Medical Science 2024 Paper II 50 marks Describe

Q3

(a) Describe the clinical features, diagnosis and treatment of Kala-azar. 20 marks (b) What are the types of vaccines currently in use against Pneumococcus organisms ? State the National Immunization Schedule for administering Pneumococcal Vaccine in infants. Enumerate the diseases that the Pneumococcal Vaccine can safeguard against. 15 marks (c) A young female patient develops acute inflammatory papules and vesicles all over her scalp and tips of ears following repeated use of hair dye. (i) What is the diagnosis ? (ii) How can the diagnosis be confirmed ? (iii) How will this condition be treated ? 5+5+5=15 marks

हिंदी में प्रश्न पढ़ें

(a) कालाजार की रोगलाक्षणिक विशिष्टताओं, निदान तथा उपचार का वर्णन कीजिए। 20 अंक (b) वर्तमान में न्यूमोकोकस जीवाणुओं के विरुद्ध प्रयोग में लाए जा रहे वैक्सीन कौन-कौन से प्रकार के हैं ? राष्ट्रीय प्रतिरक्षीकरण सूची के अनुसार शिशुओं को न्यूमोकोकल वैक्सीन कब दी जाती है, उल्लेख कीजिए। उन रोगों के नाम बताइए जिनके विरुद्ध न्यूमोकोकल वैक्सीन सुरक्षा प्रदान करती है। 15 अंक (c) बार-बार केश रंगने की डाई प्रयोग करने के पश्चात् एक युवा महिला रोगी के सम्पूर्ण शिरोवल्क और कानों के सिरों पर तीव्र शोथज पिटिकाएँ तथा जलस्फोट उत्पन्न हो गए हैं। (i) निदान क्या है ? (ii) इस निदान की पुष्टि कैसे की जा सकती है ? (iii) इस रुग्णता का उपचार कैसे किया जाएगा ? 5+5+5=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

The directive 'describe' demands comprehensive, structured coverage of clinical features, diagnostic methods, and treatment protocols. Allocate approximately 40% of time/words to part (a) Kala-azar (20 marks), 30% to part (b) Pneumococcal vaccines (15 marks), and 30% to part (c) contact dermatitis with its three sub-parts (15 marks). Structure as: brief introduction on tropical/immunization dermatology relevance; systematic body addressing each sub-part with headings; conclusion emphasizing public health integration in India's disease control programs.

Key points expected

  • Part (a): Kala-azar — fever pattern (undulant/quotidian), hepatosplenomegaly (massive spleen > liver), pancytopenia, hyperpigmentation; diagnosis by rK39 rapid test, splenic/bone marrow aspiration showing LD bodies; treatment with liposomal amphotericin B (single dose regimen), miltefosine, or combination therapy per NVBDCP guidelines
  • Part (b): Pneumococcal vaccines — PCV13 (conjugate), PPSV23 (polysaccharide); National Immunization Schedule: PCV13 at 6, 10, 14 weeks with booster at 9 months (UIP 2020 expansion); protection against invasive pneumococcal disease, pneumonia, meningitis, otitis media
  • Part (c)(i): Diagnosis — Allergic contact dermatitis to paraphenylenediamine (PPD) in hair dye, acute eczematous reaction with papulovesicular morphology, scalp and ear tip distribution (photo-exposed/seborrheic areas)
  • Part (c)(ii): Confirmation — Patch testing with Indian Standard Series (PPD 1%), histopathology showing spongiosis with lymphocytic infiltrate, relevance of repeated exposure history
  • Part (c)(iii): Treatment — Immediate cessation of dye, topical corticosteroids (clobetasone/betamethasone), systemic antihistamines, short course oral steroids if severe; patient education on avoidance, use of hypoallergenic alternatives
  • Integration: Mention India's Kala-azar elimination status (2020), PCV UIP rollout states, and occupational dermatitis burden in beauticians

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Accurately identifies Leishmania donovani as causative agent for (a), distinguishes PCV13/PPSV23 serotypes and immunological basis for (b), and correctly names PPD/paraphenylenediamine allergy with Type IV hypersensitivity mechanism for (c); no factual errors in drug dosages or schedule timingsCorrectly identifies diseases and basic vaccine types but confuses PCV schedule (e.g., misses 9-month booster), vague on LD body morphology, or imprecise on hypersensitivity type for contact dermatitisMajor errors such as attributing Kala-azar to Plasmodium, confusing pneumococcal with meningococcal vaccine, or labeling contact dermatitis as Type I hypersensitivity; incorrect drug names (e.g., sodium stibogluconate as first-line without context)
Clinical correlation20%10Vividly describes 'kala-azar' (black fever) hyperpigmentation, massive splenomegaly with abdominal distension; for (c) details the specific scalp/ear tip distribution pattern and occupational context of hair dye use; links PCV introduction to India's pneumonia mortality burdenLists clinical features without prioritization; generic description of rash without anatomical specificity; mentions UIP expansion without mortality contextMinimal clinical detail; fails to mention splenomegaly in Kala-azar, omits vaccine schedule entirely, or provides no morphological description of skin lesions
Diagram / pathway15%7.5Includes labeled diagram of LD body (amastigote) with nucleus and kinetoplast; flowchart for Kala-azar diagnosis-treatment algorithm; or schematic of patch testing procedure; clear immunization schedule table for PCVMentions diagrams but descriptions are text-only; rough sketch without labels; incomplete schedule table missing one doseNo diagrams or flowcharts where clearly indicated; no tabular presentation of vaccine schedule; disorganized presentation
Differential / staging20%10For (a): distinguishes PKDL, malaria, enteric fever, aplastic anemia; for (c): differentiates irritant contact dermatitis (immediate, burning), seborrheic dermatitis, tinea capitis, and psoriasis; mentions Kala-azar elimination stages per WHO criteriaLists 1-2 differentials without distinguishing features; vague on disease staging; conflates irritant and allergic contact dermatitisNo differentials provided; fails to distinguish between vaccine types' indications; misses critical distinction between allergic and irritant dermatitis
Management / public-health angle25%12.5Details NVBDCP Kala-azar elimination strategy (1.5 cases/10,000), single-dose liposomal amphotericin B regimen; PCV UIP phased rollout (Bihar, UP, MP, Rajasthan 2020-21), herd immunity concept; contact dermatitis prevention through patch testing before dye use, beautician education, and legal labeling requirementsStandard treatment mentioned without regimen specifics; knows PCV in UIP but not phased implementation; generic advice on stopping dye useOutdated treatment (pentavalent antimonials as first-line without resistance context); no public health context; no preventive counseling for contact dermatitis

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