Medical Science 2024 Paper II 50 marks Compulsory Discuss

Q1

(a) Discuss in short the role of a Chest X-ray in the diagnosis of pulmonary tuberculosis. (10 marks) (b) Describe the clinical features for diagnosing a case of Depression. (10 marks) (c) What are the key differences between Kwashiorkor and Marasmus ? Which is the easiest method which can help in the early detection of Protein Energy Malnutrition (PEM) in children ? (10 marks) (d) During the initial phase of stabilization in a severe acute malnourished child, map out the dietary plan. State the type, amount and frequency of feed that the child requires and for how long that would be necessary. In this phase, what is the vitamin and mineral supplementation given ? (10 marks) (e) In a confirmed case of scabies in an adult : (i) What are the primary manifestations of the disease and what is the pattern of distribution of lesions on the body ? (ii) What are the complications seen in scabies ? (5+5=10 marks)

हिंदी में प्रश्न पढ़ें

(a) फुफ्फुस यक्ष्मा के निदान में छाती के एक्स-रे की भूमिका की संक्षेप में चर्चा कीजिए। (10 अंक) (b) उन रोगलाक्षणिक विशिष्टताओं का वर्णन कीजिए जिनसे अवसाद (डिप्रेशन) के मामले का निदान किया जा सकता है। (10 अंक) (c) क्वाशियोरकोर एवं मरास्मस के बीच मुख्य भेद क्या-क्या हैं ? वह सबसे आसान तरीका कौन-सा है जिसकी मदद से बच्चों में प्रोटीन ऊर्जा कुपोषण (PEM) का आरंभिक अवस्था में ही निदान किया जा सकता है ? (10 अंक) (d) प्रचंड तीव्र कुपोषण से पीड़ित एक बच्चे की स्थिति में स्थिरता लाने के लिए आरंभिक चरण में अपेक्षित आहार योजना का खाका तैयार कीजिए। उसे किस प्रकार का, कितनी मात्रा में और किस अंतराल पर भोजन देना आवश्यक है और यह नित्यचर्या कब तक आचरण में लानी होगी, लिखिए। इस चरण में, विटामिनों और खनिजों की पूर्ति कैसे की जाती है ? (10 अंक) (e) एक वयस्क में जिसे स्केबीज होने की पुष्टि हो चुकी है : (i) रोग की प्राथमिक अभिव्यक्तियाँ क्या-क्या होंगी और उसमें विशिष्टियों के शरीर पर वितरण का क्या पैटर्न होगा ? (ii) स्केबीज में क्या-क्या जटिलताएँ देखी जा सकती हैं ? (5+5=10 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 directive 'discuss' in part (a) requires balanced coverage of indications, limitations, and evolving role of CXR in TB diagnosis under RNTCP/NTEP guidelines, while other parts demand 'describe,' 'what,' and mapping responses. Structure as: brief intro on diagnostic hierarchy → systematic 5-part body with equal time allocation (~8-10 minutes per 10-mark sub-part) → concluding integration on syndromic approaches in resource-limited settings. For (d), include a clear tabular or flowchart presentation of the stabilization phase dietary protocol.

Key points expected

  • (a) CXR in TB: sensitivity/specificity in active vs. latent TB, WHO/RNTCP screening criteria (chest radiography as triage tool), limitations (immunocompromised, HIV co-infection with atypical patterns), CXR as adjunct to CBNAAT/Truenat, not standalone diagnostic
  • (b) Depression: ICD-10/DSM-5 criteria (depressed mood, anhedonia, fatigue, sleep/appetite disturbance, guilt/suicidal ideation), minimum symptom duration (2 weeks), functional impairment, somatic presentations in Indian primary care settings
  • (c) Kwashiorkor vs Marasmus: pathophysiology (protein deficiency vs energy-protein deficit), edema, skin/hair changes, serum albumin, mortality patterns; early PEM detection: weight-for-height Z-score or MUAC (mid-upper arm circumference) as simplest field tool
  • (d) SAM stabilization phase: F-75 therapeutic milk (75 kcal/100ml, low protein/sodium), 130 ml/kg/day divided 2-3 hourly feeds, transition criteria to rehabilitation phase; micronutrients: vitamin A, folic acid, zinc, copper, multivitamin as per WHO/Indian Academy of Pediatrics protocol
  • (e)(i) Scabies manifestations: burrows, papules, vesicles, intense nocturnal pruritus; distribution: finger webs, wrists, axillae, periumbilical, genitalia, buttocks (spares head/neck in adults)
  • (e)(ii) Complications: secondary bacterial infection (Streptococcus/Staphylococcus), post-streptococcal glomerulonephritis, crusted (Norwegian) scabies in immunocompromised, psychological impact
  • Cross-cutting: Integration of national health program protocols (RNTCP, ICDS, NVBDCP) and community-based management approaches relevant to Indian public health context

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Precise technical accuracy across all sub-parts: for (a) cites RNTCP 2021 guidelines on CXR as screening tool with CBNAAT confirmation; for (c) correctly identifies edema as hypoalbuminemia-driven in kwashiorkor; for (d) specifies exact F-75 composition and feeding volumes; no factual errors in ICD-10 criteria or scabies mite biologyGenerally correct concepts with minor inaccuracies (e.g., conflating F-75 with F-100, vague on CXR limitations, incomplete ICD-10 symptom count for depression)Major conceptual errors: stating CXR is diagnostic for active TB, confusing kwashiorkor/marasmus pathophysiology, incorrect feeding protocol for SAM, or missing minimum duration criterion for depression diagnosis
Clinical correlation20%10Rich clinical integration: for (a) discusses miliary TB patterns in HIV and pediatric presentations; for (b) notes masked depression in Indian somatization; for (d) links stabilization phase to practical ward monitoring (hypoglycemia, hypothermia prevention); for (e) describes diagnostic confirmation by skin scraping microscopySuperficial clinical mentions without context-specific application; generic statements about 'patient care' without Indian healthcare setting relevancePurely theoretical response with no clinical application; fails to connect depression criteria to primary care diagnosis or SAM management to NFHS-5 malnutrition statistics
Diagram / pathway20%10Effective visual communication: for (a) includes labeled CXR showing upper lobe infiltrates/cavitation; for (d) presents clear flowchart/timeline of stabilization phase with feed progression; for (e) sketches body diagram showing classic scabies distribution; tables for (c) comparison enhance clarityMentions diagrams without drawing them, or poorly labeled sketches; disorganized presentation of SAM feeding scheduleNo diagrams where essential (especially SAM dietary mapping); text-only description of complex protocols reduces examiner accessibility
Differential / staging20%10Systematic differential reasoning: for (a) distinguishes active TB from healed fibrotic lesions, malignancy, fungal infections; for (b) differentiates depression from adjustment disorder, hypothyroidism, dementia; for (c) clear staging of PEM severity; for (e) distinguishes ordinary from crusted scabiesLimited differential coverage; mentions alternatives without elaborating distinguishing featuresNo differential consideration; fails to distinguish depression from grief reaction, or SAM from chronic malnutrition; misses Norwegian scabies as distinct entity
Management / public-health angle20%10Strong public health integration: for (a) discusses CXR in active case finding under NTEP; for (d) links SAM protocol to ICDS supplementary nutrition and community health worker roles; for (e) mentions mass drug administration with ivermectin in scabies-endemic areas (WHO 2023 recommendation); cost-effectiveness and accessibility emphasizedIndividual patient focus without population-level perspective; generic mention of 'health education' without specific program linkageNo public health context; misses national program relevance entirely; fails to mention RNTCP, ICDS, or WHO guidelines in management descriptions

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