Medical Science 2024 Paper II 50 marks Describe

Q2

(a) (i) Discuss in short about the different modalities used in the diagnosis of Extra-Pulmonary Tuberculosis. (10 marks) (ii) Describe the clinical features of malabsorption syndrome. (10 marks) (b) (i) Write in brief the ten steps of Baby-friendly Hospital Initiative (revised 2018). (10 marks) (ii) Write the advantages of breast-feeding. (5 marks) (c) A young adult female develops asymptomatic depigmented chalky white macules and patches with no sign of inflammation over face and around body orifices. (i) What is the diagnosis ? (ii) What are the associated findings seen in this disorder ? (iii) How is this disorder classified ? (iv) Describe the clinical course of the disease. (3+4+4+4=15 marks)

हिंदी में प्रश्न पढ़ें

(a) (i) क्षयरोगेतर यक्ष्मा के निदान में प्रयुक्त होने वाली विभिन्न प्रणालियों की संक्षेप में चर्चा कीजिए। (10 अंक) (ii) अपावशोषण संलक्षण की रोगलाक्षणिक विशिष्टताओं का वर्णन कीजिए। (10 अंक) (b) (i) सन् 2018 में संशोधित शिशु-अनुकूल अस्पताल की पहल के दस चरणों का संक्षेप में वर्णन कीजिए। (10 अंक) (ii) स्तनपान के क्या-क्या लाभ हैं, लिखिए। (5 अंक) (c) एक युवा वयस्क स्त्री को चेहरे के ऊपर और शरीर के विभिन्न द्वारों के इर्द-गिर्द अलक्षणी विवर्णक चौक जैसे श्वेत चकत्ते और धब्बे पनप आए हैं, जिनमें शोथ के कोई संकेत नहीं हैं। (i) निदान क्या है ? (ii) इस विकार में दूसरी क्या-क्या सहचारी विशेषताएँ देखी जा सकती हैं ? (iii) इस विकार को कैसे वर्गीकृत किया जाता है ? (iv) रोग के रोगलाक्षणिक व्यवहार का वर्णन कीजिए। (3+4+4+4=15 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

This multi-part descriptive question requires systematic coverage of seven sub-parts with marks-weighted time allocation: spend ~20% on (a)(i) EPTB diagnosis, ~20% on (a)(ii) malabsorption features, ~20% on (b)(i) BFHI ten steps, ~10% on (b)(ii) breastfeeding advantages, and ~30% on (c) vitiligo's four components. Structure each part with clear headings, use bullet points for the ten steps, and include a labeled diagram for vitiligo distribution patterns.

Key points expected

  • EPTB diagnosis: mention GeneXpert MTB/RIF, CBNAAT, Line Probe Assay, histopathology with caseating granulomas, ADA levels in pleural/CSF fluid, and imaging (MRI for Pott's spine, CT for abdominal TB)
  • Malabsorption syndrome: steatorrhea, weight loss, anemia (iron/B12/folate deficiency), edema from hypoproteinemia, specific features of celiac vs tropical sprue vs Whipple's disease
  • BFHI 2018 ten steps: skin-to-skin contact, early initiation, exclusive breastfeeding, rooming-in, feeding on demand, no pacifiers, no formula/foods, support groups, informed discharge, and compliance with International Code
  • Breastfeeding advantages: optimal nutrition, immunoglobulins and lactoferrin, reduced NEC in preterms, bonding, maternal cancer protection, and LAM as contraception
  • Vitiligo diagnosis: segmental vs non-segmental, Koebner phenomenon, leukotrichia, ocular/auditory associations, and Wood's lamp examination
  • Vitiligo classification: focal, segmental, mucosal, acrofacial, vulgaris, universal; plus disease activity scoring (VASI, VETF)
  • Vitiligo clinical course: progressive, stable, or spontaneous repigmentation; psychological impact; and prognostic factors (early age, facial lesions, recent onset)

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Accurately names CBNAAT/Truenat for EPTB, specifies fat-soluble vitamin deficiencies in malabsorption, lists all ten BFHI steps correctly, and correctly identifies vitiligo with precise pathogenesis (melanocyte destruction)Basic diagnostic modalities mentioned but confused (e.g., AFB staining sensitivity for EPTB), generic malabsorption features without specificity, 7-8 BFHI steps correct, vitiligo identified but pathogenesis vagueMajor factual errors: calls EPTB diagnosis same as pulmonary TB, confuses malabsorption with maldigestion, <6 correct BFHI steps, wrong diagnosis for vitiligo (e.g., pityriasis alba)
Clinical correlation20%10Correlates EPTB sites with specific presentations (lymphadenitis, pleural effusion, Pott's spine), distinguishes celiac vs tropical sprue by geography/dematitis herpetiformis, links BFHI to India's 44% exclusive breastfeeding rate, and notes vitiligo's psychological morbidity in young femalesLists clinical features without disease-site correlation, mentions steatorrhea without quantification, states breastfeeding benefits without Indian statistics, notes cosmetic concern without mental health linkageNo clinical context: EPTB as isolated tests, malabsorption as bullet list without syndrome approach, BFHI as memorized steps without implementation challenges, vitiligo purely descriptive
Diagram / pathway15%7.5Draws diagnostic algorithm for EPTB with sample-specific tests, includes labeled diagram of vitiligo patterns (focal/segmental/acral/vulgaris) with Wood's lamp findings, or illustrates breast anatomy with milk ejection reflexMentions diagrams without drawing, or draws incomplete vitiligo distribution, or basic breast cross-section without physiological annotationsNo diagrams despite clear visual requirements; or incorrect drawings (e.g., random skin patches without pattern recognition)
Differential / staging20%10Differentiates EPTB from lymphoma/sarcoidosis with key distinguishing features; contrasts malabsorption etiologies (celiac, tropical sprue, Crohn's, pancreatic insufficiency); classifies vitiligo using latest VETF/VASI scoring; stages disease activityLists differentials without distinguishing features, mentions celiac and tropical sprue without comparison, states vitiligo types without classification system, no activity assessmentNo differentials offered, or confused differentials (e.g., TB vs typhoid for EPTB), no classification of vitiligo, or wrong classification system
Management / public-health angle25%12.5States RNTCP Category I/II regimen for EPTB with duration; mentions gluten-free diet for celiac, ORS/zinc for malabsorption; discusses BFHI implementation in India (Maa program), barriers in private hospitals; covers vitiligo management (topical tacrolimus, NB-UVB, melanocyte transfer) with counselingGeneric ATT mention without regimen specifics, diet advice without details, BFHI as list without implementation context, vitiligo treatment as steroids without phototherapy optionsNo management for any condition, or dangerously wrong (e.g., 6-month ATT for EPTB without extension, topical steroids as only vitiligo treatment without side effect caution)

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