Medical Science 2023 Paper II 50 marks State

Q8

(a) State the vision, goals and objectives of the National Framework for Malaria Elimination in India, 2016-2030. What are the milestones and targets to be met under this framework by the years 2024, 2027 and 2030? Outline the broad strategies of this national framework. (20 marks) (b) (i) How do you grade anaemia in pregnancy based on the haemoglobin levels as per the World Health Organization? (ii) List the complications of anaemia in pregnancy. (iii) Briefly outline the management of a pregnant woman with severe anaemia in labour. (5+5+5=15 marks) (c) (i) Enumerate the therapeutic indications of splenectomy. (ii) Briefly mention the aetiopathogenesis and prophylaxis of 'overwhelming postsplenectomy infection (OPSI)' syndrome. (5+10=15 marks)

हिंदी में प्रश्न पढ़ें

(a) मलेरिया उन्मूलन की भारतीय राष्ट्रीय रूपरेखा, 2016-2030 का दृष्टिकोण, लक्ष्य और उद्देश्य बताइए। इस रूपरेखा के क्या-क्या मील के पत्थर हैं और क्या-क्या लक्ष्य हैं जिन्हें 2024, 2027 और 2030 तक पूरा किया जाना है? इस राष्ट्रीय रूपरेखा की व्यापक रणनीतियाँ क्या हैं? (20) (b) (i) विश्व स्वास्थ्य संगठन के अनुसार हीमोग्लोबिन के स्तर के आधार पर गर्भावस्था में अरक्तता को किस प्रकार वर्गीकृत किया जाता है? (ii) गर्भावस्था में अरक्तता से उत्पन्न होने वाली जटिलताओं की सूची प्रस्तुत कीजिए। (iii) प्रचंड अरक्तता से पीड़ित गर्भवती महिला, जो प्रसव के चरण में है, के प्रबंधन की संक्षिप्त रूपरेखा प्रस्तुत कीजिए। (5+5+5=15) (c) (i) प्लीहा-उच्छेदन के चिकित्सार्थ संकेत गिनाइए। (ii) 'प्लीहा-उच्छेदन पश्चात् दुर्दमनीय संक्रमण [ओवरवेल्मिंग पोस्ट-स्प्लीनिक्टोमी इन्फेक्शन (ओ. पी. एस. आई.)]' संलक्षण के हेतुकी-विकृतिजनन तथा रोगनिरोध पर संक्षेप में लिखिए। (5+10=15)

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Directive word: State

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How this answer will be evaluated

Approach

Begin with the directive 'state' for part (a), which demands precise factual recall of the National Framework for Malaria Elimination. Allocate approximately 40% of time/words to part (a) given its 20 marks, covering vision, goals, objectives, milestones (2024, 2027, 2030) and broad strategies. For part (b) (30% allocation), apply 'how' for grading anaemia, 'list' for complications, and 'outline' for labour management. For part (c) (30% allocation), use 'enumerate' for splenectomy indications and 'mention' for OPSI pathogenesis and prophylaxis. Structure as: (a) comprehensive framework details → (b) obstetric anaemia progression from diagnosis to emergency management → (c) surgical indications leading to immunological consequences.

Key points expected

  • Part (a): Vision of malaria-free India; goals of elimination in low-burden states by 2024, all states by 2027, maintenance by 2030; objectives of reducing API, mortality, indigenous cases; milestones (2024: zero indigenous in category 1 states, 2027: zero indigenous nationwide, 2030: prevention of re-establishment); strategies including case-based surveillance, vector control, cross-border coordination
  • Part (b)(i): WHO haemoglobin grading in pregnancy—mild (10.0-10.9 g/dL), moderate (7.0-9.9 g/dL), severe (<7.0 g/dL); physiological dilution consideration
  • Part (b)(ii): Maternal complications (heart failure, infection, PPH, eclampsia, maternal death); fetal complications (IUGR, preterm labour, low birth weight, perinatal mortality)
  • Part (b)(iii): Labour management of severe anaemia—oxygen, IV access, blood transfusion criteria (Hb <5 g/dL or 5-7 g/dL with complications), active management of third stage, ergometrine avoidance, iron/folate supplementation, cardiorespiratory monitoring
  • Part (c)(i): Therapeutic splenectomy indications—hereditary spherocytosis, ITP refractory, autoimmune haemolytic anaemia, thalassaemia major, hypersplenism, trauma, lymphoproliferative disorders, staging laparotomy for Hodgkin lymphoma
  • Part (c)(ii): OPSI aetiopathogenesis—impaired opsonization, decreased IgM/IgG production, defective clearance of encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis); fulminant sepsis within 2 years post-splenectomy; prophylaxis—pneumococcal, meningococcal, Hib vaccines, daily penicillin prophylaxis, patient education, emergency standby antibiotics

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Precisely recalls NFME 2016-2030 milestones (2024/2027/2030), correct WHO Hb cut-offs for pregnancy anaemia grading, accurate encapsulated organisms in OPSI, and correct vaccine schedule; no factual errors across all five sub-partsGenerally correct framework years and Hb levels but minor errors in milestone details or vaccine timing; some confusion between elimination and eradicationIncorrect milestone years, wrong Hb cut-offs (e.g., using non-pregnant thresholds), wrong organisms in OPSI, or conflates splenectomy indications with contraindications
Clinical correlation20%10Links severe anaemia in labour to specific obstetric risks (PPH, cardiac decompensation); connects OPSI to lifelong immunocompromised status; relates malaria elimination strategies to India's epidemiological categories (0,1,2,3); demonstrates understanding of why splenectomy patients need emergency antibioticsMentions clinical outcomes but lacks mechanistic explanation; lists complications without prioritizing severity; basic awareness of OPSI risk without explaining 'overwhelming' natureNo clinical context provided; treats all complications equally without severity grading; fails to mention emergency nature of OPSI or specific labour risks of severe anaemia
Diagram / pathway15%7.5Includes clear diagram of malaria elimination cascade (surveillance → diagnosis → treatment → prevention); flowchart for severe anaemia in labour management; or schematic of splenic immune function and OPSI pathogenesis; properly labeled with Indian programme terminologyMentions need for diagrams but provides rough sketches or incomplete flowcharts; basic algorithm for labour management without decision pointsNo diagrams despite clear opportunities; or irrelevant diagrams that do not enhance understanding of framework strategies, anaemia management, or OPSI pathogenesis
Differential / staging20%10Clear staging of malaria elimination categories (0-3) with API thresholds; precise WHO anaemia severity staging with trimester-specific considerations; distinguishes therapeutic from diagnostic splenectomy; differentiates early vs late OPSI presentationBasic categorization present but lacks specific API cut-offs; mentions mild/moderate/severe anaemia without precise Hb values; conflates some splenectomy indicationsNo staging or classification system used; confuses malaria elimination categories with disease severity staging; misses severity grading entirely for anaemia
Management / public-health angle25%12.5Comprehensive NFME strategies including 1-3-7 surveillance, vector control (LLINs, IRS), cross-border coordination with neighbouring countries; detailed labour management protocol with transfusion triggers; complete OPSI prophylaxis including lifelong penicillin, vaccination schedule, and patient alert card; integrates National Health Mission and NVBDCP linkagesLists some strategies and management steps but misses specific programme elements (1-3-7, LLINs); generic transfusion advice without Hb thresholds; incomplete vaccine prophylaxisVague generalities about malaria control; no specific management protocol for labour; missing or incorrect OPSI prophylaxis (no mention of encapsulated vaccines or emergency antibiotics)

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