity/prolonged labor; for (b): Correlates ABI values with severity and tissue loss; for (c): Connects ASHA incentives to institutional delivery rates—demonstrates bedside-to-policy integrationSurface-level clinical links without quantitative correlations (ABI <0.9 mentioned but not graded), generic statements on NRHM impact without dataPure theoretical recall without clinical application, no mention of risk stratification or outcome metrics
Diagram / pathway20%10Includes WHO PPH management algorithm/flowchart, draws Rutherford classification table with ABI values and clinical features, sketches ASHA-to-hospital referral pathway; clear labeled diagrams enhance answerMentions algorithms without drawing, describes classification verbally without tabular presentation, no visual elements for NRHM structureNo diagrams or flowcharts where clearly expected; disorganized presentation without algorithmic thinking
Differential / staging20%10For (a): Differentiates atonic vs traumatic PPH by timing and response to uterotonics; for (b): Distinguishes PAD from lumbar stenosis, DVT, Buerger disease using Rutherford vs Fontaine staging; for (c): Contrasts NRHM with earlier CSSM programBasic differentials listed without discriminatory features, mentions staging without applying to clinical scenariosNo differential diagnosis attempted, confuses venous vs arterial disease, or mixes up program chronology
Management / public-health angle20%10For (a): Prioritizes active management third stage, mentions tranexamic acid (WOMAN trial evidence), stepwise escalation protocol; for (b): Evidence-based PAD management with cilostazol, supervised exercise programs; for (c): Specific NRHM outcomes—JSY increased institutional deliveries from 40% to 80%, ASHA selection criteria, performance-based incentivesStandard management lists without prioritization or evidence citation, generic NRHM description without outcome dataOutdated management (no misoprostol/TXA), no public health perspective, or completely misses ASHA/JSY core components

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