Medical Science 2025 Paper II 50 marks Outline

Q2

(a) A 23-year-old woman with type I diabetes mellitus presents with nausea, vomiting and altered sensorium. On examination, she is tachypneic and hypotensive. Her random blood sugar is 460 mg/dL, and routine examination of urine is positive (++) for ketone. Outline the stepwise approach to the diagnosis and management of this patient. 20 (b) (i) Define acute diarrhoea in children. List its causes. How would you assess for dehydration in such a child? 2+3+5=10 (ii) Write the nutritional management of acute diarrhoea and the steps to be taken for prevention of acute diarrhoea. 5+5=10 (c) (i) Define eczema. (ii) How do you classify eczema? (iii) Enumerate the differences between allergic contact dermatitis and irritant contact dermatitis. 3+3+4=10

हिंदी में प्रश्न पढ़ें

(a) एक 23-वर्षीय महिला, जिसे टाइप I डायबिटीज मेलिटस है, मतली, वमन तथा अपरिवर्ती चेतना के साथ लायी जाती है। जाँच करने पर उसे श्वासध्वसिता है तथा वह दाबहीन है। उसकी यादृच्छिक रक्त शर्करा 460 mg/dL है तथा मूत्र की साधारण जाँच करने पर उसमें कीटोन पॉजिटिव (++) है। इस रोगी के निदान एवं प्रबंधन के लिए क्रमवत् अप्रोच की रूपरेखा प्रस्तुत कीजिए। 20 (b) (i) बच्चों में तीव्र प्रवाहिका को परिभाषित कीजिए। इसके कारणों की सूची बनाइए। ऐसे बच्चे में निर्जलीकरण का आकलन कैसे करेंगे? 2+3+5=10 (ii) तीव्र प्रवाहिका के पोषण प्रबंधन तथा इसके निवारण के लिए उठाए जाने वाले कदमों पर लिखिए। 5+5=10 (c) (i) एक्जिमा को परिभाषित कीजिए। (ii) एक्जिमा को कैसे वर्गीकृत किया जाता है? (iii) प्रत्यूजिता संपर्शी त्वक्शोथ तथा शोभक संपर्शी त्वक्शोथ के बीच के अंतर गिनाइए। 3+3+4=10

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Directive word: Outline

This question asks you to outline. 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 'outline' demands a systematic, stepwise presentation of diagnostic and management protocols. Structure: (a) DKA—20 marks—spend ~40% time/words on ABC approach, fluid resuscitation, insulin protocol, potassium management, and complication monitoring; (b) Diarrhoea—20 marks—~35% on definition (WHO criteria), aetiological classification (infectious vs non-infectious), dehydration assessment using IAP/IMNCI guidelines, nutritional management (BRAT diet continuation, zinc supplementation), and preventive strategies (ORS promotion, rotavirus vaccination under UIP); (c) Eczema—10 marks—~25% on definition (dermatitis), morphological classification (endogenous vs exogenous), and structured comparison table for contact dermatitis types. Use flowcharts for DKA management and dehydration assessment.

Key points expected

  • (a) DKA: Recognition of triad (hyperglycaemia >250 mg/dL, ketonaemia, metabolic acidosis pH <7.3), immediate ABC stabilization, isotonic saline resuscitation (15-20 mL/kg in first hour), fixed-rate IV insulin (0.1 U/kg/hr) or weight-based protocol, potassium replacement protocol (maintain 4-5 mEq/L), bicarbonate controversy (avoid unless pH <6.9), and cerebral oedema monitoring
  • (b)(i) Acute diarrhoea: WHO definition (<14 days duration, ≥3 loose stools/24h), causes—viral (rotavirus, norovirus), bacterial (ETEC, Shigella, Salmonella, V. cholerae), protozoal (Giardia, Entamoeba), and non-infectious (antibiotic-associated, lactose intolerance); dehydration assessment using IAP/IMNCI 4-point scale (none, some, severe, shock) with clinical markers (skin pinch, tears, mental status, radial pulse)
  • (b)(ii) Nutritional management: continued feeding (breast milk/formula), energy-dense foods, zinc supplementation (10-20 mg/day for 10-14 days), avoidance of sugary drinks; prevention—exclusive breastfeeding 6 months, safe water/sanitation, handwashing, rotavirus vaccine (RVV) under India's UIP, typhoid conjugate vaccine, and ORS corner promotion
  • (c)(i)-(ii) Eczema: Definition as inflammatory dermatosis with pruritus, erythema, and epidermal changes; classification into endogenous (atopic, seborrhoeic, nummular, dyshidrotic, lichen simplex chronicus) and exogenous (contact, photodermatitis, stasis)
  • (c)(iii) Allergic vs irritant contact dermatitis: structured comparison—immunological mechanism (type IV delayed hypersensitivity vs direct cytotoxicity), dose-response (no threshold vs threshold-dependent), clinical pattern (well-demarcated, spreading beyond contact area vs confined to contact site), latency period (sensitization required vs immediate), and common examples (nickel, poison ivy vs detergents, acids)

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Precise DKA diagnostic criteria (ADA 2021: glucose >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, anion gap >10); accurate WHO diarrhoea definition; correct eczema terminology (endogenous/exogenous classification per Rook's Textbook); no confusion between allergic (type IV) and irritant (non-immunological) mechanismsBroadly correct definitions with minor numerical errors (e.g., pH threshold slightly off); generic diarrhoea causes without specific organisms; eczema classification incomplete or conflated with psoriasisFundamental errors—confusing DKA with HHS, defining chronic diarrhoea as <14 days, or describing eczema as purely infectious; incorrect immunological basis for contact dermatitis
Clinical correlation20%10Links Kussmaul respiration to metabolic acidosis compensation in (a); correlates IAP/IMNCI dehydration signs to actual fluid deficit calculation; connects atopic diathesis (asthma, allergic rhinitis triad) to endogenous eczema; cites Indian epidemiology (rotavirus 40% of diarrhoeal deaths pre-vaccination, rising T1DM incidence in urban India)Mentions clinical signs without physiological explanation; lists dehydration signs without severity stratification; notes atopy without triad elaborationNo clinical reasoning—mechanical listing without pathophysiology; misses Kussmaul breathing significance; no connection between dehydration grade and management urgency
Diagram / pathway20%10Flowchart for DKA management with decision nodes (pH, anion gap, potassium levels); IMNCI dehydration assessment algorithm with colour coding; comparative table for contact dermatitis; insulin infusion rate nomogram or fluid replacement protocol diagramSimple linear flowchart without decision branches; basic dehydration classification table; no visual for eczema classificationNo diagrams despite clear need for algorithmic presentation; or incorrect/schematically wrong diagrams (e.g., wrong fluid sequence in DKA)
Differential / staging20%10DKA: distinguishes from HHS (absence of ketosis, higher glucose, higher osmolality, more altered sensorium), starvation ketosis, alcoholic ketoacidosis; Diarrhoea: differentiates invasive vs non-invasive, secretory vs osmotic; Eczema: stages acute (vesicular), subacute (crusting), chronic (lichenified) with appropriate clinical examplesBrief mention of HHS without differentiating features; generic bacterial vs viral distinction; acknowledges chronicity without morphological stagingNo differential for altered sensorium in diabetic patient; misses cholera in epidemic diarrhoea; no staging or classification attempt for eczema
Management / public-health angle20%10DKA: stepwise protocol—fluid resuscitation → insulin → potassium → bicarbonate (if indicated) → complication monitoring; Diarrhoea: WHO Plan A/B/C management, zinc supplementation per Indian guidelines, ORS <90 mOsm/L (low-osmolarity) formulation; Prevention: India's UIP rotavirus vaccine (RVV), Mission Indradhanush, Swachh Bharat impact; Eczema: topical corticosteroid potency ladder, calcineurin inhibitors, trigger avoidanceGeneric fluid and insulin mention without potassium protocol; standard ORS without low-osmolarity specification; basic hygiene advice without national programme namesDangerous errors—subcutaneous insulin in DKA, fluid restriction, or bicarbonate overuse; no ORS mention; no preventive strategy for diarrhoea; systemic steroids as first-line for eczema

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